Minnesota Gov. Tim Walz is being urged to require residents of the state to wear masks when out in public, as COVID-19 cases hit record highs nationally and health officials worry infections may regain dangerous momentum here.

Governors in states with rising COVID-19 numbers, including California, Kansas and Pennsylvania, have mandated mask use statewide in recent weeks, saying it’s a simple and effective step to slow the spread of a virus that has killed more than 127,000 Americans, including 1,445 in Minnesota. Even President Donald Trump, who has resisted wearing a mask in public, said Wednesday he’s “all for” wearing masks, adding that people should wear them “if they feel good about it.”

Walz’s potential step comes amid growing evidence for how masks can work in concert with other safety protocols health officials are pleading with people to adopt — if masks are worn properly and made with the right materials. Physician groups in Minnesota and the state Health Department are now fully backing a mandate.

“That’s been a vigorous conversation within the executive branch, and with the governor directly. And I think he is listening,” Minnesota Health Commissioner Jan Malcolm said Wednesday.

“It is our advice from the Health Department’s perspective that this is so important and so effective and the evidence has gotten more and more clear on this point. We do recommend that it become a requirement at the statewide level.”

When properly worn, cloth masks, such as those made at home or bought from retail stores, are intended to capture the microscopic droplets of moisture on the wearer’s breath that are a main source for spreading the virus. Because people can be contagious without having symptoms of COVID-19, many health officials say it’s important face masks be worn all the time while in public. The mask must cover the nose and mouth to be most effective.

To date, more than a dozen states are requiring people to wear masks while in public.

Walz said Wednesday that he’s considering factors such as the continued spread of COVID-19 in Minnesota as part of a daily evaluation over whether to issue an order requiring public mask-wearing statewide.

“Does our thinking change as we start to see these numbers in other states? Yes, absolutely,” Walz said Wednesday. “But we’re still looking at our own.”

The number of new lab-confirmed cases of COVID-19 nationally hit a new daily record of 48,365 on Tuesday, just before the July 4th holiday weekend.

Minnesota reported 426 newly confirmed cases of COVID-19 on Wednesday, bringing the statewide total of lab-confirmed cases to 36,716. Minnesota’s rate of new positive cases declined during the first half of June on a seven-day average basis, but started climbing again June 16. The seven-day average surpassed 400 on June 26.

Yet the number of new deaths and hospitalizations from COVID-19 remain on downward trajectories in Minnesota. The state added four deaths of elderly group-home residents to its tally of COVID-19 fatalities on Wednesday.

Pressure for mandate

Walz, at the urging of physician groups and public health officials, is facing mounting pressure to declare a statewide mask order. Members of the state’s business community are watching closely.

Business leaders, who have been urging Walz to safely lift pandemic restrictions first declared in March, see both risks and benefits in such an order. The key is its scope and whether it provides enough flexibility for businesses, said Doug Loon, president of the Minnesota Chamber of Commerce.

“Safety and engaging workers and customers is the biggest priority for businesses right now — because without safety and without reassuring customers, we will not have our economy back,” Loon said. “There’s plenty of evidence to show that face masks work.”

In April, the federal Centers for Disease Control and Prevention (CDC) recommended that people wear cloth face coverings in places like grocery stores and pharmacies where it’s difficult to stay at least 6 feet apart. The National Academies of Science, Engineering and Medicine issued a report that month that found “the available evidence is inconclusive about the degree to which homemade fabric masks may suppress spread of COVID-19 from the wearer to others.”

But many public health experts have become convinced of the benefits of wearing homemade masks after seeing what has happened in hospitals, where workers who don’t directly work with patients have had to resort to cloth masks, said Dr. Priya Sampathkumar, a critical care and infectious disease specialist at Mayo Clinic.

“When we instituted that, we did see a significant decrease in person-to-person transmission between these workers,” she said. “So, it definitely works.”

Internal hospital data at Duke University suggest universal mask requirements significantly reduce the spread among health care workers, said Dr. Sallie Permar, a pediatric infectious disease specialist at Duke. She also cited case studies such as one published in Missouri about a hair salon where masks were credited with helping 140 clients and six workers avoid illness even though two stylists were infected.

Dr. Roger Shapiro, associate professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health in Boston, said Asian nations including Japan, South Korea and Singapore have proved that social distancing and mask use are effective in controlling the viral outbreak.

“If everyone wears masks, this epidemic will go down. It’s very simple,” Shaprio said in a June 20 call with reporters. “Association is not causation, but these [results] are hard to ignore. We really need to be looking to Asia for how to control this.”

Dr. Keith Stelter, a family medicine physician in Mankato and president of the Minnesota Medical Association, said some research shows mask-wearing adds an additional 20% protection when used with other pandemic precautions such as social distancing and hand-washing.

“Statistically speaking, it’s a no-brainer,” said Dr. Jon Pryor, president of Essentia Health’s east market. “Masks make a difference. They have been proven to protect us. By wearing a mask you are not making a political statement; you are making a statement that says ‘I care about others.’ ”

Masks vs. distance

Still, some remain skeptical that the quality of evidence for cloth masks is strong.

Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, said he is concerned that advocates have oversold the scientific data on cloth masks, giving users a false sense of security.

“Distance, distance and distance — it’s the most important risk-reduction activity you can do,” he said, referring to social distancing of 6 feet or more.

Yet Osterholm also supports using cloth masks. He says there is no harm in wearing one, even if it helps only a little bit, as long as it is worn properly.

After studying news footage showing crowds of people gathered in public in recent weeks, Osterholm’s research group at the U estimated 26% of people fail to cover their noses when wearing a mask.

“That’s like fixing three of the five screen doors on your submarine,” he said.

Staff writers Brooks Johnson and Torey Van Oot contributed to this report.