Face masks during the COVID-19 pandemic in the United States

The wearing of face masks in public to lessen spread of COVID-19 in the United States was first recommended by the CDC on April 3, 2020, as supplemental to hygiene and appropriate social distancing. Federal officials had initially discouraged the practice, showing concerns that it would lead to shortages of medical-grade personal protective equipment (PPE) for health professionals.

CDC poster recommending the use of non-medical face masks to slow transmission of COVID-19.

As of June 2020, a number of cities, counties, and states have issued health orders requiring the wearing of face coverings — such as cloth masks — by those in public spaces (or at the very least, requiring their use by public-facing employees of businesses, but allowing them to be used at the discretion of customers) and/or essential businesses. Some businesses have voluntarily required their customers to wear masks, regardless of local regulations.

Despite recommendations by state and federal health officials, the wearing of face masks has been divisive among Americans. Some have considered them to be a sign of vulnerability, while attitudes have also varied along the political spectrum; those on the left have been more receptive to the practice, seeing it as a sign of respect towards others, while those on the right have largely considered mask mandates to be an infringement of their personal liberties.[1][2]

It was observed that Republican-led states were less likely to impose health orders requiring the wearing of masks than Democratic-led states, and polls in April 2020 similarly indicated that a larger proportion of self-identified Democrats surveyed had worn masks in public than Republicans. President Donald Trump has also resisted being wearing masks in public media appearances,[3][4][5] has remarked upon their use by Joe Biden — his Democratic opponent in the 2020 presidential election,[6] and has not mandated their use at his public campaign events since their resumption in June 2020.[7][8] Biden, House Speaker Nancy Pelosi, Michigan Attorney General Dana Nessel, and other critics have argued that Trump was not being a good role model for his constituents.[9][10][11][12]

Recommendations
Guidance from the US Centers for Disease Control and Prevention on using and making cloth masks during the COVID-19 pandemic[13]

Initially, the U.S. government did not recommend the use of face masks by the general public outside of medical settings, as to prevent shortages of medical-grade personal protective equipment (PPE) for doctors treating COVID-19 patients.[14][15] In February 2020, Surgeon General Jerome M. Adams stated that proper hygiene and getting a flu vaccine were appropriate preventive actions to be taken by the public, and stated on Twitter that masks should be saved for healthcare professionals, and that they were "NOT effective in preventing [the] general public from catching Coronavirus".[16]

In late-March 2020, the Centers for Disease Control and Prevention (CDC) published a recommendation that masks be used by those who are sick, or are caring for someone who is sick and not able to wear a mask themselves, and discouraged their use by healthy members of the general public.[14][17] This guidance was consistent with that of the World Health Organization (WHO) at the time.[17] By then, some government officials began to endorse the wearing of face masks by the general public when out-of-home, including Commissioner of Food and Drugs Scott Gottlieb — who stated in a report that "face masks will be most effective at slowing the spread of SARS-CoV-2 if they are widely used [as in Hong Kong and South Korea], because they may help prevent people who are asymptomatically infected from transmitting the disease unknowingly".[14]

On March 30, Director of the CDC Robert R. Redfield stated that the organization was evaluating data regarding use of masks by the general public. The next day, President Donald Trump suggested in a White House Coronavirus Task Force briefing that scarves or "something else" could be worn as face coverings. COVID-19 response coordinator Deborah Birx stated that the task force was discussing the addition of face masks to its guidance.[14]

On April 3, 2020, the CDC issued guidance recommending that non-medical face coverings be worn in public when social distancing is difficult to maintain, such as at grocery stores and pharmacies, and especially in areas with significant amounts of community transmission.[18][19] The CDC published tutorials on making non-medical face masks, including a design only requiring a t-shirt and rubber bands, and no sewing.[17][14]

