Debate over masks uncovers deep White House divisions

President Donald Trump said on Friday that the Centers for Disease Control and Prevention was urging all Americans to wear a mask when they leave their homes, but he immediately undercut the message by repeatedly calling the recommendation voluntary and promising that he would not wear one himself.

“With the masks, it is going to be really a voluntary thing,” the president said at the beginning of the daily coronavirus briefing at the White House. “You can do it. You don’t have to do it. I am choosing not to do it. But some people may want to do it, and that’s OK. It may be good. Probably will — they’re making a recommendation. It’s only a recommendation, it’s voluntary.”

“Wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens — I don’t know,” he added. “Somehow, I don’t see it for myself.”

Trump’s announcement, followed by his quick dismissal, was a remarkable public display of the intense debate that has played out inside the West Wing over the past several days as a divided administration argued about whether to request such a drastic change in Americans’ social behaviour.

Dr Steven Choi, the chief quality officer and associate dean at Yale New Haven Health System and Yale University School of Medicine, said the president’s behaviour at the briefing contributed to confusion among health care workers and regular Americans.

“For anyone, particularly the president of the United States, to ignore recommendations from the CDC is not only irresponsible but selfish,” Choi said.

The president’s remarks came during a particularly contentious briefing where Trump insulted reporters, jousted with members of his own administration and returned to pugilistic form after several days in which he appeared to grasp the grim implications of a virus that could kill hundreds of thousands of Americans.

Trump again dismissed the recommendation of Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, for a national stay-at-home order, saying he would leave such demands to the governors. But he did say that the federal government would pay hospitals to treat coronavirus patients, instead of allowing people to buy heavily subsidised insurance on the Affordable Care Act’s insurance exchanges, as many Democrats have urged.

The mask debate has played out in public and in private. Trump said Americans who choose to comply with the CDC’s recommendation should use a basic cloth or face mask, not medical- or surgical-grade masks that are used by hospital workers and emergency workers. He also said people must still follow social distancing guidelines, which he called the “safest way to avoid the infection.”

Senior officials at the CDC have been pushing the president for days to advise everyone — even people who appear to be healthy — to wear a mask or a scarf that covers their mouth and nose when shopping at the grocery store or while in other public places.

The embrace of such a policy would be one of the most visible alterations to social habits in the United States in the face of a pandemic that has infected more than 1 million people around the globe and killed nearly 60,000 — a physical manifestation of fear that has gripped millions of Americans.

The issue became more urgent after the CDC’s director, Dr. Robert Redfield, said that as many as a quarter of those already infected may show no symptoms but still contribute to “significant” transmission. Local officials in New York and Los Angeles have already called for people to cover their faces in public. On Friday, the governor of Pennsylvania called on his state’s residents to wear masks when they go out.

The surgeon general, Jerome Adams, stood next to the president Friday and urged Americans to comply.

“The virus can spread between people interacting in close proximity, for example coughing, speaking or sneezing, even if those people were not exhibiting symptoms,” Adams said. “In light of this new evidence, the CDC recommends and the task force recommends wearing cloth face coverings in public settings where other social distancing measures are difficult.”

But some White House officials have resisted and Trump on Friday time and again said it was voluntary.

Matthew Pottinger, the deputy national security adviser, who has been wearing a mask during meetings in the White House, has shown people studies that advocate the wide use of masks, one official said. Other officials believed that was excessive.

One top CDC official who has seen emails from people in the West Wing said that some of Trump’s advisers were pressing him to recommend mask wearing only in “areas of widespread transmission.” That worried CDC officials because the virus has already spread, largely undetected to most parts of the country. Wearing masks or other face coverings everywhere, including in places where there are few reported cases, will help slow the rate of infection, they believe.

The result was been a policy stalemate that played out on live television.

Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and Dr Deborah Birx, White House coronavirus response coordinator, wait for the start of a coronavirus news conference at the White House in Washington, Mach 31, 2020. House advisers and public health officials are engaged in a fierce debate over recommending that all Americans wear masks when they leave their homes, with such a dramatic change in Americans’ social behavior deeply dividing the Trump administration. (Erin Schaff/The New York Times)

Dr Deborah Birx, coordinator of the White House coronavirus response, expressed serious reservations Thursday, saying that asking all Americans to wear masks could inadvertently signal that Americans can abandon social distancing and return to public life as long as they wear a mask.

