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Face Coverings Could Save 130,000 American Lives from COVID-19 by March

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Wearing a mask
Credit: Diane Baker

The coronavirus disease 2019 (COVID-19) pandemic has already claimed the lives of more than 230,000 Americans, the population of a mid-sized U.S. city. As we look ahead to winter and the coming flu season, the question weighing on the minds of most folks is: Can we pull together to contain the spread of this virus and limit its growing death toll?

I believe that we can, but only if each of us gets fully engaged with the public health recommendations. We need all Americans to do the right thing and wear a mask in public to protect themselves and their communities from spreading the virus. Driving home this point is a powerful new study that models just how critical this simple, low-cost step will be this winter and through the course of this pandemic [1].

Right now, it’s estimated that about half of Americans always wear a mask in public. According to the new study, published in Nature Medicine, if this incomplete rate of mask-wearing continues and social distancing guidelines are not adhered to, the total number of COVID-19 deaths in the United States could soar to more than 1 million by the end of February.

However, the model doesn’t accept that we’ll actually end up at this daunting number. It anticipates that once COVID mortality reaches a daily threshold of 8 deaths per 1 million citizens, U.S. states would re-instate limits on social and economic activity—as much of Europe is now doing. If so, the model predicts that by March, such state-sanctioned measures would cut the projected number of deaths in half to about 510,000—though that would still add another 280,000 lives lost to this devastating virus.

The authors, led by Christopher Murray, Institute of Health Metrics and Evaluations, University of Washington School of Medicine, Seattle, show that we can do better than that. But doing better will require action by all of us. If 95 percent of people in the U.S. began wearing masks in public right now, the death toll would drop by March from the projected 510,000 to about 380,000.

In other words, if most Americans pulled together to do the right thing and wore a mask in public, this simple, selfless act would save more than 130,000 lives in the next few months alone. If mask-wearers increased to just 85 percent, the model predicts it would save about 96,000 lives across the country.

What’s important here aren’t the precise numbers. It’s the realization that, under any scenario, this pandemic is far from over, and, together, we have it within our power to shape what happens next. If more people make the decision to wear masks in public today, it could help to delay—or possibly even prevent—the need for future shutdowns. As such, the widespread use of face coverings has the potential to protect lives while also minimizing further damage to the economy and American livelihoods. It’s a point that NIH’s Anthony Fauci and colleagues presented quite well in a recent commentary in JAMA [2].

As we anxiously await the approved vaccines for COVID-19 and other advances in its prevention and treatment, the life-saving potential of face coverings simply can’t be overstated. I know that many people are tired of this message, and, unfortunately, mask-wearing has been tangled up in political perspectives at this time of deep divisions in our country.

But think about it in the same way you think about putting on your seat belt—a minor inconvenience that can save lives. I’m careful to wear a mask outside my home every time I’m out and about. But, ultimately, saving lives and livelihoods as we head into these winter months will require a collective effort from all of us.

To do so, each of us needs to follow these three W’s: Wear a mask. Watch your distance (stay 6 feet apart). Wash your hands often.

References:

[1] Modeling COVID-19 scenarios for the United States. IHME COVID-19 Forecasting Team. Nat Med. 2020 Oct 23.

[2] Preventing the spread of SARS-CoV-2 with masks and other “low-tech” interventions. Lerner AM, Folkers, GK, Fauci AS. JAMA. 2020 October 26.

Links:

Coronavirus (COVID-19) (NIH)

Institute for Health Metrics and Evaluations (University of Washington School of Medicine, Seattle)

22 Comments

  • Yvette Dulohery says:

    Thank you for your blog. It is vital that we have discussion on the gaps causing continued increases in the spread of COVID-19 and the current pandemic. I am a retired nurse, clinical nurse specialist, and adult nurse practitioner. The health care population is schooled in detail as to isolation procedures, sterile technique, and universal precautions. This has not been promoted for the general public-and I professionally and personally feel this has been an injustice. A similar education focus needs to become a priority for global societies.

    There have been only minimal reports of fit-testing with publication/findings for facial coverings, home-made masks, and masks for purchase. And the information that is available has NOT been publicized to the general public!

    I have personally been sewing masks, and in searching for optimal techniques, there are some recommendations for fabric thread count, not using any needles or decorations that could cause decreases in material integrity, numbers of layers of material, interfacing, nasal bridge wires, chin functioning, mask shape (conical versus flat), pleats or darts, facial contours and fit, and ties or ear loops-just to name a few factors.

    There is no readily available information on use of disinfectant wipes for handwashing compared to hand sanitizer or hand soap. What mode should be used when? For how long? How much hand sanitizer? How saturated do the disinfectant wipes need to be for effectiveness? What is done with disinfecting wipes that are drying out in their containers?

