Biden officials divided on message over N95 masks for all

WASHINGTON — As Covid cases have surged, top Biden administration officials have been divided over how strongly to encourage Americans to wear high filtration masks such as N95 respirators, as they have come under increasing pressure from public health experts to urge Americans to switch to masks that offer better protection.

Biden said in remarks Thursday that he was planning to take some action to make “high quality masks” available for free, but administration officials didn’t give further details and those who have been involved in talks over what to do around the issue of N95 masks were caught off guard by the president’s statement, said one person involved in those conversations.

As cases and hospitalizations have surged 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 said could significantly reduce the transmission over cloth masks. While the CDC said this week it is working to update its mask recommendations, its current guidelines updated Oct. 25 still include the wearing of a well-fitting cloth mask as an option.

Inside the White House, Surgeon General Vivek Murthy has been among those pushing for more widespread distribution of the N95 masks, including mailing one to every American, said the person involved in the conversations.

But others, including officials at the Centers for Disease Control and Prevention, have pushed back on the idea of a mass distribution of N95 masks and would rather see the agency strengthen its mask recommendation to tell people to wear a surgical mask instead of cloth masks, the person said.

CDC director Rochelle Walensky said Wednesday that the CDC was planning to update the information about masks on its website “to best reflect the options that are available to people … and the different levels of protection different masks provide,” when asked about the current recommendations during a White House Covid briefing Wednesday, but didn’t indicate a significant change was coming.

“CDC continues to recommend that any mask is better than no mask and we do encourage all Americans to wear a well-fitting mask to protect themselves and prevent the spread of Covid 19, and that recommendation is not going to change,” Walensky said.

The issue marks the latest point of division for Biden’s top health officials. Last month, Biden’s chief medical advisor Anthony Fauci appeared to contradict updated guidelines from the CDC that said infected people could leave isolation after five days without a negative Covid test. There was disagreement over the summer over how widely booster shots should be made available and when with Biden’s top medical advisors breaking with career FDA officials.

The administration has struggled throughout the pandemic on its recommendations around masks, which quickly became an area of political division. The CDC told vaccinated Americans in the spring they were free to go maskless before reversing the recommendation in July, telling even the vaccinated to wear masks in areas where the virus was widely circulating.

Since the arrival of the omicron variant, Biden has increased his calls for people to wear masks indoors, but has stopped short of advising them to wear the same highly protective N95 masks that he, the vice president and top administration officials have been wearing publicly and around the halls of the White House for weeks.

”I know we all wish that we could finally be done with wearing masks, I get it,” Biden said Thursday. “But they are clearly a really important tool to stop the spread, especially of a highly transmittable omicron version. So please, please wear the mask.”

Press secretary Jen Psaki said the administration would have more details next week on how free masks would be made available, noting the administration has already given out more than 30 million masks to food banks and community health centers.

Biden administration officials have solicited advice in recent weeks from outside medical experts who have given a range of recommendations, including letting people use a new website the administration is developing for free at-home Covid test to also request an N95 mask, said one person who has been in contact with the administration. A group of medical experts who advised Biden during the transition encouraged the White House publicly last week to give Americans a voucher to buy masks on their own from a retailer.

There has also been division outside the White House over how the benefit of N95 masks should be communicated and how far the administration should go in urging Americans to wear them with some public health experts advocating for the masks being shipped to every American and others warning it would be a waste of resources.

“There is no question that high quality masks can make a difference, they have protected myself and many other healthcare workers from significant exposures in hospitals and clinics,” said Kavita Patel, a former Obama administration advisor. “But the administration will need to be cautious about overpromising on the effect that this action might have given the trajectory of omicron, we are already seeing cases peaking in parts of the country. High-quality masks are important, but in terms of controlling omicrons it’s a bit like bringing an umbrella to a Category 5 Hurricane.”

Administration officials have also expressed concern that emphasizing the benefits of N95 masks and discouraging cloth masks could lead people to stop wearing masks altogether if they don’t like the fit of the N95 masks, an issue Walensky alluded to during remarks Wednesday.

“We will provide information on improved filtration that occurs with other masks such as N-95 and information that the public needs about how to make a choice of which mask is the right one for them,” Walensky said. “But most importantly, we want to highlight the best mask for you as one that you can wear comfortably.”

Another concern about more strongly urging N95 masks has been the 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 cost effective than a reusable cloth mask over time.

During the early days of the pandemic, Americans were urged to leave N95 masks and the KN95 versions made in China for health care workers. But since then the U.S. has bolstered its manufacturing capacity and the U.S. currently has a stockpile of 750 million N95 masks as part of the Strategic National Stockpile for health care workers.

“It’s not a supply problem at all,” said Ezekiel Emanuel, a former health advisor to the Obama administration, who says all Americans should be wearing N95 masks. “We could easily gin up production in this country and get going. So it’s not an issue of we’ve got to reserve these for the healthcare profession. That’s just nonsense.”

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