Index-Based Policy to Guide Mask-Wearing for SARS-CoV-2 and Other Pandemics

Abstract

As the world experiences yet another surge in cases of COVID-19, many organizations and jurisdictions have reinstated or expanded mandates to protect workers, children, older people, and the public at large. Mandates to wear face masks in indoor public areas are often met with confusion, fear, anger, disagreement, and lack of knowledge about risks and benefits of action and inaction. To move towards an evidence-based approach, we propose that when five criteria collectively signal that a communicable disease poses greater harm to society than that of a benchmark, such as that of the average seasonal influenza during years 2010 to 2019, then the local, state, and federal government should introduce an indoor mask-wearing mandate, subject to certain exceptions. We suggest the following five measures and corresponding metrics comprising composite criteria for the requirement to wear a mask: contagiousness (R₀), vulnerability of communities to infection (rate of growth in the percentage of the national population that is infected), harm caused by the disease (cumulative deaths per week), severity of harm (infection fatality rate), and direction of harm (percentage change in cumulative deaths per week). Each criterion would be scored. An aggregate score would then signal when the social health risk exceeds that of seasonal influenza as a point of reference, based on methodology. Although additional details would require clarification, attention to validity and timeliness of measurement, and development of appropriate scoring thresholds, the criteria provide a foundation for action that goes beyond rhetoric, politics, impulsiveness, and guesswork. Pursuing measurement of these factors would yield an improvement over the current approach.

Note:
Funding: None.

Declaration of Interests: Micheael Weiner discloses his following stock options: AbbVie Inc. Accuray, Inc. ADA Disclosure System Login Page Allscripts Healthcare Solutions Amgen Inc. Boston Scientific Corporation Bristol-Myers Squibb Company Crispr Therapeutics Ag Com Express Scripts Hdlg Co General Electric Co. Globus Med, Inc. Integer Hldgs Corp Com Integra Lifesciences Holdings Johnson & Johnson Mallinckrodt PLC Mead Johnson & Company, LLC Metlife Inc Com Mylan N.V. Novo Nordisk A/S Nuvasive, Inc. Orthofix Medical Inc. Perspecta Inc Com Pfizer Inc. Resmed, Inc. Roche Pharmaceuticals Seaspine Hldgs, Inc. Senseonics Stryker Corp. Teva Pharmaceutical Industries Ltd. Varian Med Sys, Inc. Walgreens Boots Alliance, Inc., all other authors have nothing to declare.

Keywords: Policy, Face Masks, SARS-CoV-2, COVID-19, Pandemics, Civil Liberties