Infectious Diseases Organizations Urge Coherent National Face Mask Policy

The Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) submitted a letter to the White House Coronavirus Task Force, addressed to Vice President Mike Pence, advocating for a federal directive to all states calling for mask mandates in public settings.

The letter was penned by IDSA President Thomas M. File, Jr., MD, MSc, FIDSA and HIVMA Chair Judith Feinberg, MD, FIDSA on behalf of their organizations.

The letter argues that a uniform national message on mask wearing is necessary to allow for the safe reopening of schools. Alongside the call for a federal directive to states on masks, File and Feinberg also encourage a public education campaign about the importance of wearing masks or face coverings.

The authors note the need for exceptions if an individual has a valid medical condition or mask requirements are not developmentally-appropriate.

The letter further advocates all individuals in the White House complex wear a mask, “both for their own protection and to serve as role models for our country.”

According to authors, a substantial decrease in COVID-19 cases could spur consumer confidence, bolstering the economy. They cite similar analysis recently provided by Goldman Sachs.

On July 14, the White House Coronavirus Task Force recommended that states with more than 100 new cases per 100,000 population in the previous week should ask residents to wear masks at all times when in public and unable to socially distance, a move the letter highlights as having saved lives.

While a sizable majority of America’s registered voters support a federal mask mandate, the debate has often devolved along partisan lines at the political level.

Given recent national conversations about race and policing in the United States, mixed messaging also leaves public health officials having to balance the potential benefits of widespread masking with a vaguely defined expansion of police responsibilities that has thus far come with variations in clarity for officers about appropriate outdoor enforcement.

Some police officials have even resisted enforcement of such orders.

“Due to the minor nature of the offense, the potential for negative outcomes during enforcement encounters, and anticipating the various ways in which the order may be violated, it would be inappropriate for deputies to criminally enforce the governor’s mandate,” Sacramento County Sheriff Scott Jones, a Republican, said of a California mandate.

However, California Governor Gavin Newsom himself has said that he did not support a punitive approach.

“We’re not looking to fine people. We’re looking to educate people, encourage people,” Newsom said. “And to the extent that people flout and abuse, which may be the exception, then we have many tools in the tool kit."

In addition, an initial mask mandate in Denver, Colorado sparked fears of state overreach, but thus far citations have been limited and concentrated on establishments more than individual citizens.

Danica Lee, director of public health investigations at the Denver Department of Public Health & Environment, said that there are dangers to both the public and law enforcement in targeting individuals. Such encounters may lead to unnecessary escalation in the current political climate.

“Basically, we’re advising taking all the measures you can, short of intervening with individuals, because there were quite a few safety concerns over interactions becoming politicized,” Lee told Vox. “Any time there is a conflict with a patron that looks like it could pose safety hazards, our guidance would be to contact law enforcement.”

Outrage erupted in May when police were seen distributing masks in an affluent white neighborhood around the same time that a black man was recorded being roughly arrested after a dispute with officers over social distancing.

Same city. Same police force.

Passing out masks to white folks not social distancing, while literally having their foots on our necks.

This is beyond ridiculous at this point. pic.twitter.com/pY6kSGVEaZ

— zellie (@zellieimani) May 3, 2020

The officer in the video strikes the unarmed man several times, and is seen kneeling on his neck. The officer has since been taken off-duty, and Mayor Bill De Blasio said that he was disturbed by the video.

An NYPD spokesperson cited “a bag of alleged marijuana in plain view” when explaining the incident. And while the spokesperson cited the citizen taking a “fighting stance,” bystanders reported the confrontation differently.

Ultimately, across partisan lines, it is clear there is not a uniform strategy like that the authors of the IDSA-HIVMA statement propose. And the lack of a unified strategy has likely contributed to these troubling variations in enforcement.

In most Asian countries, mask uptake is not a partisan issue, with past cultural precedent that means the practice arises out of social norms rather than a complex political intervention.

“Clear, consistent messaging from our nation’s highest leaders and trusted health experts is essential to normalize masking as we have normalized other critical health and safety measures, such as wearing seatbelts and bicycle helmets,” File and Feinberg wrote.

The authors write that any mask policy must also be paired with increasing testing capacity and timeliness to allow for better COVID-19 contact tracing. And as clinicians have urged since the beginning, they emphasized that state and federal planners should bolster supplies of personal protective equipment and medical supplies to support the nation’s infectious diseases workforce.