NYT: Mask Science is perfect, but will be more perfect in another few years

Two years into the forced masking of the general public (except in Florida!), the Science experts at the New York Times give us “Maskless Flying: What might a more effective mask mandate look like?”

On Sunday, I spent nearly five hours on an airplane, flying home from the West Coast. For long stretches of the flight, whenever the crew was serving food and drinks, many passengers were not wearing masks. Even when people did have their masks on, many wore them below their noses.

My flight was the day before a federal judge threw out the C.D.C.’s transportation mask mandate, but my experience was typical, as any recent flier can attest. The mandate was already more of an aspiration than a reality, which indicates that the ruling may be less important than the furor over it suggests. The Covid-19 virus, after all, doesn’t take a break from spreading so that you can enjoy the in-flight beverage service.

As Michael Osterholm, a University of Minnesota epidemiologist, puts it, a mask mandate with as many exceptions as the airline mandate is like a submarine that closes three of its five doors.

The trouble with the transportation mask mandate was that it was both too broad and too lenient.

Its breadth required people to muzzle their faces for long periods of time, and most people don’t enjoy doing so. (If you doubt that, check out the gleeful responses of airline passengers and school children when told they didn’t have to wear masks anymore.)

The transportation mandate had so many exceptions that many Americans understandably questioned its worth. Travelers took off their masks to eat and drink. Some flight attendants removed their masks to make announcements. Some passengers wore their masks on their chins. The mandate also did not require N95 and KN95 masks, which are more effective against the virus than cloth masks or standard medical masks.

Rigorous laboratory tests show that masks reduce Covid transmission, but supporting real-world evidence tends to be much weaker.

The most glaring example in the U.S. is that liberal communities, where masks are a cherished symbol of solidarity, have experienced nearly as much Covid spread as conservative communities, where masks are a hated symbol of oppression. Another example is school mask mandates, which don’t seem to have had much effect. A third example is Hong Kong, where mask wearing is very popular (although often not with N95 or KN95 masks, Osterholm notes); Hong Kong has just endured a horrific Covid wave, among the world’s worst since the pandemic began.

So the Science was perfect and should be #Followed (according to previous NYT articles), but the American public let down the Scientists. Regarding schools, see Face mask mandates in schools were not associated with lower SARS-CoV-2 incidence or transmission for data from 600,000 Spanish schoolchildren. On the righteous versus unrighteous community data, see the following chart (I can’t find a source for it, unfortunately):

Following the Science accelerated COVID-19 plagues by encouraging people to leave the safety of their homes:

Osterholm, who spent 15 years as Minnesota’s state epidemiologist and has advised both Democratic and Republican administrations in Washington, argues that much of the U.S. public health community has exaggerated the value of broad mask mandates. KN95 and N95 masks reduce the virus’s spread, he believes, but mandates like the one on airlines do little good.

“Public health advice has been way off the mark, all along, about mask protection,” he told me. “We have given the public a sense of a level of protection that is just not warranted.”

Note that this is exactly what the Swedish MD/PhDs (i.e., anti-Science heretics) said in March 2020. Ordering masks would give people a false sense of safety when what people actually needed to do was stay at home (if vulnerable) or maintain physical separation. Could it be that America’s public health officials are responsible for more COVID-19 deaths than anyone else? What could be worse than encouraging people to leave the safety of their houses and rely on a saliva-soaked face rag for protection from an aerosol virus?

The rest of the article speculates on what the Great Minds of Science might yet accomplish with redesigned mask mandates to keep us all safe from future COVID variants.

On a related note, “Judge’s Ruling on the CDC Mask Mandate Highlights the Limits of the Agency’s Power” (KHN) is about a CDC that still has the power to order landlords to continue providing apartments to tenants who don’t pay rent:

“If CDC can’t impose an unintrusive requirement to wear a mask to prevent a virus from going state to state, then it literally has no power to do anything,” said public health law expert Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University.

For the public health technocrats, it is “unintrusive” to force a 2-year-old to wear a mask for 16 hours straight (Uber, airport, flight 1, airport 2, flight 2, airport 3, Uber).

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JetBlue doesn’t recognize Judge Kathryn Kimball Mizelle’s authority?