“We don’t want people to feel like, ‘Oh, I’m wearing a mask. I’m protected and I’m protecting others,’” Birx said at the daily briefing. Others at the White House have expressed worry that asking all Americans to wear masks could heighten shortages for doctors, nurses and emergency workers, even if they urge people not to seek the highly protective, and scarce, N95 masks used by hospital staff.

Fauci said in an interview on CNN this week that “you don’t want to take masks away from the health care providers who are in a real and present danger of getting infected.”

Hospitals across the country are running out of N95 masks, which filter at least 95% of particles that are 0.3 microns or larger. In a move to increase the availability of masks, the Food and Drug Administration said Friday it would allow use of a Chinese equivalent.

Sceptics inside the administration also raised doubts about whether people in the United States would ever feel comfortable wearing masks in public, noting that the cultural norms are different in America from some Asian countries, where the use of masks became more common after previous outbreaks.

Some conservatives have said they did not believe that Americans would ever accept wide usage. Michael Dougherty, a conservative writer at National Review, wrote that Americans would “quickly feel that masks are ridiculous, menacing, or an imposition on life, then conclude they must be temporary.”

Trump’s personal hesitance also underscored questions about whether other politicians or media personalities would choose to wear masks while appearing in public.

Outside the White House, the move toward masks accelerated quickly this week. On Friday, after Gov. Tom Wolf of Pennsylvania, a Democrat, urged residents of his state to wear masks if they ventured out of their homes, the state’s health secretary reiterated that staying at home — away from groups of people — remained the most effective way to ensure that the virus would not spread.

“A mask isn’t a pass to go back to work, or go visit friends, or go socialize,” said the health secretary, Rachel Levine.

At the World Health Organization briefing on Friday, Dr Michael Ryan, executive director of the health emergency program, said that while the WHO still recommended masks only for front-line health workers and those who are sick or caring for someone who is, “we can certainly see circumstances in which the use of masks, both homemade or cloth masks, at community level may help in an overall comprehensive response to this disease.”

Sen. Patrick Toomey, R-Pa., has been one of the most vocal supporters of wearing masks. In an interview from the basement of his home, where he is isolating because of his recent contact with lawmakers who tested positive for the virus, he said wearing masks would help limit the effect of it.

“It just makes sense to have some kind of physical barrier that would reduce the droplets that are released when people speak and breathe,” Toomey said. “The idea is to protect everyone else. My mask protects you. Your mask protects me.”

Toomey said he spoke with Trump on Wednesday to urge him to recommend masks for everyone. He said the president seemed “very sympathetic” to the idea but did not reveal his course.

“He did acknowledge that it was under very serious consideration and the subject of fairly intense discussion among his team,” Toomey said.

He said it was “premature” to conclude that Americans would not wear masks. “Who’s to say that people won’t respond in a way that this becomes acceptable and normal?” he asked.

Evidence arguing for the use of face masks to limit the spread of the coronavirus continues to mount. A study published Friday in the journal Nature found that flat surgical face masks significantly reduced the number of virus-carrying droplets that mask wearers released into the surrounding air.

Although the study did not look at the new coronavirus, researchers based their analysis on closely related seasonal coronaviruses that cause the common cold and are similar in size to the virus that causes the disease COVID-19. They also looked at influenza viruses and rhinoviruses that typically spread in winter.

The researchers asked 246 people with suspected respiratory viral infections to breathe into a machine for 30 minutes to measure the amount of virus they exhaled. Half of the participants wore a face mask, while the other half performed the experiment without any face covering. Among 111 people whose infections were later confirmed with a lab test, masks stopped the spread of all seasonal coronavirus and more than 70% of influenza virus infections, the study showed. Masks were not as effective in reducing transmission of rhinoviruses, or the common cold.

For the current coronavirus pandemic, all health officials, including those at the WHO and CDC, agree that masks should be worn by anyone with symptoms like a cough or fever, and anyone caring for someone with a confirmed or suspected case.

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