America Needs a National Mask Mandate ASAP
There’s precious little time to prevent hundreds of thousands more deaths
Remember Friday, October 23, 2020 as the day America stood at the abyss, staring at a looming perfect pandemic storm threatening a horrific winter of overcrowded hospitals, deepening economic catastrophe, and hundreds of thousands more deaths. And its leaders did nothing.
On October 23, the United States set a record for new daily Covid-19 cases, above 80,000 for the first time, while Covid hospitalizations were already rising significantly, and deaths had started creeping back up, including deaths in nursing homes — revealing that the country has not figured out how to protect its most vulnerable. Cases counts are rising or high and staying high in 80% of states, with deaths now rising in two dozen states and poised to accelerate given the simple fact that it typically takes a few weeks for the disease to take a life.
On October 23, a study published in the journal Nature Medicine projected a national mask mandate, all by itself, could prevent U.S. 130,000 deaths between now and the end of February.
On October 23, Tom Frieden, MD, former director of the U.S. Centers for Disease Control and Prevention, said that if national policy on pandemic prevention does not turn on a dime, and soon, expect a “tsunami of cases, hospitalizations, and death.” His prognostication reflects the urgency of the scientific consensus on the disastrous winter ahead.
On October 23, Anthony Fauci, MD, finally said what the White House didn’t want to hear.
Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, has for months walked a professional tightrope on surefooted science but with a political balancing pole. His advice has been clear, but his language guarded, and his ability to affect federal policy thwarted by the whims and anti-science stance of the president and his aides.
In the early days of the pandemic, with little understanding of how the novel coronavirus spread and no serious outbreaks in the United States, Fauci and other health officials advised against mask-wearing — it just didn’t make sense given the situation and the knowledge at the time. Since then, he and other infectious-disease experts have increasingly encouraged Americans to mask up and prodded local and state health officials and governors to encourage the same.
Still, Fauci has refrained from recommending a national mask mandate, something anathema in the White House.
He just changed his tune.
“Well, if people are not wearing masks, then maybe we should be mandating it,” Fauci said on CNN on, yes, Friday, October 23.
Scientists could not agree more.
“You think!?!?” That was the reaction of Shelly Miller, PhD, an environmental engineer at the University of Colorado, Boulder, and an expert on the indoor transmission of infectious diseases. Miller added to her tweet the hashtag #nationalmaskmandate.
“We need a national mask mandate to have any hope of slowing down the cases,” Miller tells me. “We have allowed the virus to seed in our communities and now the only way to get ourselves out of this dangerous situation is to take this kind of action while we wait for the vaccine. Engineering our way out of this with more ventilation is not enough. Another way would be a national lockdown as some countries are considering or have done, and many more people would be impacted by this approach.”
An economic imperative
Reigning in the pandemic, scientists are quick to say, is not just a public health imperative nor even just a moral issue. It’s an economic one. If people are sick and dying or dead, they can’t work, and the economy can’t recover.
There’s data to back this claim. An analysis by the Financial Times shows that countries with the worst outbreaks have suffered the greatest economic pain.
Researchers at the Brookings Institution, in an extensive analysis of the pandemic’s impact on the U.S. economy, conclude: “Given the cost to life and livelihood of a weak economy and labor market, policymakers must continue to use the fiscal, monetary, and public health tools at their disposal to end the COVID-19 pandemic and hasten a self-sustaining economic recovery.”
Instead, the White House has largely pinned its hopes on unproven cures and the potential for one or more vaccines, with the president claiming we’re turning the corner on the pandemic and resolution will come soon.
Paralyzed by the promise of a vaccine
There won’t be widespread availability of vaccines until at least late spring, says Michael Mina, MD, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health. And then, there’s no guarantee how effective they will be, he says. Mina adds that pinning hopes on a vaccine has steered the federal response away from doing things that could have already stamped out the pandemic.
“The hope and the expectation for a vaccine has effectively paralyzed effective control of this virus,” Mina said to reporters on, yes, Friday, October 23.
That paralyzation began in the spring, when lockdowns were supposed to give the nation time to deal with the virus, to figure out prevention, to flatten the curve.
“We didn’t,” Mina says. “Now we’re going to have to live with the consequences of that, or some people won’t live, as a result.”
In addition to universal masking and social distancing that many epidemiologists have been pushing for since spring, Mina argues for federal support for the development and deployment of rapid Covid tests, which people could self-administer several times a week. That way far more people would learn that they have the disease, and learn sooner, and self-quarantining would leave the virus nowhere to go. He says the tests can be cheap — a few dollars each — and a $20 billion federal investment could make the effort a reality.
Instead, like many scientists, Mina’s frustration with federal inaction continues to grow, while the White House entertains the idea of “natural herd immunity,” which calls for letting the virus run its course — an idea that would cost anywhere from 500,000 to perhaps two million American lives, Mina and other scientists say.
Imagine, Mina says, if this were war, and bombs had killed more than 220,000 Americans.
