WASHINGTON — As Covid-19 cases have spiked, top Biden administration officials have been split on whether to encourage Americans to wear high-filtration face masks such as N95 respirators, as they have suffered a growing pressure from public health experts to urge people to switch to masks that offer better protection.
The Centers for Disease Control and Prevention updated its guidelines on Friday, saying Americans “may choose” to wear N95 and KN95 masks because they provide the best protection against Covid-19. But the agency refrained from recommending people opt for certain masks over others.
The White House has indicated that it is ready to go further. President Joe Biden, who for weeks has worn N95 masks in public, said Thursday that he plans to make “high-quality masks available to Americans free of charge,” without further details. Some inside the White House have been pushing for the federal government to send an N95 mask to every American, a person involved in those conversations said.
As cases and hospitalizations have increased due to the highly contagious omicron variant, public health officials have criticized the administration for not doing more to encourage Americans to wear N95 or KN95 masks, which they believe could significantly reduce transmission compared to cloth masks. But CDC guidelines on Friday said the agency “continues to recommend that you wear the most protective mask possible that fits you well and that you will wear consistently.”
Inside the White House, Surgeon General Vivek Murthy was among those pushing for wider distribution of N95 masks, including sending one to every American, the person involved in the conversations said. But others, including CDC officials, pushed back against the idea of a mass distribution of N95 masks, the person said.
The debate marks the final point of division for Biden’s top health officials. Last month, Biden’s chief medical adviser, Dr. Anthony Fauci, appeared to contradict updated CDC guidance that infected people could leave isolation after five days without a negative Covid test. There was disagreement over the summer over how much booster shots should be available and when, with Biden’s top medical advisers breaking with career officials at the Food and Drug Administration.
The Biden administration has struggled throughout the pandemic over its recommendations around masks, which quickly became an area of political division. The CDC told Americans vaccinated in the spring that they were free to go without masks before rescinding the recommendation in July, even telling vaccinees to wear masks in areas where the virus was circulating widely.
Since the arrival of the omicron variant, Biden has ramped up calls for people to wear masks indoors, but stopped short of advising them to wear N95 masks, something he, the vice president and senior administration officials have worn it publicly and around the halls of the White House for weeks.
“I know we all wish we could finally be done with wearing masks, I get it,” Biden said Thursday. “But they are clearly a very important tool in stopping the spread, especially of a highly transmissible omicron version. So please, please wear the mask.
White House press secretary Jen Psaki said the administration would have more details next week on how the free masks would be made available, noting that it has already distributed more than 30 million masks to food banks and community health centers.
Biden administration officials have in recent weeks sought advice from outside medical experts who have given a series of recommendations, including allowing people to use a new website the administration is developing for free Covid tests at home to also request an N95 mask, a person who has been in contact with the administration said. A group of medical experts who advised Biden during the transition publicly encouraged the White House last week to give Americans a voucher to buy masks themselves from a retailer.
There have also been divisions outside the White House over how the benefits of N95 masks should be communicated and how far the administration should go to get people to wear them, with some public health experts advocating masks to be shipped to every person in the country and others warn it would be a waste of resources.
“There is no doubt that high quality masks can make a difference, they have protected me and many other healthcare workers from significant exposures in hospitals and clinics,” said Dr Kavita Patel, former adviser to the Obama administration. “But the administration will have to be careful about over-promising about what effect this action might have had on omicron’s trajectory. We are already seeing a spike in cases in some parts of the country. High-quality masks are important, but in terms of controlling the omicron, it’s a bit like bringing an umbrella to a Category 5 hurricane.”
Michael Osterholm, an infectious disease expert who advised the Biden transition, said he has pushed the administration over the past year to strengthen its recommendations on masks. He said he supports the idea of sending an N95 mask to every American and that the CDC’s recommendations should outline the benefits of wearing an N95 mask over cloth or surgical masks.
“I think the CDC recommendations have been problematic because they’re not based on good science. They make assumptions about what people will and won’t wear,” said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “We just need to have clear messages. If anyone hasn’t learned anything right now in this pandemic, it’s to keep it simple and stupid. We’ve failed at communication because we’ve made it so complicated.”
Administration officials have also expressed concern that emphasizing the benefits of N95 masks and discouraging cloth masks could cause people to stop wearing masks altogether if they don’t like the mask. fit of N95 masks, an issue CDC Director Dr. Rochelle Walensky alluded to during her remarks on Wednesday.
“We will provide information on the improved filtration that occurs with other masks such as the N95 and the information the public needs on how to choose the mask that is right for them,” she said. . “But most importantly, we want to highlight the best mask for you like one you can wear comfortably.”
Osterholm said he disagreed with that notion, saying a more comfortable cloth or surgical mask would offer less protection.
“I take issue with this whole notion that the CDC continues to have that we have to recommend what people wear and for me that has always been a backwards approach,” Osterholm said. “What you do is you recommend what makes the difference and then you work from there.”
Another concern with more pressing N95 masks has been cost, said a person who has been involved in conversations with the administration on the issue. While N95 masks can sell for as little as $1 and be reused, they are far less profitable than a reusable cloth mask over time.
Early in the pandemic, Americans were told to leave N95 masks and Chinese-made KN95 versions to healthcare workers. But since then, the United States has boosted its manufacturing capacity and the country currently has a stockpile of 750 million N95 masks as part of the strategic national stockpile for healthcare workers.
“It’s not a supply issue at all,” said Obama administration health adviser Dr. Ezekiel Emanuel, who says all Americans should wear N95 masks. “We could easily launch production in this country and get started. It is therefore not a question of reserving these services to the health profession. It’s just nonsense.