When asked by National Public Radio about the April 3 reversal, the CDC cited studies from February and March showing presymptomatic and asymptomatic transmission, and reports from Asian countries regarding the effectiveness of face coverings in this manner.[20] Professor of public health Larry Gostin said that the CDC could have revised its recommendation sooner; by maintaining its initial recommendation throughout March, it had given the public the impression that widespread mask usage was ineffective even though scientific evidence to the contrary was already available.[20] The earlier recommendation damaged the agency's credibility.[21][22][23]

On May 27, Director of the NIAID Anthony Fauci urged Americans to wear face masks in public. Fauci stated that he would wear face masks as a role model for others to follow, "to protect myself and protect others", even though it would not be "100% effective". Fauci further said that wearing face masks showed "respect" for others.[24] On June 5, Fauci said that people not wearing face masks in crowds may "propagate the further spread of infection".[25]

Attitudes
A member of the Rhode Island National Guard sewing handmade face masks.

Prior to the COVID-19 pandemic, the public wearing of face masks to protect others from oneself was not a widely-accepted phenomenon in the Western world, and had historically been more prevalent in East Asian countries. By contrast, the wearing of masks had historically been considered a symbol of protecting oneself from others.[26][27][28] The issue of whether or not to wear a mask in public became, for some, a dividing line in the culture war between the supporters and opposition of President Trump.[29]

Politico described progressives as considering masks "a sign that you take the pandemic seriously and are willing to make a personal sacrifice to save lives".[1] Supporters of the CDC's recommendations derided what they described as their opponents' ignorance, selfishness, antiscience stance, and lack of respect for fellow citizens.[30]

Opponents have invoked conspiracy theories to discredit proponents, and accused them of violating rights to free expression, and inhibiting development of herd immunity.[31][32] There have been instances of confrontations and violence by retail patrons refused service for not wearing masks,[33][33][34] while a Key Largo bus driver was arrested for swinging a metal rod at a passenger who lowered his mask to make a call on his cell phone.[35]

The Washington Post reported that in an April 2020 poll, 79% of self-identified Democrats stated that they had worn a mask or other face covering in public, as opposed to 59% of Republicans. Those who knew someone who had been infected with COVID-19 were 40% more likely to wear a mask in public than those who didn't.[36] A Gallup poll the same month similarly found that Democrats were more likely to wear masks than Republicans, at 75% to 50%.[37] In June 2020, 80% of those surveyed by Politico and Morning Consult said they supported the wearing of masks, with 60% of them having also stated that their opinion of the Trump administration was "very favorable".[38]

In mid-June 2020, Casears Entertainment experimented with a promotion to incentivize mask usage at its re-opened Las Vegas casinos; patrons had a chance to receive $20 credits if they were spotted wearing a mask on the casino floor, and were a member of the company's rewards program. Casears stated that this promotion would likely continue until Nevada enacted a mandate.[39] On June 24, the company announced that it would require all patrons of its casino properties nationwide to wear masks, while the Nevada government announced later in the day that masks would become mandatory in all public spaces effective June 26.[40][41]

Among minorities
Protesters of the killing of George Floyd wearing masks; one is inscribed with the text "#BLACKLIVESMATTER".

Concerns surrounding the politicization of masks have been especially prominent among minority communities, such as African and Asian Americans. Concerns were raised by African Americans that the wearing of masks may encourage racial profiling due to their association with their use by criminals to conceal identity, such as an officer shown handcuffing a black doctor wearing a mask steps from his home, and a police officer in Illinois following two black men wearing surgical masks as they exited a Walmart, and falsely claiming that the city prohibited the wearing of masks.[42][43] There have also been incidents of discrimination against Asian Americans who wear masks, as part of ongoing anti-Asian sentiment tied to the pandemic due to its Chinese origin.[44][45]

The April 2020 poll found that 32% of Hispanic and Latino Americans surveyed, and 30% of African Americans surveyed, were concerned that wearing a mask would cause them to be mistaken for a criminal, as opposed to 19% each of Asian Americans and whites.[36] Despite this, larger proportions of people among minority communities said they had worn a mask in public than whites (66%), at 71% of Hispanic and Latino Americans surveyed, 74% of African Americans surveyed, and 82% of Asian Americans surveyed.[36]

