One day after taking office, the Biden administration released a National Strategy for The COVID-19 Response and Pandemic Preparedness, a comprehensive plan for mitigating the significant impact that COVID-19 has had on our country. And, while the seven-point plan focuses necessary attention on the distribution of very promising vaccines and expanding masking, testing and treatment, one small omission may have a greater immediate impact than all of the other plans combined.
Now is the time to leverage the power of the federal government to procure and distribute high-quality surgical masks for free to every American. On Feb. 1, U.S. Reps. Adam Schiff and Ro Khanna, both California Democrats, and Sens. Bernie Sanders, I-Vt., and Brian Schatz, D-Hawaii, penned a letter to President Joe Biden asking him to do just that. And, importantly, this is not a new idea — the Trump administration reportedly considered and scrapped a plan to do exactly this in April.
It is clear that we will be living with the COVID-19 pandemic for much of 2021. Roughly 260 million Americans are eligible for the currently available vaccines, and to date only 10 million of them have received their full two-dose series. And, while it seems at present that President Biden's ambitious plan to administer 100 million vaccine doses in the first 100 days of the administration is on a path to succeed, fewer than half of eligible Americans will be vaccinated by the end of April. And, so, there is no more important time to invest in the non-pharmaceutical interventions that other countries have used to stamp out the spread of the novel coronavirus within their borders, including leveraging the Defense Production Act to increase availability of better masks, drive down their cost, and remedy previous shortcomings in pandemic response.
Evidence is mounting that some masks are better than others. While the fabric face coverings recommended by public health officials in the U.S. and European Union early in the pandemic as a stopgap measure offer "source control" — that is, they help keep infected persons from spreading the novel coronavirus — they are much less effective than medical grade masks at protecting the wearer. Experts like Harvard's Joseph G. Allen and Virginia Tech's Linsey Marr are calling for better masks, and Anthony Fauci, chief medical adviser to the Biden administration, has endorsed "double masking" — wearing a cloth mask over a surgical mask — for greater protection, as did the director of the CDC on Wednesday.
And, as new and more contagious strains of the coronavirus continue to spread in the U.S., and pressure mounts to safely reopen schools, businesses and travel, there is an increased urgency to increase the quality of masks available to most Americans. The SARS-CoV-2 variant known as B.1.1.7 is believed to be about 50% to 70% more transmissible than earlier strains of the novel coronavirus. We must urgently move beyond simple source control to decrease COVID-19 transmission to protection for individuals by reducing the amount and likelihood of coronavirus inhaled by someone wearing a mask.
Therein the problem lies. Not everyone has access to better masks, and so yet another inequality of the pandemic is revealed. Surgical masks are generally more protective to those who wear them and to others, but cost is still an undue burden on many. A family of four would have to spend nearly $100 for the 100 days of mask wearing that the president has proposed.
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N95 respirators — the filtering face pieces that offer the greatest protection but have been in short supply since the beginning of the pandemic — are even more protective, but less available and much more expensive. And so Americans who can afford the expense of better masks are afforded in turn a greater degree of protection from COVID-19, while those most at risk may be least able to afford the best protection.
President Biden has asked Americans "to do what they do best: step up in a time of crisis and wear masks." The best time for the federal government to distribute high quality face masks to every American was last April; the next best time is now.
Neil J. Sehgal is an Assistant Professor of Health Policy and Management, University of Maryland School of Public Health. E-mail: firstname.lastname@example.org. He wrote this article for the Baltimore Sun.