The US has entered an ominous new surge of the coronavirus pandemic, with more cases reported on Friday than any other day since the crisis began in March. And yet, in many areas of the country where infections are spiking, wearing a mask in public is still completely optional.
Eight months into the pandemic, 15 states still do not require residents to wear masks. They are all led by Republicans governors who have stressed the importance of individual responsibility over broad government action to halt the spread of the virus. Many are now COVID-19 hot spots.
Governors, of course, look to the White House for guidance, and the Trump administration has been inconsistent on the question of masks. Infectious disease experts interviewed by HuffPost said the failure of the White House to put forth a coherent, unified plan to stem the pandemic ― including a nationwide mask mandate ― has had calamitous repercussions.
Of the 10 states with the highest rates of new coronavirus cases per capita according to a White House Coronavirus Task Force report this month, seven do not require residents to wear masks.
“We have an orchestra with all the instruments playing their own notes, and there’s a conductor who is indifferent to what’s going on,” said William Schaffner, professor of infectious diseases at Vanderbilt University School of Medicine in Tennessee. He supports a national mask mandate. “By leaving it to the various states, it has confused the public enormously. Our national response gets an F,” Schaffner said.
In North Dakota, which now leads the nation in new coronavirus cases per capita, Republican Gov. Doug Burgum has refused to implement a mask mandate, saying that he prefers a “light touch of government.” Last week, Fargo became the first city in the state to institute a mask mandate, despite months of rising infections. Overwhelmed by the increase in cases, state health officials are now asking residents to conduct their own contact tracing if they test positive.
“For North Dakota to have its first city issue a mask requirement this late into the response ... it’s just chilling,” said Howard Koh, a professor at the Harvard T.H. Chan School of Public Health, who was assistant secretary of health and human services in the Obama administration.
“I understand that states want to have total control, but these are not usual times. This is the worst pandemic we’ve had in a century,” he said. “Every governor should be following recommended standards, and that’s the only way to prevent transmission right now.”
“This virus is now spreading widely out of the cities into the suburbs and is roaring through our rural counties. That all could have been averted if we had a mask mandate.”
As cases spike, calls for a nationwide mask mandate are getting louder. In an op-ed for The Wall Street Journal on Sunday, Scott Gottlieb, former commissioner of the US Food and Drug Administration, suggested a national mask mandate, writing that “states should be able to choose how to enforce a mandate, but the goal should be to make masks a social and cultural norm, not a political statement.” On Friday, Anthony Fauci, the nation’s top infectious disease expert who has been resistant to a national mandate, told CNN’s Erin Burnett that it might be time to consider one.
A study published Friday in the journal Nature Medicine projects that universal mask use, defined as 95% mask use in public, could save nearly 130,000 US lives through the end of February. Even increasing mask-wearing to 85% could save almost 96,000 lives, researchers at the University of Washington’s Institute for Health Metrics and Evaluation estimated.
President Donald Trump, who has repeatedly downplayed the importance of masks, even after contracting the virus himself, gave a half-hearted endorsement of them in a “60 Minutes” interview that aired on Sunday.
“I feel masks possibly work, but certainly you want to stay away a certain distance, socially distance, etc.,” he told Lesley Stahl. “But I would say a mask works. And I have nothing against masks. And I tell people to wear masks.”
A number of people connected to the White House, including most recently aides to Vice President Mike Pence, have also contracted the coronavirus.
Because of the White House’s distrust of public health experts, masks have emerged as a flashpoint in a bigger debate over personal freedom and public responsibility. For some, wearing or not wearing a mask has become a political statement.
Opponents of statewide mask mandates argue that they are difficult to enforce. If someone doesn’t want to wear a facial covering, they won’t. Others argue that the issue should be left up to city and county governments to handle.
In Tennessee, where cases are rising, Republican Gov. Bill Lee has declined to mandate masks. Instead, he has launched an ad campaign, “Choices,” to promote responsible decision-making by residents. He said he has also encouraged mayors in hot spot areas to enforce their own mask orders. But in the state’s 10 counties with the highest positivity rates, only one has a mask mandate, according to a review by The Tennessean.
Schaffner, who teaches on infectious diseases in Tennessee, said the politicization of masks has had a devastating impact in the state, leading to some mask-wearers being treated with hostility and derision.
“This virus is now spreading widely out of the cities into the suburbs and is roaring through our rural counties. That all could have been averted if we had a mask mandate,” he said.
By contrast, in Arizona, once Republican Gov. Doug Ducey began allowing local jurisdictions to require masks, the rates of coronavirus infection fell.
Although Ducey did not implement a statewide mandate, city and county governments instituted mask mandates that covered 85% of the population. Less than two months later, the state saw a 75% drop in new cases, according to a Centers for Disease Control and Prevention report.
“Mitigation measures, including mask mandates, that are implemented and enforced statewide appear to have been effective in decreasing the spread of COVID-19 in Arizona,” the report said.
“If we could boost mask usage to over 95%, as opposed to the 70% or so where it is right now, that could save many thousands of lives.”
Research out of Kansas shows a similar impact there.
In July, Democratic Gov. Laura Kelly ordered residents to wear masks in public places where social distancing couldn’t be maintained. Around 80 of the state’s counties opted out of the mandate under a state law that allowed local officials to override state restrictions.
Researchers at the University of Kansas found that counties that opted out of the mask order saw a surge in coronavirus infection rates, while counties with a mask mandate saw cases flatline.
“Within three weeks to a month, you really start to see cases flatten in counties that have the mask mandate,” said Donna Ginther, director of the Institute for Policy & Social Research at the University of Kansas. “The mask mandate slows the spread; it doesn’t eliminate it. But it slows the spread by about 50%.”
Her research shows that mask mandates can work even in states like Kansas, where many residents are hostile to government interference.
“You probably have imperfect compliance in those counties with a mask mandate,” Ginther said. “Our results are likely an underestimate of the full effect if you had 100% compliance.”
Koh, the Harvard professor, said it is never too late to leverage the power of prevention.
“We know it works,” he said. “If we could boost mask usage to over 95%, as opposed to the 70% or so where it is right now, that could save many thousands of lives.”
Still, mask mandates are only part of the puzzle, added Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
Despite being months into the pandemic, with more than 220,000 dead and nearly 9 million infected in the US, states remain unable to widely and rapidly test for the virus, trace contacts and isolate patients.
“That’s how you avoid a third peak, by having the ability to intervene very quickly,” Adalja said. “It’s not magic how you fix this.”
The flaws in the US’s handling of the pandemic are too numerous to count, he said. All year, infectious disease experts have gone hoarse repeating the same advice to policymakers, with little change.
“It’s no surprise that we had a disastrous COVID-19 response,” Adalja said. “It’s completely predictable when you look at the biology of this virus and the incompetence of the leadership at both the federal and the state level.”