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Universal Masking in the United StatesThe Role of Mandates, Health Education, and the CDC

Educational Objective
To understand the pros and cons of a national mandate to wear masks in the United States
1 Credit CME

The Centers for Disease Control and Prevention (CDC) recommends cloth face coverings in public settings to prevent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). Face coverings decrease the amount of infectious virus exhaled into the environment, reducing the risk an exposed person will become infected.1 Although many states and localities have ordered mask use, considerable variability and inconsistencies exist. Would a national mandate be an effective COVID-19 prevention strategy, and would it be lawful? Given the patchwork of state pandemic responses, should the CDC have enhanced funding and powers to forge a nationally coordinated response to COVID-19 and to future health emergencies?

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Article Information

Corresponding Author: Lawrence O Gostin, JD, Georgetown University Law Center, 600 New Jersey Ave, NW, Washington, DC 20001 (gostin@georgetown.edu).

Published Online: August 10, 2020. doi:10.1001/jama.2020.15271

Conflict of Interest Disclosures: None reported.

Additional Contributions: The authors thank Charles H. Bjork, JD, MSLIS, International & Foreign Law Reference Librarian, Georgetown University Law Center. Mr Bjork did not receive compensation in association with his contribution to this article.

References
1.
Centers for Disease Control and Prevention.  Considerations for wearing masks. Accessed August 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
2.
Brooks  JT , Butler  JC , Redfield  RR .  Universal masking to prevent SARS-CoV-2 transmission—the time is now.   JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.13107PubMedGoogle Scholar
3.
Leung  NHL , Chu  DKW , Shiu  EYC ,  et al.  Respiratory virus shedding in exhaled breath and efficacy of face masks.   Nat Med. 2020;26(5):676-680. doi:10.1038/s41591-020-0843-2 PubMedGoogle ScholarCrossref
4.
Wang  X , Ferro  EG , Zhou  G , Hashimoto  D , Bhatt  DL .  Association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers.   JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.12897PubMedGoogle Scholar
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Lyu  W , Wehby  GL .  Community use of face masks and COVID-19: evidence from a natural experiment of state mandates in the US.   Health Aff (Millwood). Published online June 16, 2020. doi:10.1377/hlthaff.2020.00818.PubMedGoogle Scholar
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South Bay United Pentecostal Church, et al v Gavin Newsom, Governor of California, et al, 590 US _ (2020). On application for injunctive relief May 29, 2020. Accessed August 5, 2020. https://www.supremecourt.gov/opinions/19pdf/19a1044_pok0.pdf
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Flynn  M , Iati  M .  Georgia Gov Brian Kemp sues Atlanta over mask requirement as coronavirus surges in the state. Washington Post. July 16, 2020. Accessed August 5, 2020. https://www.washingtonpost.com/nation/2020/07/16/kemp-georgia-mask-mandates/
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 South Dakota v Dole, 483 US 203 (1987). Accessed August 5, 2020. https://supreme.justia.com/cases/federal/us/483/203/
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Institute of Medicine.  The Future of Drug Safety: Promoting and Protecting the Health of the Public. Washington, DC: National Academies Press; 2007.
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Administrative Duties of Commissioner, 42 USC (§904[b][1][A]). Accessed August 5, 2020. https://www.govinfo.gov/app/details/USCODE-2005-title42/USCODE-2005-title42-chap7-subchapVII-sec904
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