With COVID-19 surging nationally, there are increasing calls for a national mask mandate for the public. There appears to be sufficient evidence to support such a measure as we enter a winter of considerable discontent.

The political reality is a mask mandate is not likely to happen unless the Trump administration is voted out, as the president politicized the mask issue early in the pandemic and some see it as an issue of individual freedom than collective public health.

Although he has cautioned against such mandates in the past, National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD, recently made comments more open to the idea. Democratic presidential candidate Joe Biden has said a mask mandate will be a priority if he is elected.1

‘Low-Tech’ Measures

Fauci recently co-authored a paper that said “multiple lines of evidence support the effectiveness of masks for the prevention of SARS-CoV-2 transmission. Mandates for the wearing of masks in public have been associated with a decline in the daily growth rate of COVID-19 cases in the U.S.”2 The implementation of such mandates averted more than 200,000 cases of COVID-19 by May 22, according to modeling estimates.3

Other “low-tech” measures in to prevent COVID-19 include wearing masks, physical distancing, hand hygiene, and limiting crowds and gatherings.

“If a vaccine has only moderate efficacy, or if vaccine uptake is low, these … modalities will be even more critical,” Fauci and colleagues noted. “Wearing face coverings — masks — in the community setting to prevent the spread of SARS-CoV-2 is a key component of this combination approach.”2

The paper cited a study at a U.S. academic medical center, where infection rates fell after adoption of universal masking by all healthcare workers and patients. “The SARS-CoV-2 positivity rate among healthcare workers declined from 14.65% to 11.46%, with a decline of 0.49% per day,” they emphasized.4

The epidemiology of SARS-CoV-2 indicates most infections are likely spread through exposures within about six feet, but there is the risk of airborne spread over greater distance under certain conditions like poorly ventilated enclosed spaces.

“Blocking the dispersion of respiratory droplets from an individual infected with SARS-CoV-2 via use of a mask that functions as a physical barrier is a logical strategy to curb transmission,” the authors concluded. “Since it has now become evident that individuals capable of transmitting SARS-CoV-2 cannot be identified solely by the presence of symptoms, universal mask-wearing in the community for source control is recommended.”

REFERENCES

  1. Fottrell Q. Fauci and Biden advocate a federal mask mandate, as new COVID-19 infections surge. Market Watch, Oct. 6, 2020. https://www.marketwatch.com/story/dr-fauci-says-if-people-are-not-wearing-masks-then-maybe-we-should-be-mandating-as-new-us-covid-19-cases-hit-85000-2020-10-24
  2. Lerner AM, Folkers GK, Fauci AS, et al. Preventing the spread of SARS-CoV-2 with masks and other “low-tech” interventions. JAMA 2020; doi:10.1001/jama.2020.21946. [Online ahead of print].
  3. Lyu W, Wehby GL. Community use of face masks and COVID-19: Evidence from a natural experiment of state mandates in the US. Health Aff (Millwood) 2020;39:1419-1425.
  4. Wang X, Ferro EG, Zhou G, et al. Association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers. JAMA 2020;324:703-704.