    Once a mask is worn, how can it safely be reused, if at all? What are the laundry recommendations for cloth masks, including water temperature, soap/bleach, and avoidance of using laundry softener? Should the masks be air-dried or dried on hot or sanitize settings? What of the individuals who wear masks below their nose? Can a mask be withdrawn from the face and reused? What contaminants are on the exterior of the masks? When masks are removed, how should they be stored prior to reuse or laundry? What of the masks that are used, folded, placed in a pocket or purse, and then brought back out for reuse? Even health care facilities are requiring masks to be worn, but there is no stipulations as to prior use. Can masks be worn into a public place and then worn in a person’s vehicle? And can that same mask be worn into the next public place?

    What are the handwashing recommendations during mask removal? When should handwashing be done in a public place, after touching something or someone, or before/after touching a mask that is being worn?

    We in healthcare ASSUME that others have the same/similar basic processes as we maintain. There are so many questions that remain unanswered, and the continued spread of COVID-19 is a testimony to the lack of a cohesive mechanism to take those questions and instead of merely tracking, we need to identify the causative issues and change our processes.

  • Steve White says:

    I strongly suspect the epidemic would be over if we had pursued a very aggressive vaccine development program with human challenge testing. There were vaccines being tested in animals, and reportedly working, in March or April.
    We were told for months, early on, not to worry about face masks, by public health officials in the US, not partisan appointees, but the long term people – so I am not very happy on both those counts.
    I also believe, after it was clear the death rate for people under 30 was very low, we should have gone for herd immunity in that group by having something like the CCC, where the young people enrolled and infected each other and were not let back out until undergoing quarantine, where appropriate. The long term public health people opposed allowing young people to get infected, which, done too haphazardly often put old folks at risk (ie, party in Spring Break then go home and so see Grandma and Grandpa), but done correctly would now mean most of the spreaders would be immune.
    It does look like a lot of people will die in the next few months.
    I feel frankly let down by everyone – i feel our Federal Public Health regulatory people were very hidebound and obstructed vaccine development, like they are said to obstruct a lot of medical progress, with excessive concern for safety, Maybe one can say, if Trump and all Americans listened and been as careful as possible, the advice given would have saved us. Given the realities, which were clear in April, they needed better plans.

  • Andrew says:

    Since mask wearing will probably continue for quite a while, I would like to see more masks rated for particle filtering efficiency. It can be voluntary and certified masks would command a higher price, but having worked in environments with airborne particulates, solvents or strong odors, I always took comfort in knowing that my protective respirators were meeting government or industry standards and not just that they contain three layers of fabric or can accomodate filter inserts. I suspect the growing list of mask options have filtering efficiency ranging from near-N95 levels to nearly worthless and are purchased as much for looks as for quality.

    • Chris says:

      Concur! And baseline such studies by clearly stating the assumed efficacy of the masks. If the study assumes everyone is wearing properly fitted N95’s, then it’s not particularly useful.

  • John H says:

    Real world evidence (RWE) should really be considered rather than just focusing on random controlled trials.(RCT). While it is the focus of the NIH to support researchers in academic positions, for the sake of humanity please consider real world evidence. two examples. Taiwan’s actions with COVID19. There has been 7 deaths in a country of 23 million because they learned from real world experiences of the SARS epidemic a few years earlier. Wear a mask to stop the spread. Just like scrubbing before surgery, there was no RCT just RWE. Common sense observation and action. The opioid crisis is the second example. The DEA/FDA considers the pharmacy the end user of opioids not the patient. All policies, all lawsuits, all science has been directed upstream all the way to the opioid manufacturer, the pharmacy, and the physician. Opioids are triple locked in hospitals and dispensed under active control by nurses. There are no rules when patients take at home. Let’s use common sense and technology to extend the safe dispensing of opioid in the hospital to the home. RWE is in WorkComp. Opioid related claims dropped from 60% to 25%.

    The opioid crisis is 20 years old with double digit increases in the overdose death rate. I stepped away from medicine to devote the rest of my career to fighting the opioid crisis.When I make presentations about prevention, the response I get is that “we will take it into consideration”. How much funding will the next RCT get while 130 people die a day. Our country spends $696 billion per year to treat opioid use disorder and cover loss of worker productivity. Let’s not do the same thing over and over again and expect a different result. Let’s look at RWE as a potential path to solve real world problems.

