A Mask Mandate is Not Enough

Recently, the U.S. Bureau of Economic Analysis released its estimate of the US gross domestic product for the second quarter of this year (April through June). The chart below shows the percentage change from one quarter to the next since 1947.

As the chart shows, the recent decline is the largest the country has seen in over 70 years. This decline was expected after much of the economy shut down to tamp down the spread of the coronavirus. Declines in Europe have been equal or greater. The difference is in the outcomes. In much of Europe the virus was largely controlled as a result shut-downs. In the United States, it continues to spread wildly in areas across the country. Was the American economy sacrificed in vain?

There is general agreement among economists that the American economy will not recover until the virus is under control. Reopening prematurely just allows the virus to explode. Meanwhile, Congress dithers about authorizing the aid needed to help people who are hurt by the economic shutdown, which is, in turn, needed to slow the spread of the virus.

The politics regarding COVID-19 have become very strange. Oddly, it seems, many Republican politicians chose to ally themselves with the coronavirus, rather than with their constituents.

Polls find a majority of the public support mask requirements. For example, a national Yahoo poll from the end of July found that 77 percent of registered voters supported requiring masks in public places. This included 65 percent of Republicans and 59 percent of those who said they intended to vote for Donald Trump. (See here for a summary of polls on masks.)

Despite widespread support for the use of masks, the immediate reaction of many Republican politicians to Governor Evers’ order requiring a face covering indoors was to denounce it. Senate Majority Leader Scott Fitzgerald threatens to call a special session of the legislature overturn the order.  Other Republican politicians responded by lying. Representative Chris Kapenga claimed, “The (COVID-19) cases are going up, but it’s because the testing is going up.” Rep. Michael Schraa claimed that wearing masks has been “proven ineffective.” Senator Van Wanggaard claimed that the mask order would require him to “wear a mask in my house, or walking my dog.” All three claims are false.

Why are these people so hostile to masks? Perhaps part of the answer is the strange power President Trump holds over many of his voters.

Herman Cain attended Trump’s Tulsa Rally on June 20 and tweeted out the picture below along with the message: “Here’s just a few of the #BlackVoicesForTrump at tonight’s rally!  Having a fantastic time!” 11 days later he was hospitalized with the coronavirus and later died.

Why did Cain decide to attend the event? The Tulsa rally was widely viewed in advance as a likely “super spreader” event, with a crowd of people close together, shouting and laughing, and not wearing masks, as documented in the photo Cain sent out. He fit into three groups particularly susceptible to the virus—male, aged 74 and a cancer survivor. By all accounts he was a skilled businessman, credited with turning around Godfather’s Pizza. Yet, he still attended this very dangerous event.

I am unaware of any American politician now or in history who generated the kind of credulous obedience that Trump does. That may be part of the reason that the United States has fared worse than any other nation at controlling COVID-19. When wearing a mask or any of the other steps needed to stop the virus is regarded as a political statement, stopping the coronavirus becomes much more difficult.

The chart below shows the number of new COVID-19 cases in Wisconsin since early March. The underlying data are taken from a database maintained by the New York Times. In order to compare states with differing populations, the number of new cases per day was converted to cases per 100,000 residents.

New York, New Jersey, and Connecticut require that travelers arriving from Wisconsin (and numerous other states) quarantine themselves for fourteen days. Wisconsin was placed on this list because its daily rate of new COVID-19 cases exceeds 10 per 100,000 residents (shown with yellow dashes on the chart). Similarly, having passed 15 cases per day for every 100,000 people (shown with purple dashes), Wisconsin was recently added to Chicago’s similar quarantine list. Having exceeded 10 daily cases per 100,000 residents (shown with yellow dashes).

In an article published May 13, Bruce Murphy observed that Wisconsin had the lowest number of new COVID-19 cases of any state in the upper Midwest. This situation was not to last. Coincidentally, the Wisconsin Supreme Court issued its decision lifting Wisconsin’s stay at home order on May 13.

The graph below tracks the number per-capita of new daily cases (using a 7-day moving average) in Wisconsin versus the other six Midwestern states. At the time of the court’s decision, Wisconsin shared with Michigan and Ohio the distinction of having the lowest per capita new cases.

A few weeks after the Wisconsin Supreme Court decision, Wisconsin’s new cases exploded, first leaving Michigan and Ohio behind, and then passing Illinois, Indiana, and Minnesota. Today, Wisconsin shares with Iowa the dubious distinction of having the highest new case rate in the upper Midwest. After Evers’ mask order, Iowa became the last of the seven states without a mask requirement.

Unfortunately, the graph makes clear that a mask order is not sufficient to reverse an upward trend of infections. Despite their mask orders, all these states see growing COVID-19 cases. All need to do more to control the pandemic.

The graph below shows the per capita daily cases in Milwaukee County compared to the WOW counties: Waukesha, Ozaukee, and Washington. Although the WOW counties have historically enjoyed relatively low COVID-19 caseloads, they have recently peaked. Both Milwaukee and Waukesha counties have high daily new case rates, around 25 per 100,000 residents. The other two WOW counties are lower but still disturbingly high.

And all three WOW counties follow the same pattern. Up to the end of June, they had low caseloads relative to Milwaukee. Suddenly, their cases take off. Two-thirds of Waukesha County’s total cases occurred in July. The July proportion is smaller for the other two counties but still over 50 percent. What explains this pattern?

The pre-July pattern probably can be explained by the region’s demographics. Most poor people in the Milwaukee metropolis live in the City of Milwaukee. They are particularly vulnerable to a disease that spreads like COVID-19, less able to isolate themselves from others, living with a larger number of people, and working jobs that cannot be done remotely.

The July suburban explosion is harder to explain. Perhaps complacency played a role: a belief that it can’t happen here. Perhaps partisanship—the notion that only Democrats worried about COVID-19. For some, wearing a mask was considered a political statement.

Two amici briefs submitted to the Wisconsin Supreme Court illustrate the partisan divide. Endorsing the state’s stay-at-home order, the Wisconsin Association of Local Health Departments and Boards, along with several local health departments, argued that: “The public health response to COVID-19 must be a statewide response. We are stronger together when we rely on the authority the legislature granted DHS to take immediate action during a statewide pandemic.”

Washington County, in contrast, wrote that

DHS Exceeded its authority … because the primary responsibility for managing a public health crisis is vested by law in the County’s local health department. … DHS’s role is to serve as a backdrop to the local health officer when the local health officer is acting appropriately in managing the crisis in his or her jurisdiction.

The claim in the county’s brief is contrary to Wisconsin law. But given the county’s position, it is not surprising to find an article reporting that employees of the Ozaukee Washington Health Department “are being harassed by coronavirus skeptics in Ozaukee and Washington counties.” Leadership matters.

Ironically, the more successful the coronavirus skeptics are in discouraging the use of masks and other measures aimed at controlling the spread of the virus, the greater the need there will be for more intrusive measures such as closing non-essential businesses or limiting restaurant service to take-out.

The Wisconsin Supreme Court’s decision against the state’s stay-at-home order, along with the legislature’s refusal to negotiate a replacement, was a huge win for the coronavirus. The governor’s mask order is a step in the right direction but probably not enough to control spread of the virus, particularly with the return of cold weather and influenza in the fall.