I attended a family event this weekend in Washington, D.C. The Cirrus is in for annual inspection and, in any case, is not suitable for transportation on a rigid schedule so I bought a ticket on JetBlue. On Monday, Judge Kathryn Kimball Mizelle famously freed Americans from the rule of the CDC (“Our system does not permit agencies to act unlawfully even in pursuit of desirable ends”). On Tuesday, however, JetBlue emailed to say

Federal law requires masks to be worn by all travelers 2 years and older at all times during air travel including during boarding/deplaning, on board and at the airport. Failure to comply may result in denied boarding, removal from the aircraft and/or penalties under federal law.

Here’s the core of the “Need-to-knows for your trip” email:

The IT department was still catching up or should we read something deeper into this apparent defiance of Judge Mizelle’s authority to say what Federal law does and does not require?

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Joe Biden asks to speak to Judge Kathryn Kimball Mizelle’s manager

“Biden administration to appeal ruling striking down transit mask mandate” (Washington Post, today):

The Biden administration will appeal a federal judge’s decision that struck down the mask mandate on public transportation, officials announced Wednesday.

The Justice Department filed notice of its plans to appeal after U.S. District Judge Kathryn Kimball Mizelle of Florida on Monday concluded that the mandate exceeded the statutory authority of the Centers for Disease Control and Prevention. The ruling blindsided the White House and sparked days of debate within the administration about how to proceed.

In other words, the muscular Vanquisher of Corn Pop has asked to speak to the young judge’s manager!

Separately, as long as we’re talking about COVID Karens, I still can’t figure out why people who want to wear masks in public are in public to begin with. They’re afraid of COVID-19 so they put on a cloth mask or a non-fitted N95 mask after leaving the house. But if they’re afraid of COVID-19, why did they leave their houses in the first place? Karen visits a Florida theme park is an extreme example of this conundrum.

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Pandemic increases the wealth, power, and prestige of doctors and public health officials even when their remedies are ineffective

I recently finished After the Plague, a lecture series by Simon Doubleday, a professor at Hofstra. The pandemic of the lectures is the Black Death of the 14th century. As with the physicians of spring 2020 who harmed COVID-19 patients by putting them on ventilators (today we realize that most would have done better if they’d stayed home with an oxygen bottle), doctors in 1349 often made plague patients worse and certainly had no effective treatment to offer. As with the fanatical sanitizers of today, public health officials back then tried to stop the pandemic by cleaning up the filthy streets. Ultimately, just as with SARS-CoV-2, the pathogen killed nearly everyone that could be killed despite the best efforts of the doctors and officials.

Professor Doubleday relates that the lack of effective remedies did not reduce public confidence in the experts. In fact, physicians made more money, officials got more power, and both classes of health experts got more prestige even as 50 percent of the population was being felled by Yersinia pestis.

In common with other scholars, Professor Doubleday relates that the reduction in population resulted in a tremendous increase in wages for the survivors (see Immigration is the Reverse Black Death?) due to the reduced supply of labor.

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Forced masking: the 34-year-old judge versus the 79-year-old president

In a perfect illustration of the intergenerational conflict exposed by COVID-19 and with perfect timing for Passover (a holiday all about freedom), a 34-year-old federal judge struck down the 79-year-old’s order forcing healthy young (non-elite) people to wear masks on buses, subways, and commercial airliners. On one side, we have Dr. Biden’s husband at an age where COVID-19 is often serious and sometimes fatal. He’s presumably hoping to make it to 100 so that he can attend the Metropolitan Museum’s opening of a permanent wing devoted to the work of Hunter Biden (today: “face coverings required for all visitors age 2 and older; in 2043 maybe it will be “face coverings required except for visitors under age 2”?). On the other side, Judge Kathryn Kimball Mizelle, a 34-year-old with no obvious COVID-19 risks (photo below from a Tampa Bay Bar Association interview) who can rely on her immune system to co-evolve with SARS-CoV-2.

Most young Americans meekly accepted the loss of their liberty (and, in many cases, their education) that was, at least in theory, supposed to help rich old people get richer and older. But not this judge!

As you might expect, the ruling was based on more technical grounds, as explained in “CDC mask mandate for travelers struck down by federal judge” (CNN):

A federal judge in Florida struck down on Monday the Biden administration’s mask mandate for airplanes and other public transport methods.