    • Steve White says:

      I understand you are trying to help people, but if we are spending $700B per year to combat opioids, I would like to see that stop. I seriously question the paradigm of dragging everyone down for the sake of a small number of people who are not helpless victims – it’s not like they got some rare form of cancer suddenly and need expensive treatment for that. Can we develop drugs which get them high but have lower risk of death from overdose, and all other side effects? Maybe spend a few billion on that.
      I do not mean to offend but it seems like way too much is put into trying to make people not harm themselves. And also, as a normal person, the restrictions are too burdensome. I know someone who gets bad colds and he needs cough medicine for them – every year – one big bottle – every YEAR – but it is a big hassle, and now nearly impossible, to get cough medicine – because it can make you high – A big bottle would get someone high, I don’t know, maybe ten times – I do not regard it as worthwhile to deny it to everyone so some people do not get high, which is effectively what has happened.
      I also object to a drug company being fined billions for selling a legal product – how about the AG’s who brought suit fine themselves for not properly enforcing the law?
      Please consider leaving people alone to screw up and even die if that is what happens when you let them be free.

      • Jessica Ybarra says:

        I’m not going to get into too much detail, but having worked with an Addiction Specialist/Family Practice doctor, I can say that roughly 75% of his “addiction” patients became addicted to opioids after some type of injury and/or surgery not because “they wanted to get high” or “hurt themselves”. Also, their pain management doctor wasn’t “managing” their pain, or addressing the fact that just like anything else, our bodies start building a tolerance for any substance and will require more. Proper management of ANY controlled substance can greatly reduced the opioid crisis we are seeing today.

        • Steve White says:

          I realize people got addicted after injuries in many cases, but I still do not want to spend $700B to end something which is voluntary. To be honest, I very much doubt that is a true expense – but, who knows, it could be. A heck of a lot of money even if they faked up the numbers by a factor of 10. You can not divert all expense from some things to other things, on paper maybe but not in real life, but I can think of a lot of good stuff we can do for half of that. Heck, I can fund renewable energy research, or a massive zoonotic disease warning and crash treatment/vaccine effort for about 1/20th of that probably. $35B ought to hire says 35,000 people and pay all their lab costs, at $1M per year. Or buy 35M genetically engineered lab rats for all kinds of medical research. People with dementia or autism can be tracked for about $1 per day – spend 1% of what this piece says is the cost of fighting opiates, $7B, and track about 20M people at about $1 per day per person. Everyone who needs it.
          Also, can we get cough medicine when we need it? The measures taken against drugs which get you high are just too burdensome, which is really silly when you consider marijuana has now been allowed in such a large part of the country. I realize it does not cause fatal overdoses, but as far as youth being messed up by drugs, we have plenty of that even if people can not buy cough medicine and painkilers when they need them. It is a lot easier to get weed and booze probably.
          My Dad used to have a rant about everyone being denied things because of a few fools, and that problem has only gotten worse and worse with the increasing nanny state.

  • Alexander Ramig says:

    Could you comment concerning the reliability of Covid death data you reference. Thank you.

  • Will Sawyer says:

    Yes Full face coverings(Health Shield) WILL save lives and stop this Pandemic. But nose-mouth masks alone will not! Remember the eyes, nose and mouth (T Zone) are THE portal of entry for COVID-19 and ALL other respiratory infections! I have been teaching and preaching this for 15+ years since SARS!
    It is time for people to put on a Full face shield and protect yourself from droplets, aerosols and your fingers (10 most deadly weapons) …

  • Suhaina says:

    I ‘m interested in seeing more masks appreciated for particle filtering efficiency, as wearing masks would likely last for some time. Although it is likely and approved masks can be more costly, I have taken precautions to ensure that my respiratory protections follow public or industrial requirements where particulates, solvents or heavy odors have been used by airborne and not just three layers of cloth or filter inserts can be integrated. I suppose that the increasing list of filtering choices, from nearly N95 to nearly useful, is correct and looked after.

  • Steven Hogg says:

    Do I understand Dr Collins correctly that he is recommending wearing a face coverings at all times when not in the home or seated for consumption of food or drink? While I understand risks are much less in the open air, it does strike me that there are still risks associated with only wearing face coverings indoors, not least the extra risk of virus transmitting to the hands each time one is put on or taken off.
    I also understand that a face covering principally protects others from the wearer should the wearer be infected but pre-symptomatic or asymptomatic, and reducing the amount of virus exhaled to non-viable levels to cause infection is the aim.
    I have been thinking for some time that extending the requirement to wear face coverings would seem sensible, and a less severe measure than any form of lock-down. It seems odd that more severe methods have been introduced (I live in the UK, just entering ‘a lock-down’ again today) but not this simple measure. We just have face coverings must be worn indoors or on public transport.

