More widespread wearing of face masks could prevent tens of thousands of deaths by COVID-19, epidemiologists and mathematicians project.
A model from the University of Washington's Institute for Health Metrics and Evaluation shows that near-universal wearing of cloth or homemade masks could prevent between 17,742 and 28,030 deaths across the US before Oct. 1.
The group, which advises the White House as well as state and local governments, is submitting the model for peer review, says Theo Vos, Professor of Health Metrics Sciences at IHME.
Another projection developed by researchers at Arizona State University in April showed that 24–65% of projected deaths could be prevented in Washington state in April and May if 80% of people wore cloth or homemade masks in public.
These projections shed light on the promises face masks might hold as COVID-19 cases surge in some states and more local authorities mandate the wearing of face masks.
Texas is now mandating face masks in public in most of the state; Jacksonville Fl, host city of the Republican National Convention in August, mandated wearing face masks in public and indoor locations where people cannot otherwise social distance on June 29.
Republican leaders including Vice President Mike Pence, Majority Leader Mitch McConnell, Tim Scott of South Carolina, Lamar Alexander of Tennessee and Marco Rubio of Florida, have joined public health officials urging the public to wear facemasks. Dr. Anthony Fauci and members of Congress appealed to the public to wear face masks in a congressional hearing Tuesday. And President Trump, in a change of tone, told Fox Business on Wednesday he's 'all for masks.'
But public health professionals lament that trust in face masks is hampered by the government's earlier recommendation against them.
Fauci told TheStreet mid-June that he did not recommend face masks at the beginning of the outbreak to conserve supplies for healthcare workers. On Thursday Fauci told NPR that the administration's initial ambivalence towards face masks was 'detrimental in getting the message across.'
Benjamin Cowling, Professor and head of the Division of Epidemiology and Biostatistics in the School of Public Health at the University of Hong Kong, has studied effects of face masks for ten years and co-wrote a commentary in The Lancet advocating more face mask usage in March. He says while he understands the authorities' desire to preserve supplies for medical workers, the messaging made the public distrust masks.
"Few months ago, medical experts were saying that they don't work and you don't need them. And now suddenly, without any change in the evidence base, they're suddenly saying that they do work and you should wear them." Cowling says, 'I think that that's unhelpful.
Mask adoption in the US has been uneven. A survey from the data collection firm Premise shows that the percentage of people who 'always wear a mask when going out' ranges from 15% in Tennessee to 62% in Massachusetts as of June 19.
For both ASU and IHME's models, the proportion of deaths face masks could prevent differs from location to location and during different stages of the pandemic because transmission rates in the community at the time of projection affect outcomes.
In ASU's model, widespread community transmission would call for more effective face masks - for example, the surgical masks used in hospitals - to significantly reduce the number of projected deaths. But in places where transmission is not as widespread, most people wearing simple cloth masks would be able to prevent a significant portion of deaths.
In IHME's model, the more people each infected individual can spread the virus to, the more deaths masking can prevent. It also projects that the virus would follow seasonal patterns and pick up again in the fall. Vos says this means places that have relatively safe levels of the spread now could see more pressure to contain the virus later.
"The use of masks...in those places is going to become a lot more marked and beneficial." Vos says.
Regardless of community transmission rates, both models show that the more universal face masks are worn, the more deaths can be prevented.
It's difficult to know whether the projections are correct because it's difficult to know how the public is actually wearing masks. But considering that research on face masks show that they can tamp down transmission, modellers agree that they should help save lives when worn by a large portion of the population.
"Clearly, clearly the data shows that every model and study that we have seen, every public health policy in the world has said exactly the same thing," says Abba Gumel, who led the ASU project, 'We have to wear a face mask.'
MARY LOUISE KELLY, HOST:
Someday when we sit down to write the history of the coronavirus pandemic, this week may be the one we point to and say that, that is when the tide turned in this country on masks.
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VICE PRESIDENT MIKE PENCE: Wearing a mask is just a good idea, and it will slow the spread of the coronavirus.
JEROME ADAMS: Please, please, please wear a face covering when you go out in public.
MITCH MCCONNELL: We must have no stigma - none.
KELLY: That is Senate Majority Leader Mitch McConnell, Surgeon General Jerome Adams and Vice President Mike Pence all speaking over the past week as coronavirus cases have exploded. The U.S. is now recording more than 50,000 new cases a day - 50,000. Businesses that had reopened are shutting down again, hence the growing chorus of voices calling on Americans to embrace this cheap, low-tech, simplest of weapons in the fight against the virus. So will Americans finally listen? And how much can masks help?
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PRESIDENT DONALD TRUMP: OK. Thank you very much everybody.
KELLY: It was three months ago today that the CDC started encouraging Americans to wear cloth masks. Here's how President Trump delivered the guidance.
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TRUMP: The CDC is advising the use of nonmedical cloth face covering as an additional voluntary public health measure. So it's voluntary. You don't have to do it. They suggest it for a period of time. But this is voluntary. I don't think I'm going to be doing it.
KELLY: A lot of Americans weren't doing it. That April 3 guidance followed weeks and weeks when Americans were actually told not to wear masks. They were in short supply and the CDC said face masks should be worn only by people showing symptoms of COVID-19 and their caregivers and, most crucially, by health care workers. If you Googled, should I wear a mask, back in February or March, you'd turn up article after article explaining the CDC reasoning. Surgical masks are not tight fitting, so they don't prevent you from inhaling virus particles and wearing a mask could lead you to touch your face a lot, increasing the chances of spread.
