In Indonesia, individuals caught without face masks could choose to lie in an open coffin and count to 100 in order to avoid monetary fines or community service. The government’s aim was to encourage culprits to “contemplate their actions because with Covid-19 there is a risk of them being laid inside a real coffin,” one official said. After intense public outcry, however, the option was quickly removed in favor of more traditional punitive consequences.
While a coffin punishment is unlikely to make its way to the U.S., officials in the states have resorted to monetary fines, Robert Cialdini-inspired ad campaigns, and public pleas to encourage Americans to wear masks. The science is unequivocal: masks, particularly the gold standard N95s, are incredibly effective at reducing the transmission of coronavirus. Moreover, the optimal way to catalyze economic recovery is to mitigate viral spread. Therefore, an off-the-cuff remark by Salesforce CEO, Mark Benioff, to give every American 10 N95 masks with each stimulus check, has merit. It could be the ultimate combination of health and wealth; a preventative measure that would reduce viral outbreaks as well as prevent financial insecurity.
The Virus Drives The Economics
Salesforce CEO’s Prescient Remarks
In a June video interview with The Washington Post on how the coronavirus crisis will change the future of work, Benioff also weighed in on masks. “I wish that when they sent everyone $1,000 they also sent them 10 N95 masks,” he said. “I think it would have helped reduce the spread even more dramatically in our country. Since we know that masks are critical to do that.”
Benioff has been vocal on what is needed to address the coronavirus-induced economic crisis, articulating an eight-point plan in June that included wearing and expanding the supply chain for masks. More recently, he tweeted a “Hawaii 5-0: 5 Steps to Zero Covid” message, which advocated for a state-wide mask mandate coupled with a $100 fine for disobedience, among other measures.
Economic Recovery Depends On Preventative Action
“The virus drives the economics,” said Betsey Stevenson, who served on President Obama’s Council of Economic Advisers and is now a professor at the University of Michigan. If Covid-cases keep rising, “we’re not going to have people going back to work,” she added. While unemployment has started to decline, the August rate of 8.4 percent is hardly something to cheer. Not only is the U.S. down still 11 million jobs since February, but we were also adding roughly 200,000 jobs per month in 2019, which have not been factored into the calculated jobs deficit.
Moreover, there is still tremendous imbalance between labor demand and supply. The Bureau of Labor Statistics calculated that there were still 2.5 unemployed workers per job opening in July meaning the supply of jobs is insufficient to meet demand for work. The imbalance peaked in April with 4.6 workers per job opening; it was 0.9 in July, 2019. “You can’t incentivize people to get jobs that aren’t there,” the left-leaning Economic Policy Institute remarked. Job creation will fully gain steam only when coronavirus is contained. Virus outbreaks in multiple states over the last few months have not helped, forcing states to either pause or reverse planned re-openings, leaving the economic recovery in even greater jeopardy.
To reduce outbreaks and catalyze the economy, we have to focus on reducing the transmission of coronavirus. Despite the allure of a vaccine, a safe and efficacious one is still months away, meaning the safest route to economic recovery is Americans via widespread adoption of preventative measures including mask wearing, social distancing, and hand washing. The government could facilitate economic recovery in the next coronavirus stimulus package by simply subsidizing and sending N95 masks along with a stimulus check.
Masks are Critical to Control Coronavirus Pandemic
Masks Help Reduce Coronavirus Spread
A model created by the University of Washington predicts that if 95 percent of the American population wears face masks in public, the US could prevent at least 45,000 coronavirus deaths by November. That squares with research from Arizona State University showing that “broad adoption of even relatively ineffective face masks may meaningfully reduce community transmission of COVID-19.” In hypothetical mask adoption scenarios, the researchers modeled that “immediate near universal (80%) adoption of moderately (50%) effective masks could prevent on the order of 17–45% of projected deaths over two months in New York, while decreasing the peak daily death rate by 34–58%, absent other changes in epidemic dynamics.”
Real-world data also supports this. For example, jurisdictions in South Carolina with mask requirements showed a 46 percent greater decrease in total cases compared to jurisdictions without a mandate. “This new data shows us what we already knew, wearing face masks works,” said Dr. Linda Bell, South Carolina’s State epidemiologist. UK researchers had similar conclusions, but were more frank in voicing their support. “We believe broader mask use is key to control the pandemic,” they wrote.