US District Judge Kathryn Kimball Mizelle said the mandate was unlawful because it exceeded the statutory authority of the US Centers for Disease Control and Prevention and because its implementation violated administrative law.

A Biden administration official familiar with the White House’s decision previously told CNN the goal of the extension was to gather more information and understanding of the BA.2 variant of the coronavirus. Covid-19 cases in the US are on the rise, leading universities and the City of Philadelphia to reimplement indoor mask mandates.

The first part of the judge’s 59-page ruling turned on the meaning of the word “sanitation,” as it functions in the 1944 statute that gives the federal government the authority — in its efforts to combat communicable diseases — to issue regulations concerning “sanitation.”

Mizelle concluded that that the use of the word in the statute was limited to “measures that clean something.”

“Wearing a mask cleans nothing,” she wrote. “At most, it traps virus droplets. But it neither ‘sanitizes’ the person wearing the mask nor ‘sanitizes’ the conveyance.”

Mizelle suggested that the government’s implementation of the mandate — in which non-complying travelers are “forcibly removed from their airplane seats, denied board at the bus steps, and turned away at the train station doors” — was akin to “detention and quarantine,” which are not contemplated in the section of the law in question, she said.

“As a result, the Mask Mandate is best understood not as sanitation, but as an exercise of the CDC’s power to conditionally release individuals to travel despite concerns that they may spread a communicable disease (and to detain or partially quarantine those who refuse),” she wrote. “But the power to conditionally release and detain is ordinarily limited to individuals entering the United States from a foreign country.”

If her order sticks, maybe young people will say “Thank Mizelle” every time they get on public transit (which the rich old people who created the mask orders never used to begin with).

Speaking of Tampa, the children’s museum there in a photo from December 2021:

(One of the things that I am liking about Florida is the priority given to children. Events that would require paid tickets for each child up in Maskachusetts are generally free to children here. At least half of the time that I expect to pay for our kids I find out that a paid adult admission enables an unlimited numbers of kids to come in as well. A family of modest means, therefore, can afford a wide range of activities that would be out of reach for a family in the Northeast. Disney, of course, is an exception and is financially ruinous for anyone with kids.)

Reaction from a Facebook friend (old white guy): “If there was a hell, it would hold a special place for U.S. District Judge Kathryn Kimball Mizelle”

From the NYT readers:

(Kathleen in NY) It’s a shame that not one major airline was brave enough to keep the mask policy in place—offering passengers a choice to fly with other safety-minded people. Missed business opportunity too. It’s a tragedy that airlines caved to the vocal minority, rather than the more compliant majority—placing more importance on individual liberty (aka selfishness) than to the common good.

(Andy in Chicago) Even if masks were about to become optional anyway, this judge’s decision sets a dangerous right-wing precedent for future Covid waves and other epidemics.

(josh in NY): The judge who made this decision was a political appointee of Donald Trump, and utilized no scientific based reasoning in the decision to remove masks from travel. I think this will only harm the nation further and while no one likes to wear them, they are especially useful in tightly packed places like planes, trains, and buses. I hope the administration appeals this blatantly political opinion.

(Jason in NY): I had a trip planned to California next week. As a result of this politically motivated and dangerous move to end masks on flights, I have cancelled my trip.

(Martha in Tennessee) Woo hoo! Now the US needs to drop the negative test requirement for citizens to get back into the country. Those of you who insist on living in fear are just going to have to stay home.

(David in California, replying to Martha) I’ll stay home, thanks for your consideration. And I’m not the only one. Taking action that drives customers away isn’t necessarily a good business decision.

(John in San Jose) I read the decision of Judge Mizelle. It is shockingly bad and is based on narrow views of select words while ignoring not only other sections, but even common sense. … Judge Mizelle claims that the mask mandate exceeds its authority because it does not fit into the suggested list of remedies listed in the law, but she also chose to ignore the closing words of 42 U.S. Code 264 which state “and other measures, as in his judgment may be necessary.” It is sad to realize that the hard work of thousands of well-trained people can be rendered moot by one judge with no knowledge of diseases and a partisan agenda.