On February 29, Surgeon General Jerome Adams tweeted, quote, "seriously people stop buying masks. They are not effective in preventing general public from catching coronavirus." Well, this week, I asked Anthony Fauci about that tweet. Fauci is the top infectious disease doctor at the National Institutes of Health. And I pressed him, why were we told that masks don't work?
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ANTHONY FAUCI: Well, you know, it was I think a lot of confusion about what you mean by work. I think what was really I think miscommunicated was that they are not perfect. It isn't like there's a 100% protection.
KELLY: Dr. Fauci acknowledged that mixed messages from U.S. officials have made it harder to convince people to mask up now. I was still curious how much was known, how much research was there early on in the pandemic on whether face masks work. Ben Cowling is an infectious disease epidemiologist at the University of Hong Kong. He has studied masks for more than a decade. He told me there really isn't a lot of good research out there, not the kind of big randomized trials considered the gold standard in science.
BEN COWLING: In the past, it hasn't been a very sexy topic to do research on. It hasn't been a very hot topic compared to research on vaccines or antiviral drugs, as you can imagine.
KELLY: Of course, there has been some research. Last year, Cowling started work for the World Health Organization looking at which interventions would help in a flu pandemic. And here's what he found about surgical masks.
COWLING: There's a lot of good mechanistic evidence that face masks should do something. They block stuff in the air you breathe in and the air you breathe out. They act as a filter. But the trials that have been done in the community have mixed results. There haven't been very many very convincing trials of how well face masks work for influenza.
KELLY: Still, Cowling says, the findings were convincing enough to draw up some recommendations for the WHO.
COWLING: What we decided to recommend was in a mild influenza pandemic, maybe there's no need to think about face masks. But in a severe influenza pandemic, something like what happened in 1918, we should be recommending face masks. We're not 100% sure that they will do a lot of good, but we're pretty confident they'll do some good. And we need all the help we can get. And actually when we come to COVID, it's in some ways like a severe influenza pandemic.
KELLY: So was it obvious to you, when you first started hearing about this coronavirus, masks are probably going to be a good idea? They probably will do at least some good in trying to control the spread.
COWLING: Yeah. And that's what I've been saying from the very beginning going back to January, February, that masks should do some good. But we can't expect them to be the only intervention that's needed because they're not perfect. And the trials that have been done have modest effects. But we shouldn't let the perfect be the enemy of the good.
KELLY: Ben Cowling of the University of Hong Kong. So to our central question, how much might masks help going forward, among the people trying to figure that out is Abba Gumel. He's a mathematician at Arizona State University. He develops models to study how diseases spread and how they can be controlled. With coronavirus, the models indicate that all the things we've been hearing about, like social distancing and hand-washing and staying home when you're sick, they're important, but Gumel says masks, they're paramount.
ABBA GUMEL: Until we get a vaccine and therapeutics, the only thing we have going for us, the only way, the only hope we have to at least mitigate or to manage this pandemic is wearing a face mask, No. 1. It's all about masks, mask and mask.
KELLY: This spring, Gumel and his colleagues looked at New York. New York City was then the epicenter of the pandemic. By April, more than 700 people across the state were dying of COVID-19 every day. Their model showed that if 80% of people were to wear masks that were moderately effective, such as medical-grade surgical masks, 17% to 45% of deaths could be prevented over a two-month period.
GUMEL: So that's a huge, huge projection.
KELLY: Those are huge numbers, particularly if you stop thinking about the statistic and think about just the number of actual people that that represents.
GUMEL: Exactly. Actual people dying - we can prevent this.
KELLY: So let me turn us to this moment. We are now in early July. You have noted that a delay in widespread mask wearing can undermine how effective it is, that it would have been better if early on everybody had worn a mask. Now that we're here, it's July 3. Is it too late for the U.S.?
GUMEL: Oh, no, it's not. I mean, in fact, we have projections. It's absolutely not too late.
KELLY: In a new paper that Abba Gumel is just about to submit for peer review, he has another model, also with eye-popping numbers. It finds that if 50% of Americans - so just half of us - wore medical-grade surgical masks starting now, more than 30,000 deaths could be prevented by early December. Other models offer different numbers. Researchers at the University of Washington asked what if almost all of us, 95% of Americans, were to adopt cloth masks? In that scenario, they project as many as 28,000 fewer deaths between now and October 1. Gumel acknowledges the models are only as good as the assumptions put into them. Still, he says the consensus is masks help, and any mask is better than no mask.
GUMEL: Every public health policy in the world has said exactly the same thing. I have not seen one public health person of record - or clinician or virologist or mathematical model who would not say the same thing.
KELLY: As you know, there is a huge debate raging over the politics of wearing masks. You see zero debate. There is zero question in your mind how much this would help.
GUMEL: Absolutely. There's just - it's not - why is it - I'm trying to protect myself from getting infected and also protect other people from getting an infection from me. There's no politics whatsoever.
KELLY: There's always politics. But this week, even President Trump softened his tone in an interview on Fox Business.
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TRUMP: I'm all for masks. I think masks are good. I would wear - if I were in a group of people and I was close...
BLAKE BURMAN: You would wear one.
TRUMP: Oh, I would - I would - oh, I have.
KELLY: Meanwhile, more and more Americans will soon face a choice - mask up or pay up. Yesterday, Republican Governor Greg Abbott of Texas ordered a statewide mask mandate, one of a growing roster of state and local leaders pinning their hopes on face masks to save lives and to save America from shutting down again. Transcript provided by NPR, Copyright NPR.