Holiday goers across the country during the Memorial Day weekend, in places such as the Lake of the Ozarks in Missouri; Ocean City, Maryland; and beaches across the Southeast, seemed without a worry in the world. Booze and hugging in cramped pools were far more common than masks and social distancing. The images may have seemed shocking, after weeks of quarantine, but the scenes like these will only increase as the forecasts grow ever warmer across the country.
To guard against a sooner-than-expected resurgence in COVID-19 cases, as they open up their economies, governors across the country must institute mandatory mask policies in public places immediately. Virginia's Democratic Governor Ralph Northam issued just such an order this week. (Massachusetts, Maine and Utah have also issued similar orders, along with a handful of others).
We can’t – and shouldn’t – expect good Samaritans or fellow customers in retail stores or restaurants to compel mask-rebels to comply with a mere recommendation. We should, however, expect all citizens to comply with the law; and if they don’t, experience consequences. The killing of a security guard in Michigan trying to enforce a mask policy single-handedly at the entrance of a Family Dollar store in early May was early, immediate, evidence enough that we need strong leadership on this issue. The violent scene at a Los Angeles Target over a similar policy just weeks later should have been the last straw. Summer is coming, and with it vacationers and vacation time. Holidays shouldn’t be taken in peril. But to avoid disaster, mandatory masks in public places are needed urgently, across all 50 states. It should not fall upon store security to enforce what should come from each state’s executive office.
Why governors? Since President Donald Trump and Vice President Mike Pence have taken pains to outright defy any guidance on masks, including arrogant spectacles like the VP’s no-mask visit to the Mayo Clinic last month, which defied both hospital policy and potentially put patients and staff at risk, the responsibility to institute this policy will fall on governors nationwide.
A masks-for-all policy would be a mandate rooted in a growing body of compelling scientific evidence that even during normal conversation, speakers emit droplets of saliva that can easily spread COVID-19. Researchers from the National Institutes of Health recently used laser light-scattering technology to demonstrate that normal speech emits thousands of oral fluid droplets that can persist in the air within a closed environment for up to 14 minutes. Since many people with COVID-19 do not demonstrate symptoms, and especially since testing remains largely accessible to only those who have symptoms, we have the makings of a perfect storm as states open up: asymptomatic, unmasked, COVID-19 carriers potentially transmitting the disease to those nearby just by talking; or by singing, such as in places of worship. And computer scientists from the University of California, Berkeley, recently modeled that if 80 percent of the U.S. public wore masks now, COVID-19 transmission rates would decline 12-fold.
There are also persuasive signals out of East Asia, where mask use is almost a cultural feature of daily life, on the critical importance of widespread mask adoption by the public. Researchers from Hong Kong observed that nearly 97 percent of its population complied with public guidance on masks while enjoying a COVID-19 incidence rate that’s 10-fold less than the United States. Remember, Hong Kong is but a few hundred miles away from the initial COVID-19 epicenter of Wuhan, China, and yet somehow escaped its worst impacts. Correlation should not suggest causation, but in a world in which we need every assist we can get against an unseen threat, we shouldn’t even be debating masks as a common-sense public health policy.
A mandatory mask policy should compel states to issue penalties as enforcement. Think that’s unrealistic? Consider the fines levied if people chose to smoke cigarettes indoors, particularly in places such as restaurants, retail stores, workplaces and bars. For example, if you light up outside of designated areas in Illinois, you face a fine of at least $100. Twenty-seven states have enacted comprehensive smoke-free laws that mirror this type of enforcement. The other 23 have weaker restrictions, but there are guardrails on where you can and cannot smoke in nearly all jurisdictions nationwide. The reason is clear: exposure to secondhand smoke is a clear risk factor for early death and disability to nearby nonsmokers. Our visible approach to banning indoor smoking -– including signage everywhere, enforcement against rule breakers, and the social opprobrium of peers -- promotes herd thinking and broad acceptance. Imagine the momentum for a universal mask policy if Trump modeled good behavior and actually wore one in public instead of constantly undermining the policy every chance he got.
If the long-term risks of secondhand smoke is enough to compel states to enforce smoking bans, masks should be an obvious step. Who could possibly want someone breathing on them in close proximity, without a mask, having no clue whether they may or may not be infected with COVID-19? Every elevator becomes a land mine, every retail experience potentially disastrous.
Smoking may now be widely understood to be a health risk. But it has taken nearly a half-century for the United States to move strongly against cigarettes, and many millions died unnecessarily in the interim, because of a lack of leadership and the political will to act. We cannot afford a similar delay on masks in the setting of this pandemic. Effective action in this case requires urgency; there is no time to hear both sides of the debates and usher the nonbelievers along.
Of course, not smoking, and not starting to smoke, is now cheaper and easier than ever before. Wearing a mask, on the other hand, is a proactive act.
No one enjoys the act of wearing a mask, it chafes skin, can be frightening for young children to see, and fundamentally is intrusive to the social intimacy that fuels our way of life and our sense of personal freedom. And yet, these are trivialities when considering the benefits of a mandatory mask policy. If everyone wears a mask today, this week, this month, this summer, we can more confidently re-emerge from shelter again and re-engage in person as we work together toward longer-term solutions for this pandemic. After all, what’s more inconvenient: Being on a ventilator or wearing a mask?