Requiring people to wear a mask on public transportation and in transportation hubs when COVID-19 case counts call for extra precautions is well within the “core mission of preventing the transmission of communicable disease and protecting public health” that the Centers for Disease Control and Prevention (CDC) is charged with carrying out, physicians tell a federal appeals court.

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Consequently, in an amicus brief filed in Health Freedom Defense Fund v. Biden, the Litigation Center of the American Medical Association and State Medical Societies asked the 11th U.S. Circuit Court of Appeals to reverse a lower-court decision that vacated the CDC’s mask mandate aimed at preventing SARS-CoV-2 from spreading during the COVID-19 pandemic.

“The CDC’s core mission of protecting the public from serious illness, injury and death requires that public health officials have the ability to exercise reasonable judgment in the face of evolving conditions and the authority to enact evidence-based measures when necessary,” said AMA Immediate Past President Gerald E. Harmon, MD. “The AMA is urging the court to acknowledge the CDC’s authority to enact measures to protect the public’s health, recognizing that health authorities have the expertise to make determinations that promote public health in rapidly evolving circumstances.”

Find out more about the cases in which the AMA Litigation Center is providing assistance and learn about the Litigation Center’s case-selection criteria.

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SARS-CoV-2 was initially more contagious than the flu and the variants and subvariants have proven even more contagious than that.

COVID-19 has killed more than 1 million people in the United States. That’s more than 13 times the number who die from influenza in an average two-year span. One study has shown that one in five COVID-19 survivors aged 18–64 years, and one in four COVID-19 survivors aged 65 years or older, have experienced at least one incident condition that might be attributable to previous COVID-19 infection.

“Moreover, although vaccination has been shown to significantly reduce the likelihood of hospitalization and death from COVID-19, it ‘confers only partial protection in the post-acute phase of the disease,’ and so ‘reliance on it as a sole mitigation strategy may not optimally reduce long-term health consequences of SARS-CoV-2 infection,’” the AMA tells the court, citing a 2022 study published in Nature Medicine.

Given SARS-CoV-2’s high transmissibility, the high death rates, the vaccine’s inability to fully prevent people from breakthrough infections and the odds of long COVID, “the CDC’s reliance on masks to reduce the spread of COVID-19 is a reasonable exercise of scientific judgment,” states the AMA brief.

Data shows that masks are a “safe and effective means of preventing” SARS-CoV-2 from spreading between people on public transportation and in transportation hubs, the brief says.

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For example, one model (PDF) of an urban bus showed that if no one wore a mask, 26 people would be infected during a 15-minute ride. The number drops to 10 if everyone wears a handmade cloth mask. It drops to zero if everyone wears a surgical mask. Further, a simulation of public transport in South Korea found that mandatory mask-wearing during peak transit hours cut infection rates by 93.5%.

“The CDC should have the latitude to make a reasonable judgment regarding the use of face masks in light of the evidence supporting their efficacy,” the brief tells the court.

Public health conditions shift quickly and public health leaders need to be able to evaluate scientific information and make decisions based on the evolving facts.

“The CDC is thus particularly well placed to make determinations about the measures necessary to promote public health in fast-moving circumstances,” the AMA tells the court in its urging to reverse the district court decision that said the CDC overstepped its authority.

“And in the case of public transit, where people are often moving between communities and even between countries, a broader view that can factor in the spread of COVID-19 beyond one locality is uniquely necessary. The CDC thus requires the ability to exercise its judgment in the face of evolving COVID-19 conditions to fulfill its statutory duties to prevent the transmission of communicable disease.”

Learn more with the AMA about masking in public during the pandemic and the latest developments with COVID-19.

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