Wearing Masks in Community Settings During COVID-19

ACP Chapter Action Tool Kit

Prepared by ACP’s Division of Governmental Affairs and Public Policy

September 2, 2021

Summary

As of September 2, 2021, there have been roughly 39 million confirmed cases of COVID-19 in the U.S. resulting in over 638,000 deaths. According to the Centers for Disease Control and Prevention (CDC), 52.6 percent of the total population is fully vaccinated and 61.9 percent of the total population has received one vaccination. As cases of COVID-19 continue to increase nationwide, further compounded by the highly transmissible delta variant, there is an urgency to undertake bold measures to limit the spread of the disease until a significant portion of the population is vaccinated. The universal use of personal face masks that cover the mouth and nose is one of many measures necessary for achieving epidemic control, particularly given the current understanding of asymptomatic spread. Adoption of masks on a large scale, when combined with other infection control measures (physical distancing, hand washing, staying home when ill), can reduce transmission risk of COVID-19.

Current COVID-19 vaccines that have received U.S. Food and Drug Administration (FDA) approval or emergency use authorization (EUA) have been found to be safe and effective in preventing severe complications from COVID-19, including hospitalization and death.  However, it is important for the public to continue to follow all prevention and control measures, including the use of face masks to curb the spread of COVID-19 and its variants (specifically, the Delta variant), until sufficient vaccine-induced population immunity is achieved. While the current vaccines are effective at preventing symptomatic illness and severe disease, it is unclear if they are effective at preventing transmission of COVID-19 and its variants. In addition, hesitancy and public attitudes towards vaccines may further hinder the ability to achieve vaccine-induced population immunity while certain at-risk populations may not be eligible to receive the vaccine until it is further studied. Face masks have proven to be an easy and effective tool for preventing the spread of the virus.

Federal Action on Masks

In May 2021, the CDC announced that fully vaccinated people did not need to wear masks, that the COVID vaccines were working, and that COVID cases were decreasing. On July 27, 2021, due to a surge in COVID-19 cases, the CDC issued updated guidance (reversing its May guidance) stating that vaccinated people may be able to transmit the COVID-19 virus. The CDC updated mask guidance recommends that fully vaccinated people wear masks indoors when in an area of substantial or high transmission of Covid-19; if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease or not fully vaccinated; and recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status.

In response to five states banning universal indoor masking, on August 30, 2021, under the directive of President Biden, the U.S. Department of Education's Office for Civil Rights (OCR) announced that it has opened investigations in Iowa, Oklahoma, South Carolina, Tennessee, and Utah to determine if statewide bans on indoor mask requirements in schools violates the Rehabilitation Act of 1973, which protects children with disabilities from discrimination. The OCR said it was concerned that bans on masks could affect students with underlying health conditions caused by a disability. The OCR also announced it would investigate whether the indoor mask requirements violate Title II of the Americans with Disabilities Act of 1990.

State Action on Masks

In May 2021, many states eased or lifted their mask requirements after the CDC said that fully vaccinated people could forgo wearing masks. Since the CDC issued its revised guidance on masks on July 27, seven states have reinstated mask mandates — Hawaii, Illinois, Louisiana, Nevada, New Mexico, Oregon and Washington — due to a surge in delta variant cases. Most states have not issued new mandates, choosing instead to concentrate on vaccination and other measures.  A number of states – Delaware, Illinois, Kentucky New Jersey, New York, Oregon, Virginia and Washington State – have called for masking in schools. However, some states have resisted imposing any mask requirements/mandates – Arkansas, Florida, Iowa, Montana, South Carolina, Tennessee and Texas –  and have used legislation or executive action to prevent cities, counties and school districts in their states from instituting their own mask rules (See individual state information on masks).

On January 11, ACP’s Executive Committee of the Board of Regents approved a policy statement stating that federal, state, and local authorities may appropriately require the wearing of masks as a component of a comprehensive public health strategy to prevent and contain the spread of COVID-19 until sufficient population immunity is achieved through vaccination. While federal policy makers have several mechanisms at their disposal to support a national mask requirement, there are legal, logistical, and political challenges to the federal government acting unilaterally to implement such a mandate. A comprehensive effort involving federal, state, and local officials, as well as private sector leaders, will be necessary to accomplish universal mask usage as part of a comprehensive prevention strategy to protect public health. 

On August 13, ACP announced its agreement with recommendations from the American Academy of Pediatrics (AAP) that masks should be required in schools as part of a comprehensive public health strategy to help reduce the spread of COVID-19. The AAP’s recommendations are consistent with ACP’s Policy Statement on Wearing Masks in Community Settings. 

Action:

ACP encourages chapters to:

  • Urge state governors to follow the science by implementing CDC recommendations on wearing masks.
  • Urge state governors to require the use of masks in public facilities, manufacturing and retail establishments, public transportation, and in other workplaces facilities as part of a comprehensive prevention strategy.
  • Urge local and state governments to adequately and appropriately enforce mask requirements. Any incentives or penalties should be carefully weighed to ensure against potential negative impact on access and other measures of health equity. Officials should avoid issuing punitive fines and tickets at the individual level for noncompliance. Enforcement of mask requirements in workplaces, manufacturing and retail establishments should be focused at the business rather than personal level, in a manner that does not negatively impact access to care and other health equity measures.
  • Urge federal, state, and local officials to subsidize or directly provide face masks to the public. A sample letter that chapters can customize is available.

Resources: