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Wearing Masks in Community Settings During COVID-19

ACP Chapter Action Tool Kit

Prepared by ACP’s Division of Governmental Affairs and Public Policy

January 21, 2021


To date, there have been roughly 23 million confirmed cases of COVID-19 in the US resulting in nearly 400,000 deaths. There is an urgency to undertake bold measures to limit the spread of the disease until a significant proportion of the population is vaccinated and we have evidence that vaccination protects against COVID-19 transmission. The universal use of personal face masks that cover the mouth and nose is one of many measures necessary for achieving epidemic control, particularly given the current understanding of asymptomatic spread. Adoption of masks on a large scale, when combined with other infection control measures (physical distancing, hand washing, staying home when ill), can reduce transmission risk of COVID-19.

Early vaccines that received U.S. Food and Drug Administration (FDA) emergency use authorization (EUA) have been found to have an efficacy rate of approximately 95%; however, it is important for the public to continue to follow all prevention and control measures, including the use of face masks, until sufficient vaccine-induced population immunity is achieved and there is sufficient evidence that approved vaccines protect against the spread of infection and disease. While the current vaccines are effective at preventing symptomatic illness and severe disease, it is unclear if they are effective at preventing COVID-19 transmission. Additionally, the initial supply of vaccine is limited, so even if they are effective in preventing transmission, there will not be enough vaccine to achieve population immunity for some time. Further, hesitancy and public attitudes towards vaccines may further hinder the ability to achieve vaccine-induced population immunity while certain at-risk populations may not be eligible to receive the vaccine until it is further studied.

The Centers for Disease Control and Prevention (CDC) recommends the use of face masks to help slow the spread of COVID-19, but there is no federal mandate requiring individuals to do so. At the state level, 38 states plus the District of Columbia and Puerto Rico have implemented a statewide mask mandate as of January 2021. The specifics of these mandates vary by state, but they generally require the use of masks in indoor spaces, public transit and ridesharing services, and outdoors when social distancing is not possible. Some states offer exemptions for children or for those with medical conditions or disability. Alaska, Arizona, Florida, Georgia, Idaho, Mississippi, Missouri, Nebraska, Oklahoma, South Carolina, South Dakota, and Tennessee currently do not have any sort of statewide mask requirement.

On January 11, ACP’s Executive Committee of the Board of Regents approved a policy statement stating that federal, state, and local authorities may appropriately require the wearing of masks as a component of a comprehensive public health strategy to prevent and contain the spread of COVID-19 until sufficient population immunity is achieved through vaccination.While federal policmakers have several mechanisms at their disposal to support a national mask requirement, there are legal, logistical, and political challenges to the federal government acting unilaterally to implement such a mandate. A comprehensive effort involving federal, state, and local officials, as well as private sector leaders, will be necessary to accomplish universal mask usage as part of a comprehensive prevention strategy to protect public health.  


ACP encourages chapters to:

• Urge state governors to require the use of masks in public facilities, manufacturing and retail establishments, public transportation, and in other workplaces facilities as part of a comprehensive prevention strategy.
• Urge local and state governments to adequately and appropriately enforce mask requirements. Any incentives or penalties should be carefully weighed to ensure against potential negative impact on access and other measures of health equity. Officials should avoid issuing punitive fines and tickets at the individual level for noncompliance. Enforcement of mask requirements in workplaces, manufacturing and retail establishments should be focused at the business rather than personal level, in a manner that does not negatively impact access to care and other health equity measures.
• Urge federal, state, and local officials to subsidize or directly provide face masks to the public. A sample letter that chapters can customize is available.