In late-May and early-June 2020, masks printed with slogans related to the Black Lives Matter and police reform movements (such as "I can't breathe") attracted popularity amidst nationwide protests over the police killing of George Floyd. In June 2020, the United States Postal Inspection Service temporarily seized a shipment of face masks with the slogan "STOP KILLING BLACK PEOPLE", ordered by the Movement for Black Lives for distribution to those attending demonstrations in Minneapolis, New York City, St. Louis, and Washington D.C.. The Service stated that there "were indications that they contained non-mailable matter."[46]

On June 24, 2020, Lincoln County, Oregon backtracked on offering an exemption for people of color from its masking mandate (which had used concerns over racial profiling as a justification), with officials stating that "the expressions of racism regarding the exception has created a ripple of fear throughout our communities of color. The very policy meant to protect them, is now making them a target for further discrimination and harassment."[47]

Appearance of vulnerability

Refusal to wear a mask in public may be driven by a fear of being seen as vulnerable and fearful of COVID-19.[48][49] In a May 2020 survey of 2,459 Americans conducted by Valerio Capraro of Middlesex University London and Hélène Barcelo of the Mathematical Science Research Institute, it was found that men surveyed were more likely to display negative stigmas towards wearing masks in public, including being more likely to agree that it was "uncool", "shameful", and a "sign of weakness". Capraro noted that these stigmas were more prevalent among residents of areas that had mandated the wearing of face masks.[50]

Reporting on the study, Ben Boskovich of Esquire wrote that "the phrase toxic masculinity gets thrown around a lot, sometimes more than necessary, if we're being honest. But this thing, this reality, that men are too blinded by their own inherent privilege to acknowledge their vulnerabilities, to admit they're wrong, to let go of the steering wheel, is as real as the president's hats are red.".[51]

By the Trump administration
President Donald Trump touring a Honeywell mask factory in May 2020; Trump did not publicly wear a mask at this media event.[52]

Following the issuance of the CDC's guidance on April 3, President Trump began to express a personal reluctance to wear face masks, and emphasized that this was merely a voluntary recommendation. He explained during the day's briefing, "you can do it. You don't have to do it. I am choosing not to do it. It may be good. It is only a recommendation, voluntary." Trump has subsequently avoided being seen wearing face masks during on-camera appearances (such as, in one case, a factory producing face masks).[52][10]

When visiting the Mayo Clinic on April 28, Vice President Mike Pence did not wear a mask, despite the clinic having made them mandatory for all visitors and staff. Pence stated that he did not wear a mask because he was being regularly tested negative for COVID-19, and that "I thought it'd be a good opportunity for me to be here, to be able to speak to these researchers, these incredible health care personnel, and look them in the eye and say 'thank you'."[53] When visiting a ventilator factory on April 30, however, Pence was seen wearing a mask.[1]

When touring a Ford Motor Company plant in Ypsilanti, Michigan for a media event on May 21, Trump wore a cloth mask inscribed with the presidential seal, but took it off before making an on-camera media appearance. Trump explained that he did not want to give the press the "pleasure" of seeing him wearing a mask.[3][4][5] Following the visit, Michigan Attorney General Dana Nessel issued a warning to Ford for violations of state health orders requiring masks be worn in all enclosed public spaces.[54]

On Twitter, Nessel called Trump a "petulant child" who was "conveying the worst possible message" to the public, and stated that "I hope that the voters of Michigan will remember this when November comes, that he didn't care enough about their safety, he didn't care about their welfare, he didn't respect them enough just to engage in the very simple task, the painless task, the easy task of wearing a mask when he was provided one."[10][55] Trump subsequently responded, calling her the "do-nothing AG of the Great State of Michigan" and accusing her of "taking her anger and stupidity out on Ford Motor". He suggested that "[Ford] might get upset with you and leave the state, like so many other companies have — until I came along and brought business back to Michigan. JOBS!"[55]

