Although lawmakers are engaged with many long-delayed, vital components of a comprehensive federal response to the Covid-19 pandemic, a national mandatory mask order — which can be implemented quickly — can be an important linchpin of a better federal response to the pandemic.
The nation, and global markets, watch in alarm as cases begin to surge in both the South and West. If we hope to avoid another crippling blow to the economy as a result of a return to lockdown or a loss of consumer confidence in the face of a tsunami of deaths, federal lawmakers need to put politics aside and insist that we put on our masks while they hammer out the details of needed, sweeping mitigation and recovery packages.
Partisan politics have made masks a third-rail issue. Some opponents of wearing them argue that masks represent an infringement on rights, like the right to make personal judgments about what represents an acceptable risk to self. Some even say they infringe on constitutional rights. Several Texas sheriffs, for example, are refusing to enforce the state mask mandate, with one proclaiming in a Facebook video that the order to wear masks “is borderline infringing on some of those constitutional rights.”
This approach simply gets the evidence wrong.
Masks are not primarily about self-protection. They 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.
Although we don’t yet know what proportion of new infections are the result of transmission from people who are asymptomatic or pre-symptomatic, we know enough to require everyone, unless they have a medical condition like severe asthma that would make mask a health hazard, to wear a mask anytime they are in indoor public spaces or crowded outdoor spaces.
People infected with SARS-CoV-2, the virus that causes Covid-19, most actively shed the virus at the time symptoms begin. Individuals without symptoms who test positive for Covid-19 show viral loads as high as those with symptoms. Individuals who are infected with the virus can feel fine but still transmit virus for days before they develop any symptoms.
A national mask order can be nuanced. Evidence continues to suggest that indoor aerosol or droplet transmission is key to the spread of the epidemic. A mask probably doesn’t need to be worn while jogging or strolling through a park or lightly populated outdoor area if you won’t be close to other people. But they should be worn in urban areas with heavy pedestrian traffic, during protests, or at political rallies.
Wearing masks does not eliminate the risk of spreading Covid-19. But it prevents individuals who are infected but feel well from becoming, in essence, 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.
As national infection rates rise, along with hospitalizations and deaths, an unambiguous national mask mandate is becoming more urgent. It should apply to every public space in the nation, with an exception for outdoor exercise or recreation with appropriate physical distancing. It must apply to every person over the age of two. And it must remain in effect until the epidemic recedes. This may mean that Americans will be compelled to wear masks for many months or until an effective vaccine is developed and widely distributed.
Masks are a small price to pay to prevent even greater disaster. Mask wearing does not represent a magic bullet, but having everyone wear masks is a step in the right direction. Mandatory mask wearing must still be backed up with public health efforts that cost money. Rapid testing, swift contact tracing, and effective isolation and quarantine are also essential. So too are continuing physical distancing requirements. This approach has curtailed the epidemic in other countries.
As a country with a limited social safety net, 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.
The nation had abundant opportunities throughout this pandemic to act in a coordinated national way that would have mitigated the spread of Covid-19. We missed those chances. 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.
As we write this, several states and cities are responding with mask orders. That’s not enough for a virus that does not respect borders. Senior leadership at the Centers for Disease Control and Prevention on Tuesday called for consistent, clear messaging about the importance of universal masking from health officials and community normalization. We agree entirely with the need for education, but encourage Americans to go further at this pivotal moment. 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 is the dean of public health at The Ohio State University. Cheryl Healton is the dean of public health at New York University. Sandro Galea is the dean of public health at Boston University.