Friday, August 14, 2020

Ask the Experts: Why Do We Need a National Mask Mandate?



The main problem with masks now is the lack of a coherent message from the leaders … This leads to inaccurately assessing the risk of not wearing a mask since the signal is too noisy. If more people do not wear masks, the risk aggregates, making those who do less safe too – and possibly leading people to the false conclusion that masks don’t work.”

Alex Horenstein, assistant professor of economics at Miami Herbert Business School at the University of Miami

Masks are an effective tool for fighting a pandemic. Some people still believe that the states should be in charge of declaring a mask order. Yet, some states have been too slow to mandate such orders.

An extremely telling example is the state of Florida, which has not mandated masks. While it initially took three months for Florida to report 100,000 new cases of COVID-19, the number of new cases doubled to 200,000 in less than two weeks; this rise is not accounted for by an increase in testing. As of August 5, over 50 Florida hospitals' ICUs are at capacity.

Why should Americans support Joe Biden's call for a national mask mandate? I believe it is clear. The patchwork policy currently being implemented in our country to fight COVID-19 is failing. Allow me to share support for for a national mask order.

A national mandatory mask order would give us a much-needed second chance at a national solution to a national problem. If we want to avoid deepening our economic crisis, if we want to go back to work, if we want to save tens of thousands of lives in short order, we must de-weaponize the walking well and mandate mask wearing.”
    Amy Lauren Fairchild, dean of public health at The Ohio State University; Cheryl Healton, dean of public health at New York University; and Sandro Galea, dean of public health at Boston University
Fairchild, Healton, and Galea agree: We are again at a turning point. If we act now, decisively, with a national order on masks combined with aggressive testing, contact tracing, isolation, and quarantine, we may yet get another opportunity to reverse the pandemic and return to normal sooner rather than later.

Masks are a small price to pay to prevent even greater disaster. Partisan politics have made masks a volatile issue. People argue that masks infringe on their rights to make personal judgments, and some even claim masks violate their Constitutional rights.

The truth is that masks are about protecting others. Wearing an appropriate mask in an indoor public setting, even when social distancing can be maintained, is a crucial means of reducing transmission of virus-bearing droplets or aerosols from individuals who are infected to those who are not. Masks are particularly effective when combined with physical distancing and proper hand hygiene.

Yes, scientists agree wearing masks does not eliminate the risk of spreading COVID-19, but it prevents individuals who are infected but feel well from becoming walking weapons. Equally important, a national mask order reduces the stigma of wearing a mask by making it clear that we are all looking after each others’ health.

The United States has a limited social safety net, and we are poorly positioned to cover the costs of ongoing economic sacrifice for the sake of the common good. This makes bringing the pandemic under control, and quickly, an urgent national priority.

Lessons from other health campaigns, including seatbelts, condoms, and texting while driving, suggest that public education is important if you actually want people to change their behavior. These campaigns work. A national mask mandate should also be supported through public service campaigns and announcements that increase nationwide education of the much-needed safety measure.

A study published in June in the journal Health Affairs, which looked at 15 states and the District of Columbia before and after their mask mandates, found that masks reduced new Covid-19 cases, particularly over time. In the first five days after masks were required, new cases slowed by almost 1 percentage point; at three weeks, it was 2 percentage points. That may not sound like much, but it adds up.

The study concluded:

There was a significant decline in daily COVID-19 growth rate after the mandating of face covers in public, with the effect increasing over time after the orders were signed. Specifically, the daily case rate declined by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage points within 1–5, 6–10, 11–15, 16–20, and 21 or more days after signing, respectively. All of these declines were statistically significant (p<0.05 or less).

We also projected the number of averted COVID-19 cases with the mandates for face mask use in public by comparing actual cumulative daily cases with daily cases predicted by the model if none of the states had enacted the public face cover mandate at the time they did. The main model estimates suggested that because of these mandates, 230,000–450,000 cases may have been averted by May 22. Estimates of averted cases should be viewed cautiously and only as general approximations.”

(Wei Lyu and George L. Wehby. “Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US.” Health Affairs. June 16, 2020.)
Another study looking at coronavirus deaths in 198 countries found that countries “with cultural norms or government policies supporting public mask-wearing” had far fewer deaths.

Goldman Sachs has modeled the impact of a national mask mandate, and its analysis suggested that such an order could not only reduce the number of coronavirus cases but also prevent a 5 percent loss in GDP when used in place of lockdowns.

Also, consider, in the absence of state mandates, corporate mask rules fall on employees to enforce. Many retailers, worried about their high-risk indoor environments, haven’t waited for government orders to require clients to wear masks. Major chains, including CVS, Target, Walmart, McDonald’s, Kroger grocery stores, and Costco, have announced nationwide mask policies, even in places without a statewide order, like Arizona and Florida.

To close, widespread support for universal masking exists among the medical community. The Council of Medical Subspecialty Societies, a coalition representing 45 medical professional societies and 800,000 doctors, are advocating for a national mandate on universal masking. They are joined by over100 prominent academics (#MasksForAll) advocating for government officials to require masking in public and over 8,000 concerned citizens and health professionals who have signed a petition (#AmericaMaskUp) in support of a national mask mandate.

The American Medical Association, the American Nursing Association and the American Hospital Association issued an open letter to the public strongly encouraging masking. Lastly, the Center for Disease Control and Prevention is now encouraging universal masking and refers to wearing a mask as a “civic duty.”

The Infectious Diseases Society of America and the HIV Medicine Association sent a letter to Vice President Mike Pence on August 5 calling for a national strategy on face masks – including a federal directive requiring mask-wearing mandates in all states – saying that “unified national action is again urgently needed to save lives.”

The organizations, which collectively represent more than 12,000 infectious disease and HIV experts, physicians and health professionals, request a “strong federal directive calling for mask requirements in all states,” and to “launch a public education campaign about the importance of wearing masks.”

The letter also said that the U.S. has a “critical window of time” to bring down its cases of Covid-19 before influenza season starts, at which point “it is likely that hospitals will become overwhelmed and lives will be lost due to a shortage of ICU beds, ventilators and other essential equipment.”

(Alison Durkee. “Group Of 12,000 Infectious Disease Experts Say Federal Mask Mandate ‘Needed To Save Lives.'” Forbes Staff. August 05, 2020.)

An NPR/Ipsos poll released Tuesday found that 67% of Americans want a national Covid-19 strategy and 76% support state laws requiring masks, but President Donald Trump has so far resisted calls for a national mask mandate and said only that his administration is currently “in the process of developing” a national strategy.

(Brian Mann. “Despite Mask Wars, Americans Support Aggressive Measures To Stop COVID-19, Poll Finds.” NPR. August 4, 2020.)


So the question we’re facing with masks is: What risk should we let people take when their decisions affect others?”

Alex Horenstein



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