After former vice president and presumptive Democratic presidential nominee Joe Biden wore a black mask and sunglasses during a Memorial Day ceremony (his first major out-of-home appearance in two months), Trump shared a Twitter post ridiculing the outfit by Fox News commentator Brit Hume, captioned "This might help explain why Trump doesn’t like to wear a mask in public." In an interview the next day, Biden criticized Trump for sharing the post, and for being a bad role model for the American public. He argued that "Presidents are supposed to lead, not engage in folly and be falsely masculine."[56][9][6]

During a subsequent media appearance, Trump described Biden's decision as being "very unusual", as "he was standing outside with his wife, perfect conditions, perfect weather." He added, "I thought that was fine. I wasn't criticizing him at all. Why would I do a thing like that?"[6] After a reporter refused a request by Trump to take off his mask because it had muffled his voice, Trump accused him of "want[ng] to be politically correct."[57] In a June 2020 interview with The Wall Street Journal, Trump argued that some people were wearing masks to "signal disapproval" of him,[58] and said of Biden's use of masks, "It's like he put a knapsack over his face. He probably likes it that way. He feels good that way because he does. He seems to feel good in a mask, you know, feels better than he does without the mask, which is a strange situation."[37]

Trump returned to holding public campaign events for his 2020 re-election campaign in mid-June 2020, beginning with a rally in Tulsa, Oklahoma on June 20. Masks were optional, and not worn by the majority of participants, nor was social distancing practiced.[59][60] Trump then appeared at a Students for Trump event in Phoenix, Arizona on June 23; the state of Arizona had recently become a major hotspot for new COVID-19 cases. Despite Phoenix having enacted a health ordinance requiring the wearing of masks in public, Mayor Kate Gallego stated that the city would "[not] be focused on enforcement during the rally."[61] The owners of the megachurch where the event took place announced that it had installed an ionizing air purifier system that could "kill 99.9% of the virus", a claim disputed by the media.[62] Once again, the majority of attendees did not wear masks.[7][8]

During a Coronavirus Task Force briefing on June 26 amidst major resurgences of cases in Southern states and California, most of the participants wore masks when not at the podium. However, Pence did not wear a mask, nor did he mention the wearing of masks or social distancing when recapping the government's hygiene recommendations.[63]

On June 28, House Speaker Nancy Pelosi said that the CDC did not mandate the wearing of masks in public as to not "offend the president", adding that "The president should be an example. Real men wear masks."[12]

National stocks and shortages

At the beginning of the COVID-19 outbreak in the United States, the U.S.'s Strategic National Stockpile contained just 12 million N95 masks, far fewer than estimates of the amount required.[64] Millions of N95 masks and other supplies were purchased from 2005 to 2007 using congressional supplemental funding, but 85 million N95 masks were distributed to combat the 2009 swine flu pandemic, and Congress did not make the necessary appropriations to replenish stocks.[64] The Stockpile's primary focus has also primarily been on biodefense and response to natural disaster, with infectious disease a secondary focus.[64]

By April 2020, the Stockpile was nearly emptied of protective gear.[65] In January and February 2020, U.S. manufacturers, with the encouragement of the Trump administration, shipped millions of face masks and other personal protective equipment to China, a decision that subsequently prompted criticism given the mask shortage that the U.S. faced during the pandemic.[66]

By late-March/early-April 2020, Western countries were in turn dependent on China for supplies of masks and other equipment.[67][68]

A sign at a beach in Santa Monica, California, advising visitors of masking and social distancing requirements.

