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We Have a Cheap, Effective Way to Keep Ourselves Safer From COVID-19. Why Are We Fighting About It?

6 minute read
Yamey is a physician and professor of global health and public policy at Duke University, where he directs the Center for Policy Impact in Global Health.

At long last, we have made a truly game-changing scientific breakthrough in preventing the spread of COVID-19. The impact of this breakthrough seems almost too good to be true.

We have found a disease control tool that, when used properly, can dramatically reduce the person-to-person transmission of SARS-CoV-2, the virus that causes COVID-19. Studies have shown that this tool could reduce transmission by somewhere between 50% and 85%. The tool is cheap and remarkably low-tech. You can even make one at home. It has no significant side effects. And with each passing day, the scientific research showing the tool’s effectiveness gets stronger and stronger.

If this tool were a vaccine or medicine, we’d be high-fiving each other and popping the champagne, knowing we’d discovered a crucial means to help prevent the spread of the pandemic.

I’m talking, of course, about face masks—cloth, surgical, or even a bandanna. Face masks block the spread of respiratory droplets that can carry the novel coronavirus. But just as with so many other aspects of the response to COVID-19—including mass testing, contact tracing, and the early use of stay-at-home orders—the U.S. is once again squandering this opportunity.

In many countries that have so far successfully controlled their COVID-19 epidemics, public health leaders, politicians, and the public have fully embraced the use of face masks with no hint of controversy. A recent study found that countries where masks were widely used soon after their COVID-19 outbreak began were more likely to keep their death rates low and to have a shorter outbreak. Countries like Hong Kong, South Korea, Taiwan, Thailand, and Vietnam that quickly adopted masking, along with other control measures such as social distancing and track and trace, have reported fewer than 6 deaths per million residents as a result of COVID-19.

Yet in the U.S., where the death rate from COVID-19 is now 379 per million people, face masks have been weaponized for partisan purposes. Taking their cues from President Trump, who has refused to appear on camera wearing a face mask and has said that Americans who wear masks are doing so to show their disapproval of him, many of his supporters now see wearing a face mask as an affront to personal liberty. According to the Washington Post, Republican leaders “are less likely to mandate them, and Republican voters are more likely to forgo, and even scorn, them.” Health officials who have promoted mask mandates have quit their jobs after receiving death threats.

As a result of this alarming polarization, only 18 states and the District of Columbia are mandating face masks in public across the whole state. Only two—Massachusetts and Maryland—have Republican governors. Meanwhile, many Republican-led states are actively trying to subvert local measures. Nebraska Governor Pete Ricketts has gone so far as to say he will withhold federal coronavirus relief funds from local governments if they try and mandate mask use in their places of work.

Rejecting face masks inevitably means embracing more COVID-19 cases and deaths. One U.S. study found that states with a mandate had a more rapid decline in daily growth rates of COVID-19 and estimated that mask use prevented up to 450,000 cases of COVID-19 by May 22, 2020. And while researchers at the University of Washington now predict that the U.S. could reach 180,000 COVID-19 deaths by October, they say we could prevent 33,000 of these deaths—more than half of the new deaths the model projects—if at least 95% of people wear a mask.

That’s right. We can avert the deaths of 33,000 of our parents, grandparents, siblings, co-workers, teachers, bus drivers, mail carriers, nurses and store and factory workers by just sticking a one-dollar piece of cloth over our noses and mouths.

So what’s stopping us? One problem is the “me first” culture in the U.S., in which anti-maskers claim that their right to go around unmasked in public matters more than saving lives. What they don’t seem to get is that while masks may protect the wearer, the more important reason for wearing them is to protect others. If you are infected but don’t know it—because you have no symptoms (“asymptomatic infection”) or the symptoms have not yet appeared (“pre-symptomatic infection”)—a mask reduces the risk that you will spread the virus to others around you.

What’s more, the higher the proportion of people who wear masks, the lower the risk that the coronavirus will spread through the community, akin to herd immunity after vaccination. Once a certain percentage of people, known as a “herd,” is vaccinated (e.g. 95% in the case of measles vaccine), then the unvaccinated people also become protected. Similarly, mass masking provides benefits across a whole community.

This is why it is so important for governments to issue and enforce mask mandates. Not surprisingly, the rate of mask use is much higher in states with mandates. The highest rates of mask use (60%-70%) are in the Northeast—Connecticut, Maine, Massachusetts, and Rhode Island, all of which have statewide mandates. The lowest rates (under 10%) are in Arizona, Indiana and Tennessee, none of which have state mandates.

COVID-19 cases are on the rise in again 31 states—and growing exponentially in crisis states like Arizona, Texas, and Florida that acted much too quickly to reopen businesses. The only way to control the dramatic rise in these “humanitarian catastrophe” states will be to reinstate full lockdowns and mandatory social distancing. Mass masking isn’t the way to end a huge surge in COVID-19. Instead, it is one of the ways that we can help avoid repeated cycles of lockdown and release. There is plenty of evidence from countries around the world that widespread mask wearing—in combination with 2 meters of social distancing, handwashing, and track and trace testing—will allow us to more safely do the things we so desperately want and need to do: go back to work, reopen schools, see friends and family, and restart our economy.

But to have any success, we need to reframe and depoliticize the wearing of face masks. I have been encouraged to see some Republicans—including Mitch McConnell, Marco Rubio, Arnold Schwarzenegger and even Dick Cheney—publicly endorse the importance of wearing masks. That support needs to gain steam in state legislatures and governor’s offices. Leaders further need to strongly and publicly condemn the fringe who are spreading misinformation about masks and openly flouting public health guidelines.

Wearing a face mask is not a sign of weakness. It is an act of solidarity, an expression that all of us—Democrats, Republicans and Independents—have a role to play in defeating one of the greatest public health challenges we have faced in our lifetimes.

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