More states are now mandating wearing masks in public as coronavirus cases surge in the Southern and Western United States.
As cases surged in the Golden State late last week, Gov. Gavin Newsom made it mandatory for Californians to wear masks in public. This week, the governors of Nevada, North Carolina, and Washington followed suit as infections increased in their states.
But public health experts say it may not be enough.
“I think the answer is still really simple. Masks, hand-washing, and social distancing,” said Dr. Georges Benjamin, executive director at the American Public Health Association. “And [states] are going to have to slow down or pause their reopening activities.”
The governors of both Utah and Oregon paused the reopening of their states’ economies June 11. On Thursday, New Mexico and Texas did as well. Gov. Michelle Lujan Grisham announced that New Mexico will not be entering phase two of its reopening, which would permit bars, theaters, and non-tribal casinos to resume operations.
Gov. Greg Abbott stopped any further phases of reopening businesses in Texas and suspended elective surgeries in hospitals to preserve bed space for COVID-19 patients. Abbott has also recommended wearing masks but has thus far not allowed local governments to require residents to wear them in public.
Nevertheless, counties have found a loophole in Texas law that enables them to mandate businesses require employees and customers to wear them on-premises. Ten counties have used that loophole.
More and more studies find that wearing facial coverings is effective at reducing the spread of viruses. A recent study in Nature Medicine found virus particles in 30-40% of breath samples of infected people but no particles in those who wore a surgical mask. States that mandated masks reduced the daily spread of the coronavirus by 2%, averting an estimated 230,000–450,000 infections, according to a study in Health Affairs.
Of the 21 states that have seen record increases in virus cases over the last two weeks, only California, Kentucky, New Mexico, and Oregon have statewide requirements for all residents to wear masks in public. Public requirements in Nevada, North Carolina, and Washington take effect Friday. Most states do require employees of certain businesses to wear masks, and many allow local governments to impose such requirements.
Pressure is mounting on other states and localities to mandate masks in public. In Alaska, Anchorage Mayor Ethan Berkowitz is preparing to issue an emergency order mandating masks be worn in public if his city continues to see a rise in infections. Nine mayors in Texas, including those of Dallas, Houston, and San Antonio, have signed a letter to Abbott, urging him to allow local governments to impose mask requirements. Arizona Gov. Doug Ducey recently gave cities in his state that authority, and many have exercised it, including Phoenix, Tucson, and Scottsdale.
Still, that may not be sufficient to halt the resurgence of the virus.
“I think face masks will help to reduce transmission, but I don’t think we can rely on them as the only measure to stop transmission,” said Ben Cowling, professor and head of epidemiology and biostatistics at the University of Hong Kong’s School of Public Health. Cowling, also the lead author on the Nature Medicine study, added, “I think measures to prevent larger outbreaks — super spreading events — would be particularly useful. These could include person-density limits on bars, gyms, and leisure facilities and encouragements or incentives to hold more activities outdoors.”
Whether states will reimpose stricter limits on businesses and public facilities or perhaps even consider new stay-at-home orders remains to be seen. On Wednesday, Oklahoma City Mayor David Holt said that if cases continue to increase, he would have “little choice but to roll back to earlier phases” of the city’s reopening.
Some experts worry about the public’s response if more states and localities don’t at least take action on masks.
“I would be concerned about what I would call unmandated stay at home, which would occur if the public loses trust and is afraid to go out because COVID-19 is rampant in the community,” said Dr. Marissa Levine, a former state health commissioner in Virginia and current director at the Center for Leadership in Public Health Practice at the University of South Florida. “This would be much harder to recover from than a mandated stay at home since it is unclear what would need to happen to restore trust.”