Mask use and policies by state

A number of states have enacted executive orders requiring the wearing of face masks or a similar non-medical face covering when in public spaces or specific types of establishments, with violations of these rules often classified as a misdemeanor offence (although whether these regulations are legally enforced may vary).[69][70] Absent a state-level mandate, some municipalities and counties have instituted their own mandates via localized by-laws.[71][72][73] These orders are usually considered an exemption to anti-mask laws (prohibitions on the wearing of masks for identity concealment).[74]

Some states, such as Louisiana, Oregon, and Washington, at first only mandated the wearing of masks by the public-facing employees of businesses, but did not formally require they be worn by the general public (notwithstanding mandates enforced by individual businesses).[75][76][77] Oregon (in selected counties)[78] and Washington

The Hill noted that Democratic-led and coastal states have been more likely to have implemented or considered such mandates over Republican-led states (especially in the conservative South)—which have cited desires to preserve individual liberties, and, in some cases, have also taken steps to overrule local by-laws.[37] Not all Republican-led states have refused to do so, however, with noted examples including Maryland and Massachusetts.[37] In mid-June, Arizona and Texas began to backpedal on their outright prohibition of local masking by-laws, following a spike in cases attributed to rushed economic reopenings around the Memorial Day weekend.[37][79][80]

Summary of masking orders and recommendations issued by states
State State masking requirements Notes
Alabama Recommended, no state-wide mandate.[81] The cities of Birmingham (as of April 28)[73][82][83] and Montgomery (as of June 17, public gatherings of 25 people or more)[84] have ordinances mandating wearing of masks in public spaces.
Alaska Recommended, no state-wide mandate.[85]
Arizona Recommended, no state-wide mandate.[86] Until June 17, individual counties and municipalities were prohibited from imposing health orders stricter than those of the state itself, effectively blocking local mandates. On June 17, amidst a major spike in new cases, Governor Doug Ducey announced that he would allow them to enact mandatory masking orders.[79][80]
Arkansas Required at essential businesses (excluding restaurants).[87]
California Required in any enclosed public space, and outdoors when social distancing is not possible, since June 18.[88]
Colorado Required for employees of essential businesses.[94] Various municipalities have health orders requiring masks to be worn in public, including Denver and Boulder.[95][96]
Connecticut Required in public.[97]
Delaware Required in public when social distancing is not possible, since May 1.[98]
Florida Recommended, no state-wide mandate.[99]
Georgia Recommended, no state-wide mandate.[100]
Hawaii Required for patrons of essential businesses, since April 17.[101] Mayor of Honolulu Kirk Caldwell says it would be "incumbent on the public to comply" with requests from businesses regarding mask wearing.[101]
Idaho Recommended, no state-wide mandate.[102]
Illinois Required in public, since May 1.[103]
Indiana Recommended, no state-wide mandate.[104]
Iowa Recommended, no state-wide mandate.[105]
Kansas Recommended, no state-wide mandate.[106]
Kentucky Required for public-facing employees. Businesses have the right to refuse service to patrons without masks.[74]
Louisiana Required for public-facing employees.[77]
Maine Required in public when social distancing is not possible, since April 30.[107]
Maryland Required for patrons and employees of grocery stores, restaurants, pharmacies, stores that sell cleaning and sanitation supplies, laundromats, liquor stores, public transport, and ride sharing services, since April 15.[108]
Massachusetts Required in public when social distancing is not possible, since May 6.[109]
Michigan Required in any enclosed public space, through July 15. Businesses with in-person employees are responsible for providing masks for them.[110][111] Following anti-lockdown protests in April 2020, Governor Gretchen Whitmer criticized the participants' lack of masking and social distancing.[112]
Minnesota Recommended, no state-wide mandate.[113] Minneapolis and Saint Paul both implemented ordinances requiring the wearing of face coverings by patrons of public spaces and businesses.[114]
Mississippi Required in public settings and businesses in Attala, Leake, Scott, Jasper, Neshoba, Newton and Lauderdale counties, since May 12.[115]
