Mask wearing has become the new vaccine debate, one that is visceral and not rooted in science, but with high potential to lead to preventable infections and deaths. But, like the anti-vaccine debate, it cannot simply be combatted by lobbing science at skeptics because the science, which is rooted in a strong body of evidence, is not the only influence on decision-making.
People who don’t believe in vaccines, similar to those who do not believe that masks protect against COVID-19, grasp onto misinformation that confirms their skepticism and breeds their overconfidence that the experts are wrong. Anti-maskers, like anti-vaxxers, don’t trust science alone.
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That is why leadership — and specifically leadership by example — is critically needed about masks. Instead we have elected officials at the highest level sending mixed, and sometimes fundamentally wrong, messages. They are, in effect, spreading misinformation.
As a result, there is significant variability in mask policy at state and local levels and the public is confused about the fact that there is science behind masking. They seem to instead believe that mask-wearing is a matter of politics and policy, which contributes to a lack of willingness to wear masks.
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A number of governors in both red and blue states — including Maryland, Massachusetts, West Virginia, New York, California and Oregon — have made wearing masks outside mandatory. Yet, in other states where COVID-19 cases are now spiking, governors are refusing to step up and set sound public health policy for their state.
For example, Gov. Henry McMaster of South Carolina, a Republican, has refused to implement a statewide mandatory masking order, instead leaving the decision up to city and local officials. Gov. Jared Polis of Colorado, a Democrat, also has refused to issue a statewide mask order, though he hasn't ruled it out, saying that it's easier for counties and municipalities to do so — but tells citizens to "wear a damn mask." Gov. Doug Ducey of Arizona, a Republican, has stopped blocking local mask-wearing orders in his state, but will not implement a mandatory masking order.
Vice President Mike Pence recently began recommending mask-wearing, but President Donald Trump only just donned one in public this week and has not widely promoted mask-wearing, despite his deep influence among his supporters.
We know, however, that masking is essential to fighting the pandemic. Researchers from University of California Berkeley found that if 80 percent of the population wore masks consistently, COVID-19 transmission rates would decline 12-fold, a solution much more sustainable than a full physical and economic lockdown.
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Why? We know that COVID-19 transmission occurs primarily through bodily fluids, and that transmission can occur when these fluids are aerosolized — as they are when we speak. An extensive review of the literature suggests that nonmedical cloth masks effectively obstruct droplets and significantly reduce transmission.
We also know that mask wearing is especially useful during the asymptomatic or presymptomatic phases during which individuals may not yet know to isolate themselves and when COVID-19 is thought to be most infectious. And, recent PNAS study found that “silent transmission” during those presymptomatic and asymptomatic stages is responsible for over 50 percent of the infections during COVID-19 outbreaks, and can sustain such outbreaks even when all symptomatic cases are isolated. Furthermore, a prevalence study in New Orleans showed that 40 percent of people were asymptomatic at the time of testing, and 75 percent were asymptomatic in the early stages of illness.
Masking, then, is imperative for both people with symptoms and without, to keep them from spreading the disease to others.
Universal masking doesn’t just have a good Samaritan benefit, though: A recent Goldman Sachs study found that universal mandatory mask-wearing would not only accrue the same public health benefit as strict lockdown measures, but that it would ultimately save over $1 trillion of the U.S. GDP — mitigating at least some of the economic pressures that came from locking down.
Universal masking is effective against the disease, and it would prevent the reopening and reclosing that is now happening across the country and harming the economy.
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Yet people still aren't doing it. Mask-wearing is seen by many who oppose it as a violation of individual freedoms — and, worse, some are spreading misinformation suggesting that masks themselves are dangerous to most people's health, which they are assuredly not. The American Lung Association, for instance, strongly states that people wearing masks will not suffer any respiratory ailments, oxygen loss or a weakened immune system from wearing a nonmedical grade cloth or surgical mask in public spaces to go about their everyday lives.
But masses of people refusing to wear masks, and governors refusing to adopt a universal masking mandate, will likely lead to hundreds of thousands of new COVID-19 cases and subsequent deaths in the coming weeks and months. The freedom — and privilege — to infect another person, potentially cause their otherwise preventable death, should not supersede the "freedom" to not wear a mask.
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This is the situation facing our country: We are poised to pass 60,000 new cases of coronavirus in a day this week, for the second time. The nation officially recorded a staggering 800,000 cases during June alone; we've had more than that many cases already in July. Some Black, Latino and Indigenous populations are experiencing more than quadruple the rate of hospitalizations and deaths than white people. To compound these concerning statistics, the CDC recently estimated that the actual number of cases may be 10 times the officially reported number.
So while opinions about how best to adapt to the “new normal” of COVID-19 vary widely, masking achieves the goals of improved population health, better economic vitality and reduced chance of infection for yourself and your loved ones. Although we may be done with COVID-19, COVID-19 is not done with us.