Related:

  • COVID-safe restaurant chain idea (perfect for the NYT commenters above who want to continue living under the rules that prevailed in New York City, Washington, D.C., and San Francisco circa January 2022)
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Year 3 of the COVID emergency continues

“WHO says Covid still a global public health emergency even as deaths fall to lowest level in two years” (CNBC):

“Far from being the time to drop our guard, this is the moment to work even harder to save lives,” Tedros said during a press briefing in Geneva. “Specifically, this means investing so that Covid-19 tools are equitably distributed, and we simultaneously strengthen health systems.”

Houssin said the committee is working on criteria, including epidemiological data and the level of international assistance to contain the virus, to determine when the WHO can declare that the global health emergency is over.

“Masks Stay On: C.D.C. Keeps the Mandate on Planes” (NYT):

Despite pressure from airlines and industry groups, the Biden administration extended the requirement to wear masks while traveling on public transportation through May 3.

Dr. Ashish K. Jha, the new White House Covid response coordinator, said in an interview that the additional time will allow the C.D.C. to assess whether BA.2, a subvariant of the coronavirus, is going to become a “ripple or a wave” in the United States. The C.D.C. will use that information to determine whether the mandate should be extended further, he said.

We’re still in a COVID emergency, which is why the rabble need to wear some sort of mask on buses, subways, and commercial airliners (the elites are unmasked in their private cars and private jets, of course!), but COVID is not a sufficiently serious risk to justify trying to keep COVID-infected migrants out (“CDC orders Title 42 to wind down, saying expulsions of migrants are no longer needed” (CBS, April 1)).

It’s a worldwide and nationwide emergency, but every American has the option to move to a state that matches his/her/zir/their desired level of panic. One useful tool is the WalletHub ranking of states by COVID-19 restrictions (the Florida Free State is #2 at the free end of the spectrum). A newly released multi-state comparison from the National Bureau of Economic Research is co-authored by Casey Mulligan (see Book Review: The Redistribution Recession). From “A Final Report Card on the States’ Response to COVID-19”:

For those who seek maximum panic and securely locked-down K-12ers, the best places to live are California, Maryland, Oregon, Washington, Hawaii, and D.C. (And, in fact, some friends who were supporters of lockdowns, masks, Joe Biden, etc. recently moved to Hawaii from a state that had only a middling level of passion for lockdowns and school closures.)

As the authors point out (above), school closures will surely kill a lot of Americans in the long run; they estimate that more life-years will be lost just from this than from COVID-19. But did school closures save lives in the short run? The authors look at COVID-tagged deaths per 100,000 population and adjust for age and the prevalence of obesity and diabetes. Hawaii is ranked #1 (lowest rate), but D.C. is ranked #48 despite similar enthusiasm for school closure. (schools-open Florida is mid-pack for death rate at #22.) On the “excess deaths” guestimation, California and Florida are right next to each other despite it being illegal to keep a school open in California and it being illegal to keep a school closed in Florida.

The authors are economists so they get into a lot of GDP data and operate from the assumption that richer is better than poorer. I personally disagree with this approach as I’ve noted before. Since Americans say that they don’t care how impoverished they become so long as they can preserve at least one human life, the relevant standard for looking at lockdown is life-years, adding up those saved from COVID-19 and subtracting those lost due to the side-effects of lockdown. Wealth (GDP) factors into this only to the extent that wealth is correlated with health and longevity.

The NBER paper concludes by noting that four of the states that they ranked last in a composite score (in-person school percentage, economic performance, and minimizing deaths) are the ones that have had the highest per-capita rates of out-migration. These are DC, NY, IL, and CA.

What about our family’s August 2021 move? Florida gets an A rating and a #6 rank in the composite score. Maskachusetts is lumped in with the D students and has a #41 rank. (If you like skiing, Utah is ranked #1!)

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Science: travelers from zero-COVID China need medical testing, but undocumented migrants do not

Here’s the Science question of the day…

To protect the United States, which currently has 30,000 COVID “cases” per day and 600 COVID-tagged deaths per day., from COVID, our Science-following CDC requires that someone arriving with a passport from zero-COVID China undergo medical testing for COVID prior to travel. If he/she/ze/they is not a U.S. citizen, he/she/ze/they is required to also require proof of the Sacrament of Fauci (vaccination). (See CDC order of November 8, 2021.)

