Contentious conversations about masking are seemingly everywhere, from school board meetings to grocery stores, to public health and medical discourse. Calls for policy changes have intensified as children ages 5-11 have become eligible for vaccination. This is an opportunity for the Centers for Disease Control and Prevention (CDC) and governors across the country to lead the U.S. in a more rational and unified policy approach to managing the pandemic long term.
Vaccines and mask policies are among the most effective public health tools for addressing the virus, and these strategies work best in concert. Vaccines remain effective for reducing COVID-19 hospitalizations and deaths, even with the Delta variant. At the same time, 42 percent of Americans remain unvaccinated and the Delta variant presents a formidable challenge that makes vaccines less effective for preventing transmission. Outbreaks at college campuses, dinner parties and concerts show that the virus can spread widely, even in highly vaccinated populations. Mask policies can protect vaccinated and unvaccinated people and reduce COVID-19 cases and deaths during surges.
As policymakers consider when to require masks now that vaccines are available, data-driven mask policies such as Nevada’s are a practical and effective approach. The state’s simple policy is based on the CDC’s guidance. The policy requires everyone, regardless of vaccination status, to wear masks indoors in areas with “substantial” or “high” levels of COVID-19 transmission, as defined by the CDC. The policy is implemented at the state level and is linked to local, county-level data. Counties can lift indoor mask requirements once COVID-19 transmission rates drop to “low” or “moderate” levels for seven days.
Although the CDC’s mask guidance is aimed at individuals, mask policies for whole communities coordinate our actions to clear the air of COVID-19 in a way that no individual can do on their own. Such mask policies ensure that those who unknowingly have COVID-19, and the people around them, wear masks in public to reduce the amount of virus in the air and the amount inhaled. Unfortunately, messaging focused on individual behavior, rather than the whole community, led to a steep decline in mask-wearing without a comparable rise in vaccination.
While 43 states implemented mask policies in 2020, just seven states had mask policies during the Delta surge. As a result, most of the country was left without one of the most effective tools for slowing transmission as 130,000 Americans died of COVID-19. The U.S. death rate was eight times that of other high-income countries. If this surge in the U.S. is prolonged, as is the case in the United Kingdom, or if cases surge again in the coming months, policies implemented now could reduce sickness and death. There is widespread public support for the return of mask policies during surges in both the U.S. and the U.K.
There is strong evidence that mask policies reduce the spread of COVID-19. A study by the CDC found that masks can achieve over 95 percent effectiveness when worn by both an infected person and an exposed person. A randomized trial showed that increasing mask-wearing by 29 percent was associated with an 11 percent reduction in COVID-19 transmission. With mask policies that ensure nearly 100 percent of people wear masks in public, we would expect even greater benefits. This is consistent with rigorous policy analyses finding that COVID-19 case growth declined after states implemented mask policies relative to comparison states with no mask policies.
Concerns about the quality of data that underlie data-driven policies offer an opportunity to continue working to improve surveillance data, such as through self-reporting of at-home test results. In the meantime, we should not let the perfect be the enemy of good. Most important is clear, simple CDC guidance for policymakers and state leadership on implementing policies that are designed to handle rapidly changing conditions.
Controlling the virus creates a virtuous cycle that improves mental and physical health, the economy and labor supply, and our lives. As tempting as it is to suggest we have already achieved a return to normal, losing hundreds of thousands of people and a record number of young people to a preventable virus is not a normal to which we should aspire. Improving vaccine delivery and strategically using mask policies during surges can lead us to a better “normal.”
We all want the CDC and the country to succeed in managing the virus and so that we can move on with our lives to the extent possible. Data-driven mask policies can help manage the virus, so it doesn’t manage our lives, our health, our schools and the economy.
Julia Raifman, ScD, SM, is assistant professor of health law, policy and management at Boston University School of Public Health. Follow her on Twitter @JuliaRaifman.
Linsey Marr is the Charles P. Lunsford Professor of civil and environmental engineering at Virginia Tech. Follow her on Twitter @linseymarr.
Alexandra Skinner is a research fellow at Boston University School of Public Health and manager of its COVID-19 US state policy database. Follow her on Twitter @alexskinnermph.