    • Andrew Goldstein says:

      Yes, and I have recently noticed the availability of higher quality NIOSH N95 masks from companies like 3M and Honeywell, albeit at a 5 – 10x premium over non-N95 masks. Government help in lowering the cost of effective masks should be a priority, certainly as soon as data come out showing a significant reduction in infections among people wearing properly fitting N95 masks, just as frontline health workers are hopefully doing.

  • Jeanne Waggoner says:

    Where can I get a mask with the NIH logo on it?

  • Marie L. says:

    Now that so many are infected I wonder when I see someone without a mask if they had covid and think they are immune and don’t need to wear a mask anymore? I wear my mask when I get out of my car to go in a store and take it off after I get back in the car. I am careful to avoid touching the outer layer, these are the blue surgical masks. I lay it face up on my dashboard for the UV and Florida heat to sterilize it and then reuse it next time I go out. I do not wear one in my house or yard and only if someone shows up at my house do I put one on. Is this a safe practice? My friends all remove their masks the minute they step out of a store and only put it on upon entering the store. Is that risky and unsafe? I think the proper information on my questions should be told every night on News programs, along with whether cloth and homemade masks are giving a false sense of protection.

  • Morgan Falk says:

    If others are in sight, I wear a mask outdoors. I always wear a mask everywhere but at home where I live only with my husband. I would like to see more research on the ABO issue as well as autoimmune disease sufferers susceptibility. More on immune systems ability to fight based on childhood disease. AND MORE ON THE mutations that are bound to happen if non mask wearing continues.

  • Suhaina M says:

    For that very beautiful reading, I want to thank you! I definitely loved and enjoyed it.

  • ybs says:

    Precautions should be taken with masks and distance, correct mask use saves lives.

  • Lisa Hughes now Wilhelmi says:

    I just read an article in NIST (November 2020) which illustrated how masks with an exhalation valve do NOT work to prevent the spread of the COVID. Apparently the valve (bottle cap sized disc) lets the air out, for which it was designed, so that it provides a release of ones own air outside the mask maintaining safety and comfort for the wearer working in the HAZMAT industry. COVID is NOT hazardous it is deadly and one must be aware of this distinction when donning and doffing personal protection equipment (PPE:)

  • COC says:

    It’s very useful information. Thank you.

  • W.S. says:

    Questions for Francis and the public to answer, please: And anyone on thisnthread.
    Does your physician teach you that the eyes are a portal of entry for COVID-19?
    Have you heard the clear message that the eyes are a portal of entry in the media enough?
    Do you understand that face shields are a face cover? There is a lot of misinformation on that issue.

    Face shields are a very effective way to protect your eyes! Have you experienced the benefit when you wear a face shield?
    I am concerned that the general Public is not aware of the benefit.
    Thoughts and feedback requested.

    • Steve W. says:

      W.S. – I am not a doctor or scientist, but I have developed my own equipment based on my belief using hoods – or call them helmets,- a complete head covering so that any air coming in would have to come up from underneath the edge of it – would help a lot.

      Personally, I have built a crude looking total head covering, which I wear with an N95 mask when going to stores. Now that the virus seems to be reaching its peak spike in my area and somewhere around 2 or 3 % of the public may be contagious – go in ANY store, any time, and you might get infected from airborne virus. Every store will have an infected person in it – probably often more than one.

      I took a face shield used to protect the face while using power tools, which had zero protection except for the front of the head – just the face and not even the side of it very much – and taped plastic all around it, so that it is totally air proof now. No air can get to my face except from under the edge of the mask – just like you put a bucket with no leaks on your head, except there is a way to see out. I cover the edge of the soft plastic with other clothing, so it is tucked under my shirt for example.

      In this way, I am using my clothes as my air filter – though obviously a cotton shirt is not a great filtering material, all the air reaching my head has been slowed down a lot, meaning particles and droplets have a chance to get stuck in the cotton – whereas the air speed through a face mask is very, very high, this air is barely moving. I can breathe just fine – there is so much material, this makes no impediment to air flow.

      Although the 6 foot social distancing rule has been criticized and probably rightly so, as inadequate, still SOME virus ought to fall out rather than get to my face.

      Who knows how much, but probably this is better than the N95 mask alone.

      Even without a mask of any type underneath, it might be good enough to replace face masks used after “”Face masks required” mandates which do not specify WHAT face masks. It could be better than really crappy material masks worn far, far too loosely, or worn off the nose – It would be hard to wear a ” whole head” as badly as so many people routinely wear masks. And some people have mask phobias – or, young children will NOT get it right, and would probably wear a Star Wars, or Spiderman or Iron Man helmet – and so on.

      I do not know of strong evidence any of this is effective – no one seems to have researched it, even to the extent of computer modeling. Just one of many example of medical establishment not being capable of flexibility or creative solutions.

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