Sharon Meieran, Smitha R. Chadaga and Vesna Jovanovic
Meieran is an emergency medicine doctor and a Multnomah County commissioner. Chadaga is an internal medicine doctor and hospitalist. Jovanovic is a family medicine doctor. All three live in Portland.
Nearly all of Oregon is in Phase 1 or 2 reopening, after 10 weeks of stay home orders. In Gov. Kate Brown’s reopening plans, she stressed the importance of wearing masks to reduce the transmission of the coronavirus causing COVID-19. As physicians practicing in Oregon, we could not agree more with this basic public health approach to slowing disease transmission. Given that masks are inexpensive, have no negative health effects, and can substantially decrease the transmission of COVID-19, we believe that wearing masks in indoor public spaces should be required.
COVID-19 spreads through large or small droplets expelled when an infected person coughs, sneezes, or even talks. At the community level, we know we can slow the spread of COVID-19 with a comprehensive system of testing, contact tracing, isolating those who are infected by the virus, and quarantining those who have been exposed to an infected person. At the individual level, we know that hand washing and cleaning surfaces that are touched regularly kills the virus. We know that outdoor spaces are much safer when it comes to viral transmission, and that in indoor spaces, maintaining social distancing of six feet or greater decreases viral transmission.
There is still a significant risk of transmission of COVID-19, even applying all these measures, as more people congregate in our reopened state. We are fortunate that there is one more simple tool available to effectively slow the spread of COVID-19: masks. Masks, or other face coverings, are physical barriers that block the large or small virus-containing droplets expelled by the masked person when they talk, sing, sneeze or cough. If any droplets do make it through this barrier, a potential “recipient” further blocks the incoming virus-containing droplets with their own mask. Almost any face covering will block virus-containing droplets, but the tighter the weave and the more layers of material used, the less chance there will be for droplets to get through the barrier. Two masked people have a low chance of transmitting the virus between themselves, and we therefore believe that their use should be required in any public setting – such as grocery stores, other shops and gyms – where people will be interacting indoors.
It will be important to educate the public on the efficacy of masking, acknowledging that scientific research has changed our understanding on the value of wearing masks since the pandemic began. The Centers for Disease Control now recommends masking after initially downplaying their efficacy.
We recognize that we are in a unique moment in time, and COVID-19 represents an infectious disease pandemic that exists in the context of the pandemic of racism that has permeated our country for centuries. COVID-19 has highlighted and exacerbated many of the disparities that have always existed in our communities. We realize that certain individuals or communities could experience disparate enforcement of masking or other forms of discrimination if masks are required. In addition, people with certain disabilities may not be able to wear masks, or may be unable to communicate if others around them wear masks. And many people may not be able to afford masks or other facial coverings. For these reasons, any approach must take these and other special considerations into account, and rely on members from the affected communities to determine how to mitigate any potential negative impact.
Fourteen states require masking in public spaces statewide and portions of many other states similarly mandate wearing masks. Given that face covering is inexpensive, has no negative health effects, and is extremely effective in reducing the spread of the droplets that can cause transmission of COVID-19, we, writing on behalf of 140 physicians, strongly urge Gov. Brown and the state of Oregon to require face coverings for all people older than 2-years-old in indoor public settings.
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