The Scientists at the Science-oriented CDC, on the other hand, have Scientifically determined that a migrant who says “I am under 18” can cross the border and stay permanently in the U.S. without either a COVID test or a COVID vaccine. The Science changed after a federal judge said that the Biden administration could not exempt people who said that they were minors from the Science. See “Biden administration says it will not expel migrant children following court order” (CBS):

The Centers of Disease Control and Prevention (CDC), which first authorized the migrant expulsions in March 2020, terminated the government’s ability to expel children who enter U.S. border custody without their parents. U.S. border officials can still use the policy, known as Title 42, to expel single adult migrants and families traveling with children to Mexico or their home countries.

Last week, U.S. District Court Judge Mark Pittman said the administration could no longer exempt unaccompanied minors from Title 42, arguing that Texas, which challenged the exemption, was financially harmed by the placement of migrant children in the state due to medical and schooling costs.

In a notice Friday, CDC officials said they recognized the “unique vulnerabilities” of unaccompanied minors.

“In the current termination, CDC addresses the court’s concerns and has determined, after considering current public health conditions and recent developments, that expulsion of unaccompanied noncitizen children is not warranted to protect the public health,” the agency said.

In a separate 21-page order justifying the decision to end Title 42 for unaccompanied children, CDC Director Rochelle Walensky cited the recent nationwide decrease in COVID-19 cases, as well as increased vaccination rates in the U.S. and in the home countries of migrants who journey to the southern border.

Science dictates that the border will be completely open to all unvaccinated and untested migrants as of May (Politico), even those who don’t say “I am under 18,” thus adding approximately 1 million additional residents to the U.S. annually (2 million were expelled during the last two years, according to Politico). So don’t say “no” if you’re offered the opportunity to invest in a crony capitalist “affordable housing” scheme!

(See “The affordable majority: Three misconceptions about investment in affordable housing”:

… affordable housing targets the masses and serves the primary rental cohort in the United States, with about 72 percent of renters falling in the affordable-housing category. … Compared with market-rate apartments, affordable and workforce housing are, in a sense, recession-proof and provide downside protection to investors. … Because of this rising demand and diminishing supply, affordable-housing units experience little to no turnover and are almost always fully-occupied, consistently maintaining occupancy rates of about 98 percent. This differs significantly from market-rate apartments, which average about a 50 percent turnover rate.

Overall, “affordable” does not necessarily mean smaller returns. Investor portfolios in the affordable-housing sector tend to have stronger returns on investment, increased and stabilized cash flows, and provide investors with downside protection.

)

Circling back to the immigration policy that Science (via the CDC) has given the United States, how is it consistent with the documented traveler testing requirement policy that Science (via the CDC) has given the United States? How is a U.S. citizen returning from a zero-COVID country a higher COVID risk, thus requiring pre-departure testing, than an undocumented migrant who has traveled overland through multiple COVID-plagued countries?

Only loosely related, a hotel in China, November 2019, that already had the tables separated for COVID prevention…

(The double boiled pig’s lung soup was about $200 at the exchange rate of late 2019.)

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CDC gives us a new canonical example of chutzpah?

The standard example of chutzpah has been “that quality enshrined in a man who, having killed his mother and father, throws himself on the mercy of the court because he is an orphan.”

I wonder if we can replace this with one from a U.S. government agency. “CDC Reports Warn of Teen ‘Mental Health Crisis’ During Pandemic” (MedPage Today, 3/31/2022):

In a nationwide survey, high school students reported experiencing poor mental health and life disruptions during the COVID-19 pandemic, CDC researchers said.

Among a nationally representative sample of high school students in the U.S., 37% said that they experienced poor mental health, and 44% reported persistent feelings of sadness or hopelessness, reported Sherry Everett Jones, PhD, of the CDC, and colleagues.

Furthermore, about 20% of respondents said they seriously considered attempting suicide, and 9% had attempted suicide during the 12 months before the survey, they noted in the Morbidity and Mortality Weekly Report (MMWR).

