Masks, yes — mandates, no

Historically, planes have not been cauldrons of respiratory viral spread — in fact, just the opposite, despite the cramped spaces and specifically because of the high flow ventilation systems and the highly effective HEPA filters. 

Don’t get me wrong, if someone coughs or sneezes right on you they can certainly infect you, otherwise, chances have been shown to be rare.

When it comes to COVID, there are no real studies on the direct impact of plane travel on the virus’ spread, there’s only one simulated study from the Department of Defense using mannequins and masks back in 2020. And even with mask mandates in place on planes, people have been routinely wearing low-quality cloth masks that likely do very little to prevent COVID spread, especially when worn improperly or removed for long periods for eating. It has been more of an opportunity for virtue-signaling or blind compliance rather than a real demonstrable public health benefit.

Don’t get me wrong, I believe that airports are a sewer for viral spread and that people at high risk of severe COVID including the elderly, the obese, the chronically ill and the immunocompromised should all be wearing high-quality masks (KF94, KN95 or N95) at the airport and on planes (one-way masking). But a mandate is certainly not the way to get that to happen, and it certainly hasn’t worked so far.

I also believe that the Centers for Disease Control and Prevention has a fundamental right to ensure public health safety on a national scale and that transportation falls under this category, provided that there is some demonstrable public health risk and benefit. Since COVID has been declared a public health emergency and this has been extended because of the continued rise of new immune-evasive, highly transmittable variants from omicron BA-1 to BA-5, the travel restrictions would appear to be covered under this policy.

On the other hand, the restrictions would need to be prudent, not for show or politics rather than for effectiveness. I would like to see the CDC or the National Institutes of Health actually study airplanes and airports, trains and train stations and buses and bus stations directly to determine the rate of spread of emerging COVID variants, along with how much effect restrictions (including masking and keeping some seats empty) actually have.

In the meantime, what would work instead of mandates would be for TSA to hand out these high-quality masks and for flight attendants to instruct in their use, right before “fasten your seatbelts” or “what to do in the event of a water landing.” I wear an N95 on air flights and a KN95 mask in crowded indoor areas right now, and I continue to be an advocate for their use.

I am not an attorney, and I will not weigh in on whether the federal judge was right to block the CDC transportation mask mandate at this juncture or if the Department of Justice is right to contest the judge’s ruling. But I do know this. Public health is primarily not about legal battles or forced compliance, it is about information, protection, nuance and admitting when you are wrong while adjusting your position based on new emerging science. 

We have more tools in our COVID toolbox than ever before. And while masks remain one of them, the tool has never been the mandate, but rather the mask itself.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”