Coronavirus pandemic-related restrictions in the United States have largely been enacted at the state and local level since last spring: States have been able to make their own decisions about mask regulations, school protocols restaurant closures and more.
President-elect Joe Biden aims to provide some federal guidance when he takes office on Jan. 20. Earlier in December, he said that he would call for 100 days of wearing masks, meaning that he and other officials would ask Americans to wear masks for just over three months.
"It is important that we, in fact, the president and the vice president, we set the pattern by wearing masks, but beyond that, where the federal government has authority, I'm going to issue a standing order that in federal buildings you have to be masked," Biden said in an interview with CNN. "... Just 100 days to mask. Not forever. One hundred days. And I think we'll see a significant reduction ... If that occurs, with vaccinations and masking, to drive down the numbers considerably."
Epidemiologists agree that concerted efforts to follow mask guidelines could significantly reduce the numbers of the coronavirus cases in the nation. A recent study published in The Lancet Digital Health analyzed U.S. data and found that a 10% increase in mask-wearing (with physical distancing) was linked with reduced virus spread. The need for increased compliance is clear: Hundreds of thousands of cases of COVID-19 are reported daily, and hospitalizations continue to increase.
It could turn the tides on community transmission
Robert Hecht, a professor of clinical epidemiology at the Yale School of Public Health in New Haven, Connecticut, told TODAY that while vaccines will have an effect on the pandemic, it's important to still use non-pharmaceutical interventions (NPIs), like mask-wearing and selective closures, especially when only specific populations can get the vaccine.
"The burden that (mask-wearing) imposes economically, on people's going about their business, is so low that it seems to me like it's a small sacrifice to make to save so many avoidable infections and to ultimately save the lives in hospitals, save the space in mortuaries," Hecht said. "If we don't do that, if we're not taking advantage of something that's so easy and painless and costless to do, then frankly we're making a huge mistake."
Dr. Chris Beyrer, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, told TODAY that 100 days of consistent mask-wearing could "do a great deal" to reduce community transmission.
"We have ongoing high levels of community transmission all over this country," said Beyrer. "With that rate of community transmission, with the infectiousness of this virus and with the weather that we're dealing with (leading to) indoor activity, that really consistent mask-wearing could have a major impact on reducing community transmission."
Hecht estimated that mask-wearing could "bend the curve back down to under 100,000" cases a day, and when paired with vaccinations for elderly and high-risk populations could reduce deaths.
"That 100,000 would no longer be affecting the elderly and people with serious comorbidities and things like that," Hecht said. "We might only see 50, or 100, or a few hundred deaths (a day) because we would be having these infections in people that are much less likely to develop serious disease and die."
Beyrer said that the reduction of cases due to mask-wearing could lead to better hospital care for those severely ill patients.
"(Lower case numbers) could allow us to deal with the current huge challenge, which is that, once again, our hospitals are full, our emergency rooms are full and our ICU beds and the staff to manage those ICU beds are really wearing thin," said Beyrer. "The Army Corps of Nurses has been moving nurses around the country and trying to cover the hotspots, but there are so many (hotspots) that mask-wearing could make a big difference."
Will political modeling make a difference?
Hecht said that a federal message about consistent mask-wearing could lead to increased adherence to the recommended guidelines.
"Mayors and governors have to be really tough on it, and it shouldn't be 'It's my advice, you should do it,'" he said. "There has to be real role modeling and enforcement by state and local authorities. ... With Biden coming in and with a stronger Centers for Disease Control and Prevention (CDC), there's definitely a chance for us to do much better."
Hecht, who lives in Massachusetts, said that he hopes that consistent federal guidance can lead to a more unified state response.
"Our governor is often looking to what's happening in Washington, D.C., and what's happening at the CDC in Atlanta, so I think that sort of governor would respond much better to clearer, stronger federal guidance from the federal government," he said. "I think some states are sitting on the fence, but will go with federal guidelines."
How long will we be wearing masks?
Estimates vary on how long we might be wearing masks. Taking into account factors like timelines for COVID-19 vaccine rollouts and whether case counts decrease as the weather gets warmer and more activities are moved outside, Hecht expects that masks will be worn for at least the next six months.
Dr. Colleen Kraft, associate medical officer at Emory University Hospital in Atlanta, Georgia, told TODAY Health in November that community transmission will need to be curtailed before mask-wearing can stop.
"I think we are not going to be wearing masks any less anytime soon if people are going to continue to behave the way they're currently behaving," Kraft said. "I would say we have at least another year at the rate we're going ... But that has to do with the effort that we're sort of seeing in the public. The more people that are just refusing to wear masks and making this an issue of personal freedom, I think the longer we're going to be wearing masks. The longer we can't get it done, the longer that the pandemic rages on."