“Our data make it clear that young people experienced significant disruptions during the pandemic, and are experiencing a mental health crisis,” said co-author Kathleen Ethier, PhD, of the CDC, during a conference call with the media. “It is clear right now that young people need all the support we can give them.”

In other words, the agency that enabled state and local school systems to shut down for more than a year (while still ladling out taxpayer-funded salaries at 100%!) under the guise of following Science now says that people should look to them for advice on how to restore the mental health of kids whose schools were thus closed.

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Support for the dedicated COVID-19 treatment center idea

Exactly two years ago (April 2, 2020), I asked If we could build renal dialysis capacity, why not COVID-19 treatment centers?

On the one hand, the U.S. health care system is kind of lame. It consumes a ton of money. New York State spends $88 billion per year on its Department of Health, $4,400/year for every resident, mostly just for people on welfare in New York; Mexico spends about $1,100/year across all citizens, including those with jobs. The U.S. health care system delivers feeble results. Life expectancy in Mexico is 77 versus 78 in the U.S. Despite this prodigious spending, New York has completely failed to protect its residents from something that isn’t truly new.

On the other hand, the U.S. managed to build enough renal dialysis capacity to keep 468,000 Americans with failed kidneys alive. This is a complex procedure that requires expensive machines, and one that did not exist on a commercial basis until the 1960s.

Should this success story give us some hope that the U.S. will, in fact, be able to deal with the surge of demand for ventilation and life support created by the evil non-Chinese coronavirus?

Of course, one issue is that we had decades to build up all of this renal dialysis capability while we have only about one more month to build COVID-19 treatment capacity. But once we have built it, can we sail through the inevitable next wave or two of COVID-19?

The idea turned out to have some medical merit. “COVID Patients Fared Better at Dedicated Hospitals for It” (MedPage Today, 3/3/2022):

At the two M Health Fairview hospitals converted to treat COVID-19 starting in March and November 2020, overall mortality with COVID-19 was higher than in the health system’s other nine Minnesota hospitals (11.6% vs 8.0%, P<0.001).

But after accounting for the generally sicker patients treated at the dedicated hospitals, in-hospital mortality was a relative 22% to 25% less likely, which was significant in both unmatched and propensity-matched comparisons.

Complications were a relative 19% less likely than at mixed-use hospitals, Elizabeth Lusczek, PhD, of the University of Minnesota in Minneapolis, and colleagues reported in JAMA Network Open.

M Health Fairview converted two of its hospitals with building modifications to enhance remote telemetry, create negative airflow rooms with HEPA filters, and update interventional radiology and procedural suites and ensure that the healthcare workers there would have easy access to personal protective equipment (PPE) even in times of general shortage.

We’ve spent $10 trillion over two years in our fight against SARS-CoV-2? How many dedicated COVID-19 treatment centers did we get for this money? I’m thinking that the answer is close to zero, given that every time there is a bump in “cases”, we see media stories about non-specialized hospitals being overwhelmed.

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New York Science: masks for 2-year-olds, but not in the strip clubs

Following Science, Mayor Eric Adams of New York City orders 2-year-olds to continue wearing masks while unvaccinated adults are free to party in strip clubs, on Tinder dates, at raves, etc.

(The mayor had a bit of trouble with the courts, but an appeals court ruled in favor of continuing to burden 2-year-olds.)

Florida Realtor of 2022 for Eric Adams? At least for New Yorkers with children under 5, a move to the Sunshine State could be compelling!

And what about the flight to freedom? Can escaping families throw away their masks at JFK or will they have to wait until they’re on the curb at PBI? “Florida is challenging federal mask requirements for travelers” (government-funded WFSU, 3/30/2022):

In Florida’s latest salvo against the Biden administration over COVID-19 restrictions, Attorney General Ashley Moody on Tuesday filed a lawsuit challenging requirements that people wear masks in airports and on planes, trains and buses.

Moody, joined by attorneys general from 20 other states, filed the lawsuit in federal court in Tampa. In part, it contends that the federal Centers for Disease Control and Prevention has overstepped its legal authority in requiring masks for travelers.

“Faced with a government that displays outright disdain for the limits on its power — especially when it comes to the COVID-19 pandemic — plaintiffs seek vacatur of that mask mandate and a permanent injunction against its enforcement,” the lawsuit said.

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