Former U.S. Surgeon General Jerome Adams calls for masking 'compassion'

Before there were mask requirements or recommendations or candle tests or homemade mask drives, in the very early days of the pandemic, the U.S. Surgeon General Jerome Adams published what would become a notorious tweet: "Seriously people — STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can't get them to care for sick patients, it puts them and our communities at risk!"

As the supply increased and science emerged showing masks were effective in stopping the spread of the virus, Adams encouraged the use of masks.

These days, no longer in his federal government role, Adams is still tweeting about masks in the post-transportation mandate world. He's sharing his anger at how a Delta pilot suggested he take his mask off to breathe free, and describing the challenges of a rideshare driver with a double-lung transplant whose customers no longer needed to mask in his car.

NPR called up Adams to get his thoughts about masking in this moment of the pandemic: how he stands by his original tweet on masks, being in the room when Trump administration officials declined to institute a transportation mandate, and how to practice "compassion" toward each other in this mask-optional world.

This interview has been edited for length and clarity.

What do you think about the federal transportation mask mandate going away? It's been a little over a week now.

I'm frustrated that it's going away, because there are still many people out there who can't protect themselves.

From a scientific point of view, it's important for people to know that masking isn't the be-all and end-all, but it is incrementally effective as a public health mitigation measure in helping to slow the spread of the virus. Two-way masking – when we both wear a mask – is better than one-way masking, but one-way masking can be effective if you're wearing a high-quality mask like an N95. One of the challenges is that there are a lot of people who either can't get, or who can't wear, a tightly fitting mask. A key example would be kids under the age of five. We just don't have good-fitting masks for that population, so they rely on people around them to protect them.

Which leads to mandates. It's clear that mandates are something that stokes a lot of energy, excitement and controversy in this country. What people don't realize is that mandates are the reason why you can swim safely in a public swimming pool. They're why we can eat safely in restaurants without fear that the person preparing our food hasn't washed their hands. These are all public health mandates, and the idea that, 'Hey, everybody is on their own, mandates are inherently bad' is something that scares me, because it's going to have unintended consequences down the road.

When I'm in the grocery store, when I'm on public transportation, I personally still wear a mask to protect me and my family, but also to protect the families of people I may encounter on the way who may not be able to protect themselves.

You've been tweeting about your experiences in travel since the mask mandate has gone away. You were told to unmask by a pilot. You have had discussions with a medically vulnerable rideshare driver. So how are you thinking about masks in our tired and politically polarized society right now?

I am hopeful that now we can actually have a real conversation about when and where and why we should mask. So my tweets lately have illustrated examples of, quite frankly, one of my neighbors not being so kind and compassionate toward me – the Delta pilot who came up to me unsolicited and told me to take my mask off, without recognizing why I was wearing a mask.

One of the reasons I wear a mask is because my wife is being treated for cancer. You don't know by looking at someone what type of situation they're in. And it's important for us to understand that that's why we need to be compassionate for each other.

I've talked about Mr. Melvin, who's a rideshare driver who I met, who had a double-lung transplant. Mr. Melvin was working a job, which is what we say we want Americans to do. He actually had a mask on. It wasn't an N95, but he didn't have access to high quality masks, so I actually gave him a five-pack of new N95 masks that I had on me – something the federal government, in my opinion, should be doing.

We need to emphasize that not everyone has the tools that they need to protect themselves. We need to make sure everyone has an equitable chance to protect themselves, and recognize that in situations where they may not have that opportunity, they're relying on us to be compassionate and to protect them.

I want to talk about your time in the Trump administration as surgeon general during the pandemic. First of all, your famous tweet at the very beginning when supplies were low and there wasn't good data on mask efficacy. I'm sure you've thought about that message a lot – what are you thinking now, looking back on it?

I still come to the conclusion that I made the best recommendation I could to the American people based on the information that I had in the circumstances that were taking place at the time.

The WHO and the CDC were saying the same thing that I was saying, so the science supported me. We knew that supplies weren't there for health care workers, so there was a further crisis being created because of hoarding of masks. And we didn't have the information that we needed from China about asymptomatic spread.

The fact is, once that information trickled out of China and we then knew that it might be helpful for people to wear masks, we changed those recommendations. That's how science is supposed to work.

People are very uncomfortable watching the sausage actually get made, particularly when it has immediate implications on their day-to-day lives – we've seen this play out over and over again during the pandemic. But I hope that coming out of the pandemic, we can have a healthier respect for the scientific process, and that people are more comfortable with what they say they want, and there's a more rapid translation of the science into reality.

When you were surgeon general, masks became a political and public signal of how someone felt about the pandemic. Looking back, do you think there's more that public health officials could have done to prevent masks from becoming this political symbol?

We had one of the most divisive presidential elections of modern times superimposed on top of a once-in-a-century pandemic that would have been difficult to deal with, no matter what. And that resulted in everything being politicized.

Certainly, conservatives politicized masking to the detriment of society. But we also have people on the other side – liberals – who politicized masking. This was used as a tool to say either you're for Biden or you're for Trump, and that made it difficult.

One of the things that I always tried to do was fall back on the science. I would screen every question through the lens of: What is the science saying? For example, I was asked whether or not people should go to Trump rallies in 2020. And my answer was that people need to understand their risks. They need to understand the environment they're going into, and they need to understand the tools that are available to help them stay safe. But it is not my place – as a scientist – to tell someone they shouldn't go to see the president of the United States any more than it's my place to tell them they shouldn't go to a George Floyd rally, because the science is the same. It's a risky situation, and it's riskier depending on your particular factors.

I think we need to, as scientists, always fall back on the science and not let our biases and judgments about the worthiness of people's decisions enter into how we communicate the scientific risk.

You were on the White House Coronavirus Task Force. I understand that in the fall of 2020 , there were discussions about having the same kind of transportation mask mandate that the CDC ended up implementing under Biden. Do you remember those conversations? If the Trump administration had implemented the mask mandate on public transit, would masks have become as politically polarized?

We had continual questions about what we should do from a scientific perspective, what we could legally do and what the public would accept. Those are the components that went into every calculation that we made.

During our administration, there were certainly debates about whether or not we should have a federal transportation mask mandate. We had much greater limits on [mask] supply – that was a bigger variable for us than what it has been for the Biden administration. It was a [higher] bar for us to cross because we had limited amounts to be able to say, 'OK, we're going to mandate everyone do this, but we're not going to give you the tools that you need to actually be able to comply.'

The other thing is that there are several judges out there who are of the opinion that such a mandate was not legal. We had legal advice that we couldn't do it or that it would be likely overturned.

So for those two reasons, the Trump administration chose not to go ahead with a federal mask mandate [on transportation.]

What are your thoughts or advice on how to be kind about masks in this particular moment?

What I want people to understand is that many of us are privileged in different ways. Sometimes we're privileged because of the color of our skin. Sometimes we're privileged because of how much money we make. Sometimes we're privileged because of where we live. I live within 10 minutes of two major hospitals. But I grew up in a rural community where the nearest tertiary care center was over an hour and a half away.

If we don't recognize those privileges, then we may not understand that other people don't have the same opportunities to make healthy choices that we do. When they don't have those opportunities, that's where society has to step up and say, 'We're going to provide you those opportunities or we're going to protect you.'

What I say to people is remember the Mr. Melvins out there – the people who are trying their best to do the right thing but may not have the resources that you have to be able to do those things. I just hope that we can all understand how fortunate many of us are in different ways and how unfortunate other people are, and just have a little bit of compassion for those individuals who might not have the same opportunities to make a healthy choice as we do.

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