Call for standardized criteria for mask mandates based on objective data
Throughout the COVID-19 pandemic, mask mandates have been met with confusion, disagreement and a lack of knowledge about the risks and benefits. Health and legal experts are calling for a move toward an evidence-based approach to instituting masking policies.
In an article forthcoming in the University of Dayton Law Review, the authors from Regenstrief Institute, the U.S. Department of Veterans Affairs, Indiana University School of Medicine, Brooklyn Law School and the University of Iowa propose applying five criteria to signal that a communicable disease poses significant risk to public health. Once those criteria are reached, local, state, and federal governments should introduce mask-wearing mandates.
“The creation, implementation, and enforcement of mask mandates have varied widely at all levels of government during this pandemic,” said author Michael Weiner, M.D., MPH, Regenstrief research scientist, director of the VA Health Services Research and Development Center for Health Information and Communication and professor of medicine at Indiana University School of Medicine. “This inconsistency has created many questions, doubts and frustrations. We believe that decision-making surrounding these policies needs to be more structured and objective.”
Face masks have been shown to protect both the people wearing them and the people nearby, decreasing the spread of infection. However, clear and justified criteria for requirements to wear masks indoors do not exist.
The authors proposed five criteria for mandates, with average seasonal influenza during 2010–2019 as a point of reference. They chose flu because the disease’s longevity has yielded common and accepted practices over many years. The five suggested data points are:
- Contagiousness (R0 or the speed at which the disease spreads)
- Vulnerability of communities to infection (rate of growth in the percentage of the national population that is infected)
- Harm caused by the disease (cumulative deaths per week)
- Severity of harm (infection fatality rate)
- Direction of harm (percentage change in cumulative deaths per week)
Each criterion would be scored, and once the combined score becomes higher than that of seasonal influenza, masking policies would be put into place.
“There are many details to be worked out with this proposal,” continued Dr. Weiner. “But our goal with this article is to generate conversation so that when our country is facing this type of public health crisis, we are ready to make policy decisions based on data.”
“Index-Based Policy to Guide Mask-Wearing for SARS-CoV-2 and Other Pandemic” is available online ahead of print.
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