Mpox and mask bans – a recipe for disaster

Despite significant opposition, Nassau County has passed a mask banwith all Republican members voting in favor and Democrats abstaining. According to Howard Kopel, who chaired the hearing, the bill was introduced in response to “anti-Semitic incidents, often committed by people wearing masks.”

On August 14, the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, declared mpox a public health emergency of international concern. This PHEIC followed the similar statement from the Africa CDC as infections have risen and are 160% higher than last year, with more than 15,000 cases and 400 deaths in 2024. Moreover, the virus has spread from Congo to six new countries in just ten days. On August 15, Sweden confirmed the first case of clade 1 mpox outside Africa.

What are Clades and why is it important?

Mpox (formerly monkeypox) has two clades– or ‘groups of organisms consisting of an ancestor and its descendants’. A species is a variant with unique observable characteristics.

Clade 2 mpox has been circulating worldwide for several years and is mainly spread through sexual or close skin contact. It has a low mortality rate. This new clade, type 1, spreads more easily and can kill up to 10% of people. Children under the age of 15 now more than make up for it 70% of cases and 85% of deaths. The Omicron variant of SARS-CoV-2, on the other hand, had a 0.7% mortality rateless than previous types.

Is mpox transmission through the air?

An important question is how mpox spreads. We know that clade II mpox is mainly spread sexually, and through very close contact. However, the outbreak in children suggests that clade1 is transmitted through the air, respiratory droplets, or very close contact.

There are varying opinions as to whether mpox has airborne transmission. We repeat the debates about Covid-19. When small droplets are inhaled by people nearby, is that “airborne” or “droplet?” It is a semantic game because the implications overlap.

Experts are divided. Linsey Marra Virginia Tech expert on airborne virus transmission was quoted in the New York Times as saying: “Airborne transmission may not be the dominant transmission route nor very efficient, but it can be done still occur.”

The WHO said that transmission of mpox could occur via “respiratory droplets (and possibly short-range aerosols).” Great Britain has a list of ‘infectious diseases of major consequence’. They say: “Airborne HCIDs are spread via respiratory droplets or aerosol transmission, in addition to contact routes of transmission.” Clade 1 mpox is on this list.

While the CDC does not currently support airborne transmission, they recommended wearing a mask in 2022 to protect against transmission. The page, which stated that people could become infected through contact with “the skin lesions or bodily fluids of infected animals or humans (living or dead), including respiratory drops, has been removed.

Another thing to note that supports possible airborne transmission is that the mpox virus is closely related to smallpox. We have strong evidence for that Smallpox is transmitted through the air. CDC says smallpox transmission occurs through “inhalation of large, virus-containing droplets in the air.”

Nassau mask ban

Consider the information about the new declaration of a global public health emergency and how mpox is being distributed in the context of the Nassau County mask ban decision and hearing. The mask ban, signed this week by County Executive Bruce Blakeman, calls for penalties up to one year in prison, $1000 fine or both. It gives the police very broad discretion. There is (in theory) a medical exemption for those trying to protect themselves, but not for those trying to protect others (for example, an immune-compromised family member). It also does not allow those who are already sick to wear a mask to prevent transmission and protect others. Do you really want a police officer to stop you and decide if wearing a mask is legit?

The proponents of the mask ban, such as Congressman Anthony D’Esposito (R-NY) (1:03:02 on Vimeo) spoke of masked protesters waving Hamas and Hezbollah flags, using anti-Israel and anti-American hate speech, and threatening Jews. Others spoke similarly about the bill’s need to combat anti-Semitism. Mayor Eric Adams previously spoke forcefully about criminals hiding behind masks and the need to get back to the way things were before COVID. There is strong data showing that masks do not eliminate the identification of criminals.

There were also Jewish people who were strongly opposed to the face mask ban. Jews for mask rights now has over 1,300 signatures on their letter. A disabled speaker from that organization was loudly heckled and booed during the hearing. She then said: ‘Banning masks will not make us safer. It will not solve anti-Semitism, it will not stop crime, it will only violate our rights and put us in even more danger.”

According to several reports, the hearing itself was conducted in a biased manner. Although anti-mask speakers had previously registered to speak, supporters of the ban were allowed to speak first. Opponents, many of whom were disabled, had to wait more than five hours in an “overheated, crowded, poorly ventilated room.” Their masks prevented them from eating or drinking safely. Proponents of the ban were allowed to exceed the 3-minute limit. Opponents, including William Tronsor, a disability rights attorney, were threatened by police by Howard Kopel (R), who chaired the meeting. (A video is available here.) It appears that Kopel did nothing about the insulting bickering that pro-mask speakers faced. (Neither Blakeman nor Kopel responded to requests for comment). At one point, things got so heated that a pro-mask attendee was injured when they were arrested. In one press releaseJews for Mask Rights noted the irony of “how these bans reinforce hatred toward disabled people who rely on masks,” with vitriol directed at the pro-mask crowd.

Mpox versus mask bans

Dr. Angelique Corthals is a Covid-19 expert and scientific advisor for MaskTogetherAmerica and associate professor at CUNY. She said the mask ban “deprives us of the most important tool to prevent not only this pathogen, but new pathogens coming our way thanks to climate change.” Speaking of anti-mask advocates, she added: “These people don’t like nuance.”

Corthals continued: ‘The mask ban comes at the worst time. Not only are we facing a new pandemic of actual airborne virus (H5N1), but mpox was a new storm brewing.” Since clade 1 mpox is more contagious and virulent than the previous clade, we need to adopt non-pharmacological interventions (NPIs) to reduce its spread. Corthals emphasized “that no form of transmission can be dismissed (‘oh, it’s only through sexual contact’ or ‘it’s only skin-to-skin’).” And she concluded: “Public institutions such as schools, universities and hospitals must take precautions so that we do not see outbreaks spread from children to adults.”

What NPIs do we have that could tackle each of these infections – Covid-19, avian flu and MPOX? Masking and improved ventilation. “It seems that few lessons have been learned,” concluded Corthals.