N95’s Are The Gold-Standard
There is no doubt that N95 masks are the most effective means of decreasing coronavirus spread, due to the small size of Covid-19 viral particles (when compared to other viruses, such as the flu). It’s the reason why N95s are recommended for healthcare and frontline workers caring for Covid-19 patients. A study in The Lancet found that face masks could result in a large reduction in infection risk “with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar.” Similarly, a recent study in the Journal of Hospital Infection concluded that N95 masks are among the best at reducing a risk of infection and protecting against aerosolized virus particles.
The Center for Disease Control (CDC) offers conflicting guidance, mainly because it is trying to balance competing demands. It “does not recommend that the general public wear N95 respirators to protect themselves from respiratory diseases, including coronavirus (COVID-19). Those are critical supplies that must continue to be reserved for health care workers and other medical first responders, as recommended by current CDC guidance.” As the last sentence notes, the CDC guidance is focused on maintaining an adequate supply of personal protective equipment (PPE) for healthcare workers, rather than minimizing viral spread among everyday Americans.
Increase In N95 Supply Is Vital
Until there is adequate supply and distribution of N95’s and PPE, we must prioritize doctors, nurses, and other front-line workers. However, there are millions of other Americans who would also benefit greatly from N95s if we had a guaranteed supply to cover healthcare workers. People with severe immunocompromise, such as children undergoing chemotherapy, would be better protected against the virus if they were to come into contact with an infected person. Other essential workers, like grocery store and pharmacy employees would be safer with an N95. So would teachers, janitors, meatpackers, and warehouse workers.
Police officers, bus drivers, subway operators, and other public officials, who are often in enclosed spaces often interact with the public (without the ability to social distance) would be better protected with an N95 mask. This would be one step to mitigate the hazards that many of these essential workers are navigating. For example, “at least 87 ATU [Amalgamated Transit Union] members have died. TWU [Transit Workers Union] has lost at least 150 members, and no fewer than 10,000 members have tested positive or been in quarantine,” according to Marcia Brown of The American Prospect.
Other countries ramped up production of both surgical and N95 masks, distributed them, and ensured they were available and cheap to procure, noted former CDC director Tom Frieden. “The United States could have done this through robust use of the Defense Production Act and other means, and still should,” he said. “Shortages of N95 and surgical masks may have also led to less effective federal leadership on appropriate mask use.”
Domestic N95 Production Increasing
The Department of Defense expects domestic N95 production to exceed 1 billion in 2021. Stacey Cummings, Principal Deputy Assistant Secretary of Defense, Acquisition Enablers at the United States Department of Defense, told a House panel that she expects an increase of production of 450 million masks by a year by October and a rate of more than 800 million per year by January. “Starting in 2021, we anticipate our total domestic production to be in excess of a billion per year,” she said.
For now, shortages remain, with hospitals and nursing homes still asking workers to reuse N95 masks over multiple shifts and multiple days. The American Nurses Association recently asked the White House to invoke the Defense Production Act to ensure adequate N95 mask supply after a recent survey found that one in three nurses didn’t have enough of a supply and more than 50 percent were asked to reuse equipment intended for single use. Moreover, given that Americans used 140 million N95 masks in the 90 days through the end of May, even producing one billion N95 masks each year may be insufficient to protect frontline healthcare workers in the face of future outbreaks, let alone provide enough coverage for other essential workers and vulnerable members of the public.
For anyone forced to work indoors without proper ventilation and in close proximity to others, access to N95s would provide better protection than a cloth or regular mask alone. N95 masks are not without their own drawbacks. They are significantly more uncomfortable to wear than either surgical or cloth masks and require fit-testing in order to be used properly (as they come in different sizes, and a tight seal to the face is necessary to ensure optimal function). Thus, adherence might not be as high as if the public were required simply to wear a more comfortable option – and from the data we have so far, universal use of any mask type would decrease cases of and deaths from Covid-19 dramatically over the coming months.
The administration hasn’t prioritized widespread access to surgical masks and other forms of PPE either. President Trump had months to fully invoke the Defense Production Act. He could have ensured adequate production of masks, face shields, and other protective equipment, not only for healthcare workers, but also for all high-risk citizens.
As the U.S. starts flu season and coronavirus outbreaks continue to spread, the economy is continuing to suffer and the recovery keeps see-sawing between gains and setbacks. If we want to truly help the millions of Americans who are suffering financially because of Covid-19, Congress should aim to provide help not only by sending Americans an additional stimulus check, but also by ramping up production and distribution of masks, which we should all be encouraged (if not required) to wear in communal spaces, particularly as colder weather makes social distancing more difficult. Sadly, if we don’t follow this prescription, thousands more Americans will end up lying in coffins, and not just for 100 seconds.