Our best shot at controlling COVID: Data-driven mask mandates amplify protection of vaccines

The six New England states lead the country in achieving high vaccine coverage that reduce the severity of COVID-19. Unfortunately, rapidly growing cases and hospitalizations in New England show high levels of vaccination alone will not control the spread of delta, a COVID-19 variant that is more transmissible among both vaccinated and unvaccinated people. As schools reopen and many workers return to offices, New England has seen a 700% rise in COVID-19 hospital admissions and a 1900% rise in cases since early July. The surge threatens economic recovery and has already started to close schools in the region.

We are a group of public health researchers and physicians living and working on COVID-19 in each of the New England states. We call on New England governors – and governors across the country – to implement data-driven indoor mask policies for everyone to manage the pandemic, so the pandemic does not continue to manage our lives, schools, labor market, and economy. 

Vaccinations alone won't save us

New England governors have shown admirable leadership in vaccinating state populations, with more than 75% of people having received at least one vaccine dose in Vermont and Massachusetts. High vaccine coverage will help reduce hospitalizations and deaths for those who have received them, but it is statistically impossible to achieve herd immunity with current vaccines and the delta variant. Chittenden County in Vermont is among the most vaccinated in the country, with 87.3% of its eligible population vaccinated, but has gone from near zero case counts to high levels of COVID-19 transmission in the span of weeks. 

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Indoor mask policies are effective and complement vaccines to prevent infection in everyone, vaccinated or unvaccinated. A randomized trial, policy studies, and lab studies all provide evidence that masks reduce COVID-19 transmission. The policy studies show mask policies are associated with immediate reductions in COVID-19 case growth, with greater and greater reductions in cases over time. Each person infected with delta spreads it to 8-9 other people, on average. If the person who is infected and those around them wear masks, it can prevent spread to all or some of those other people. 

Mask policies can be linked to data to reduce volatility in all economic sectors and aspects of daily life in New England. Uncontrolled surges harm small businesses, hospitals, schools, mental health, and social connections. There is widespread public support for universal indoor mask policies, in addition to expert consensus that masks are needed. Many people are already wearing masks, but masks are most effective when everyone wears them together in indoor spaces.

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The clear endgame for mask policies is to control severe disease by reducing the spread of COVID and giving time for more children and adults to be protected by vaccines. The state of Nevada has a smart, data-driven policy that guides counties in turning indoor mask policies on and off based on cases. The data-driven approach is well suited to the New England region. The policy has something for everyone – it ensures indoor mask policies are time-limited to protect everyone when it’s most important to do so and allows people to take off masks indoors when it’s safer to do so.

Sudden surges like we see with the delta variant are a hallmark of COVID-19. We know they will continue to happen, but not where or when. The head of Pfizer suggests a variant that evades vaccines is likely and that it will take months to develop new vaccines. Data-driven mask policies that turn at the beginning of the surge prepare us to avoid waiting to act until there is an uncontrolled pandemic. 

We need political leaders to take action

Indoor mask policies linked to data prevent policymakers or the public from having to go back to the drawing board every time cases surge. We encourage New England governors to adopt the policy as a regional approach, so state governors can apply a common decision making framework, rather than putting the onus on hundreds of local policymakers, businesses, and schools. 

Mask policies are essential for protecting children in communities and the congregate setting of schools. With the more transmissible delta variant, child hospitalizations are at record highs and rising quickly, with more than 2,500 child hospitalizations each week across the U.S. Children under 12 years old will not be eligible for vaccines until the end of the year at the earliest. 

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Mask policies help reduce community COVID-19 transmission, which is associated with reduced child hospitalizations and reduced hospitalizations for everyone. Keeping child COVID-19 cases down not only prevents COVID-19 from reaching children and their families but helps keep schools open and parents at work.

Smart policies can manage the pandemic future and avoid a continued state in which the pandemic threatens to fill our hospitals, close our schools, keep customers out of businesses, and keep us away from one another.

New England states are well-equipped to lead the rest of the country by example with a comprehensive mask policy. New England’s governors can collaborate and offer a blueprint for a regional approach to combating the spread of the delta variant and any other new variants. Data-driven mask policies can help every state in the country manage the pandemic so the pandemic does not continue to manage us. 

The authors – Dr. Julia Raifman, Boston University, Massachusetts. Anne Sosin, Dartmouth College, New Hampshire and Vermont. Dr. Gregg Gonsalves, Yale University, Connecticut. Dr. Brandon D.L. Marshall, Brown University, Rhode Island. Dr. Elizabeth Samuels, Brown University, Rhode Island. Dr. Tania D. Strout, Maine Medical Center, Maine – are public health experts in New England, all working on COVID-19