“The idea of going for natural herd immunity would be like us sitting in our homes while bombs are dropping on us, and saying, ‘Well, it’s OK, eventually they’re gonna run out of bombs, but let’s just let them keep hitting us right now.”
Why masks are vital
For months now, experts on virus transmission have been saying the coronavirus is airborne, but the World Health Organization and the U.S. Centers for Disease Control and Prevention have been reluctant to embrace the fact, though the CDC did so recently. That insufficient guidance, as infectious-disease experts see it, has affected political decision-making and public willingness on both social distancing and mask-wearing, which are the two key behaviors that stand between life as we’d like it to be and another round of lockdowns or an unconscionable number of deaths this winter.
Linsey Marr, PhD, an expert on airborne virus transmission at Virginia Tech, is one of several scientists who have been working to convince policymakers, health officials and the general public to take the airborne risk seriously, which means the only way to control the pandemic is if people avoid crowds, mask up, and keep as much distance as possible from others when they are in shared spaces, especially indoors.
In a new video, Marr explains there are three primary ways this particular virus can be transmitted. If you’re not up to speed on the science, here’s Coronavirus Transmission 101 in three easy lessons:
- “By touching a sick person a sick person or an object that has been contaminated by the virus and transferring it to your eyes, nose or mouth,” Marr says.
- “By large respiratory droplets that fly like mini-cannonballs out of a sick person’s mouth and land directly in your eyes, nose or mouth,” she says. These can be so big they’re visible, like spit, but they can be smaller and not so noticeable — there’s no firm lower limit.
- “By breathing in microscopic respiratory droplets called aerosols from the air.” These are invisible.
The first pathway, through touch, was thought to be among the most important early on in the pandemic, but not now.
“It is possible that a person could get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or eyes,” the Centers for Disease Control and Prevention now states, adding, however: “Spread from touching surfaces is not thought to be a common way that COVID-19 spreads.” Leading scientists agree, cautioning that it still is a presumed means, and so handwashing remains important as a layer of protection against Covid, the flu, the common cold and other nasty viruses.
Clearing up confusion
If one word defines the public perception of the science and public policy around coronavirus and Covid-19, it’s confusion.
The CDC and other health organizations have been slow to embrace airborne transmission, and the agency still says “it is much more common for the virus that causes Covid-19 to spread through close contact with a person who has Covid-19 than through airborne transmission.”
Other scientists have moved past that claim.
“Aerosols are likely to be the most important way that Covid-19 is transmitted,” Marr says. “We release hundreds to thousands of aerosols when we breathe or talk.”
Research by multiple scientific groups has shown definitively that these aerosols, from a person infected by Covid-19, can hang in the air for several minutes or even hours while virus particles remain viable. What happens during that time depends on how close you are to an infected person, how long you stay there, how well a room is ventilated, whether you and the infected person are wearing masks, how heavily the infected person is breathing, and how deeply you are inhaling.
“There is overwhelming evidence that inhalation of the virus is a major route of transmission for Covid-19,” Marr says.
Importantly, Marr and other virus-transmission experts say, the closer you are to an infected person, the more virus-packing aerosols you’re likely to face. Within the six-foot radius, you’re at risk for inhaling more aerosols and being smacked by those tiny infectious cannonballs of spit and snot.
All this explains why the leading experts now say, as I reported recently, that the six-foot rule for distancing is, by itself, inadequate for protecting people, especially indoors.
“There’s no need to panic,” Marr says about the airborne nature of the coronavirus. We know how to mitigate the risk, she says. The odds of getting infected are lower outside compared to indoors, for one thing, and the odds can be reduced by avoiding crowds, keeping distance even beyond six feet whenever possible, and, crucially… masking up.
“#MaskUp may seem blasé, but still the single most important thing we can all do to move past this pandemic as quickly and safely as possible,” says Alex Huffman, PhD, an associate professor of chemistry and biochemistry at the University of Denver who studies biology in aerosols.
Are we OK with lots more death?
Mina, the Harvard scientist, echoes other experts in predicting a frightening convergence: the current pace of coronavirus spread, combined with reopening restaurants, bars and schools all at once—just as the favorite time of year for a virus begins—all add up to a “perfect storm” that will send the case counts off the charts, he says. “I really think we’re just seeing the beginning.”
Meanwhile, the White House stands by as a frazzled nation stares into the abyss.
“The outlook sucks,” Mina says. “It really sucks.”
Yet like other experts who study the intricate details of viral transmission and the means to control it, Mina says this raging, exhausting, invisible pandemic can still be stopped. “We have good choices,” Mina says, “if we chose to act now.”
And if we don’t?
“If we’re OK with saying, ‘My mom had another 20 years left of life but, you know, she passed away because of Covid, but you know, she was older, so whatever.’ If we’re OK saying that to 500,000 people or more, then OK, let’s do that, let’s go that direction, let’s open everything up, let’s pull the Band-Aid off quick.”