Missouri Recommended, no state-wide mandate.[116]
Montana Recommended, no state-wide mandate.[117]
Nebraska Recommended, no state-wide mandate.[118] In June, Lincoln County announced its intent to require public-facing restaurant employees to wear masks,[119] but backtracked after Governor Pete Ricketts warned that the state would withhold CARES Act funding from counties that require the wearing of masks at government facilities.[118][37]
Nevada Required in public, since June 26.[40][120] Prior to state-wide mandates, the Nevada Gaming Control Board required the wearing of face coverings by casino employees,[41] and later for players of table games if barriers are not installed.[39]
New Hampshire Recommended, no state-wide mandate. The city of Nashua passed a local ordinance requiring the wearing of face coverings in public settings.[121]
New Mexico Required in public when social distancing is not possible, since May 16.[122]
New Jersey Required when using essential services (stores, restaurant pickup) and public transport, since April 10.[123]
New York Required in public on public transport and when social distancing is not possible, since April 15. On May 15, Mayor of New York City Bill de Blasio stated that the NYPD would no longer enforce the order except in cases that pose "serious danger."[124]
North Carolina Required in public, since June 26.[125] Durham County requires the use of face masks while in public, though no one will be refused public transportation for not wearing a mask.[126] Boone, North Carolina also enacted a mandate.[72]
North Dakota Recommended, no state-wide mandate.[127] On May 23, Governor Doug Burgum urged residents to stop shaming people who do wear masks, nor consider it an ideological or political issue. He explained that people may need to wear a mask "because they’ve got a 5-year-old child who’s been going through cancer treatments. They might have vulnerable adults in their life who currently have COVID, and they’re fighting.”[128][127]
Ohio Recommended, no state-wide mandate.[129] On April 27, Governor Mike DeWine announced an order to require face masks be worn in retail stores, only to repeal the order the next day due to public resistance.[129]
Oklahoma Recommended, no state-wide mandate.[130] On May 1, the mayor of Stillwater repealed a local ordinance announced the previous day, citing that "store employees have been threatened with physical violence and showered with verbal abuse".[130][131]
Oregon
  • Required for public-facing employees.[76]
  • Required for patrons of public businesses in Clackamas, Hood River, Lincoln, Marion, Multnomah, Polk, and Washington counties since June 24.[78]
Pennsylvania Required for patrons of essential businesses.[132]
Rhode Island Required in public spaces, since May 8.[133]
South Carolina Recommended, no state-wide mandate.[134]
South Dakota Recommended, no state-wide mandate.[135]
Tennessee Recommended, no state-wide mandate.[136]
Texas Recommended, no state-wide mandate.[137][37] Governor Greg Abbott issued pronouncements and orders to prevent counties from instituting orders to fine individuals for not wearing masks in public.[137][37]

However, by mid-June 2020, Abbott had begun ease his stance, and allow by-laws requiring the wearing of masks by patrons and employees of businesses (considering it no different to stores requiring customers to wear shirts and shoes).[37][138][139]

Utah Required for public-facing employees, as of May 2,[140]
Vermont Recommended, no state-wide mandate.[140] On April 27, Governor Phil Scott stated that there were no plans to introduce a formal mandate, citing voluntary compliance with CDC recommendations by residents.[140]
Virginia Required in public spaces, retail establishments, restaurants (except when eating), personal care establishments, government services facilities, and public transport, as of May 30.[141]
Washington
  • Required for public-facing employees since June 8.[75]
  • Since June 26, masks are required in public spaces state-wide when social distancing is not possible.[142]
  • In Yakima County, masks must also be worn by all patrons of businesses.[142]
 On May 11, King County (which includes the Seattle metropolitan area) enacted a directive recommending that residents wear face coverings in public settings when appropriate social distancing is not possible. This directive is "strongly required" but is not being enforced as law.[143]
West Virginia: Recommended, no state-wide mandate.[144]
Wisconsin Recommended, no state-wide mandate.[145]
Wyoming Recommended, no state-wide mandate.[146]


See also

References
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