Background of the Issue
Coronavirus disease 2019 (COVID-19) is a global pandemic, with significant morbidity and mortality in the United States. The spread and severity of this disease have been rising steadily and show no signs of abating. Government responses have involved proactive measures to control the person-to-person virus spread. Initial interventions included border control, quarantine, surveillance, and mass testing to identify and isolate positive cases. The goal was to curb imported cases to manage community transmissions.
Later, governments adopted more measures stringent, such as the prohibition of mass gatherings, social distancing, wearing masks, hand hygiene, and movement restriction, and lockdowns in some countries to minimize the spread of the virus (Wehby, 2020). While these measures have largely been effective in reducing the transmission risk, adherence is low due to a lack of legal force. In particular, positions on community-wide use of face coverings vary between countries and states. In the U.S., initial recommendations for reducing coronavirus transmission did not include mandatory use of facemasks, partly because the asymptomatic infection was not well understood and their supply was limited. With the increasing evidence that asymptomatic and pre-symptomatic individuals can also spread the virus, there is a need to mandate wearing masks in public.
Define the Problem
COVID-19 is a major public health issue requiring urgent interventions to curb community spread. The number of confirmed positive cases and deaths is rising each day, with significant socioeconomic and healthcare impacts. About 14.8 million positive cases have been confirmed in the US, of which 282,000 have died (Wehby, 2020). Despite stringent measures, such as shelter-in-place orders, movement restrictions, and mass gathering prohibitions being implemented, community transmission remains a problem. In Miami-Dade County, phased reopening, which began in May 2020, included strict capacity and safety requirements for businesses and residents.
With the rising transmissions, attention has turned to asymptomatic infections and their role in spreading the virus. Based on CDC data, 20-75% of all cases in America show no symptoms (mild fever and respiratory distress) but are significant subclinical virus shedders (Nogrady, 2020). Therefore, asymptomatic patients may be driving the pandemic in this country. Contributing to the high transmission challenge is the lack of mandates on wearing masks in many parts of the country. Requiring facemasks in outdoor spaces may reduce COVID-19 spread, especially in asymptomatic cases.
Analyze the problem
Globally, measures to combat COVID-19 have included multiple policies to reduce community transmissions. Most governments recommended or mandated face coverings as a preventive measure. However, in the U.S., the wearing of facemasks is a contentious issue in most states, hampering efforts to prevent this pandemic. The debate has centered on their effectiveness in reducing the transmission risk, given that most infected people (20-75%) are asymptomatic (Nogrady, 2020). Reviewing the evidence on the effect of facemask usage on coronavirus mitigation can inform the proposal for the federal mandates.
A recent review found that medical masks could reduce transmission when used correctly and consistently in non-healthcare settings. Face coverings reduced the infection risk significantly, with a stronger link with N95 than reusable masks, p = 0.090 (Chu et al., 2020). Eye protections were also correlated with fewer infections. Another study by Cheng et al. (2020) found a lower COVID-19 prevalence in Hong Kong, which had implemented community-wide mask-wearing, than in nations with no such mandates, including the U.S., Singapore, South Korea, and Spain. The compliance rate was over 96.6% among Hong Kong residents. In contrast, recreational and workplace mask removal was high in countries with significant community transmissions.
Meaning and Findings of the Data
Based on the medical data and evidence above, wearing medical masks in outdoor spaces can contribute to stopping the spread of the virus. The data means that community-wide usage of face coverings limits the release of respiratory droplets containing the virus by asymptomatic people. Further, compliance with guidelines on correct and consistent use contributes to the effectiveness of this measure. The medical evidence from the studies reviewed support public mandates in facemask usage to curb COVID-19 spread.
A key finding that can be drawn from the data is that community-wide masking can break the transmission chain. Infectious asymptomatic individuals are the main drivers of the pandemic. Though they may not show any symptoms, they are active virus shedders. Thus, the incidence of the COVID-19 virus may be reduced when all people, not just those with symptoms, wear face masks. The findings also suggest that the lack of masks in restaurants, bars, gyms, and other public areas allows emitted infectious respiratory droplets to pass to people in close contact.
Recommendations and Help
Given the strong evidence that community-wide wearing of masks can prevent the spread of COVID-19, I solicit your support to sponsor a bill on mandated public usage of face coverings. This non-pharmaceutical measure is a cost-effective measure for flattening the curve and can be used with other interventions for optimal outcomes. I recommend that the bill include a requirement that every individual wears a mask in all public spaces. Further, the face coverings for outdoor use should be only those proven to offer protection against COVID-19 acquisition.
References
Cheng, V. C., Wong, S., Chuang, V. W., So, S. Y., Chen, J. H., Sridhar, S., To, K. K., Chan, J., Hung, I. F., Ho, P., & Yuen, K. (2020). The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. Journal of Infection, 81(1), 107-114.
Chu, D. K., Akl, E. A., Duda, S., Solo, K., Yaacoub, S., & Schünemann, H. J. (2020). Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. The Lancet, 394(10242), 1973-1987.
Nogrady, B. (2020). What the data say about asymptomatic COVID infections. Nature, 587, 534-535.
Wehby, G. L. (2020). Community use of face masks and COVID-19: Evidence from a natural experiment of state mandates in the US. Health Affairs, 39(8), 1419-1425.