Fauci: Wear a Mask Even When COVID Vaccine Comes

When the vaccine for coronavirus disease 2019 (COVID-19) finally arrives, people should keep on wearing masks, says a viewpoint in today’s JAMA Network which includes Anthony Fauci, MD, as one of its co-authors. “As countries around the world seek to safely reopen businesses, schools, and other facets of society, mask use in the community to prevent the spread of SARS-CoV-2, in conjunction with other low-cost, low-tech, commonsense public health practices, is and will remain critical,” writes Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID) and 2 other NIAID investigators, Andrea M. Lerner, MD, and Gregory K. Folkers, MS, MPD. “Return to normalcy will require the widespread acceptance and adoption of mask wearing and other inexpensive and effective interventions as part of the COVID-19 prevention toolbox.”

In other words, the more mundane methods for avoiding COVID spread will still be needed.

“While results of phase 3 trials for multiple candidate vaccines are on the near horizon, ‘low-tech’ tools to prevent the spread of SARS-CoV-2 are essential, and it must be emphasized that these interventions will still be needed after a vaccine is initially available,” write Fauci, Lerner and Folkers.

That’s the case even if the COVID vaccine proves to be highly effective and the public buys into taking it, neither of which can be assumed at this point. That much was made clear last week during a meeting of the US Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee. As reported by Infection Control Today®, the FDA committee listed numerous obstacles that would make a COVID-19 vaccine the answer to the pandemic by itself. To take one such obstacle: challenge trials. They have to be performed on relatively young and healthy people. But COVID-19 is most lethal against older people who may have co-morbidities and a compromised immune system.

In the JAMA Network viewpoint, Fauci, Lerner, and Folkers write that the implementation of mask wearing mandates probably averted more than 200,000 cases of COVID-19 by May 22, 2020. (Fauci, who is also a high-profile member of the White House Coronavirus Task Force, is the director of the NIAID, which is a division of the US Centers for Disease Control and Prevention.)

They admit the difficulties involved with testing the efficacy of mask wearing through either randomized control trials or observational studies. “To understand the rationale for mask wearing to prevent SARS-CoV-2 transmission, it is helpful to understand how the virus spreads from person to person,” write Fauci, Lerner and Folkers. They continue: “The epidemiology of SARS-CoV-2 indicates that most infections are likely spread through exposure to an infected individual at close range, within about 6 feet. However, recent reports indicate that aerosols remaining in the air over longer distances or times also have been involved in SARS-CoV-2 transmission in certain circumstances, often in poorly ventilated enclosed spaces and associated with behaviors such as singing, shouting, or breathing heavily during exercise.”

Because of this, the CDC recently updated its social distancing guidelines. The updated guidelines say that the contact doesn’t need to be for 15 or more consecutive minutes. The contact could constitute multiple encounters with an infected person of 6 feet or less that adds up to 15 or more minutes.

“Respiratory droplets are produced not only by coughing and sneezing, but also when speaking and simply breathing,” write Fauci, Lerner and Folkers. “Light-scattering experiments indicate that 1 minute of loud speaking potentially can generate more than 1000 virion-containing aerosols that may linger in the air in a closed, stagnant environment. These particles may accumulate in enclosed spaces with poor ventilation, especially when individuals are singing, shouting, or breathing heavily (eg, with physical exercise). Therefore, the commonly observed practice of individuals removing their mask when speaking is not advisable.”

And just as a COVID vaccine won’t provide an answer solely by itself, the same can be said about testing.

“Widespread testing for SARS-CoV-2 infection is also important but insufficient on its own for pandemic control,” Fauci, Lerner and Folkers write. “No test is perfect; all have a lower limit of detection for viral material and the potential for false negatives. In addition, the result of a test represents just one point in time and does not indicate an individual’s status outside of the moment the specimen was collected.”

They write that the anti-COVID toolbox includes masking, hand hygiene, social distancing, “prompt testing (along with isolation and contact tracing), and limits on crowds and gatherings. If a vaccine has only moderate efficacy, or if vaccine uptake is low, these other modalities will be even more critical.”