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Berkeley
Pharma Tech
Journal of Medicine

Correspondence:� 
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Keywords: 
COVID-19 
Masks� 
Mask mandates 
Public policy 
SARS-CoV2 

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Full Open Access

Creative Commons Attribution� 
License 4.0

Abstract
On March 11, 2020, the world came to a standstill in a truly unprecedented manner. Shut-
down schools, empty grocery aisles, and barren streets shifted from unfamiliarity to the 
new normal. Perhaps the most significant of these changes was the widespread usage of 
protective masks to curb the spread of SARS-CoV2, more commonly known as COVID-19. 
Along with the constant influx of changes resulting from the COVID-19 pandemic has 
been an onslaught of controversy regarding whether individuals should be legally required 
to wear masks. As of March 11, 2022, several states have announced that masks are no 
longer mandated. From what has been observed, there are two major stances on this 
subject — those who oppose the lifting of the mandate, and those who are in favor. This 
has provided a unique opportunity to demonstrate the tenuous relationship between public 
policy and scientific fact, and how the two are not mutually exclusive. This analysis seeks 
to dissect these views and present the findings through an evidence-based lens.

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Introduction
When the pandemic �rst began, much was unknown about the
transmission mechanism of SARS-COV2. It was known that the virus was
transferred from human to human, but it was not until the fall of 2020 that
the CDC reported that SARS-COV2 is an airborne virus, meaning that the
respiratory droplets of an infected individual can be transmitted to another
through actions such as speaking, coughing, and sneezing. An infectious
exposure constitutes inhaling viral particles, the deposition of the virus on
mucous membranes (i.e. mouth, nose, eyes), or touching one’s mucous
membranes with contaminated surfaces1. Given that the transmission is
respiratory in nature and the face has many points of potential viral entry,
experts proposed the implementation of masking around other people to
minimize the spread of COVID-19. Initially, due to resource limitations,
cloth masks and bandanas were acceptable for this purpose. As time went
on and cases reached record-breaking highs, there was a transition to surgical
masks and N95s, which are specially designed to have a high �ltration
capacity to block small respiratory particles2.

Mask controversy
As of March 12th, California is one of the many states that have lifted mask
mandates. Those who are in favor of this decision, alongside even
anti-vaxxers, have voiced their opinions as to why it was the right choice.
Perhaps one of the most commonly discussed reasons is the inconveniences
that come with mask use, including di�culty breathing, communicating,
and many complaining of the discomfort of wearing a mask for long hours3.
There are many voices that believe that requiring masks is an infringement
of civil liberties, as it takes away one’s sense of bodily autonomy3. In a survey
published by the National Panel Study of COVID-19, it was found that
24% of Americans refrained from wearing a mask due to discomfort, while
40% did not wear one because they simply believed it was their fundamental
right to decide4. These two factors alone accounted for more than half of
the respondents who participated in the study.

Others believe that masks perpetuate fear. This is especially a topic of
concern among minority groups, with African Americans reporting the fear

Berkeley Pharma Tech Journal of Medicine | 140



of presumed criminality due to the racial discrimination that still prevails in
the U.S. today5. In addition to racial concerns, the mask itself has become a
de facto symbol of the pandemic, a visual representation and reminder of the
loss and trauma that has ensued, as well as the uncertain future6. Many
believe that the perception of risk can be equally, if not more, detrimental
than the risk of being infected with the virus itself, demonstrating the
importance of sociological factors when it comes to understanding the
American mask controversy.

Another salient impact of the pandemic has been that of politics being
brought to the forefront of public discussion. While some believe that the
decision to wear a mask should be purely based on scienti�c data, the reality
is that partisan political a�liation has a signi�cant impact on the matter.
According to public opinion polls, those on the more liberal end of the
political spectrum are more likely to wear masks compared to conservatives3.
Published in the journal Preventive Medicine, a study analyzing COVID-19
related risky behaviors and party a�liation found that Republicans were less
likely to wear a mask for 4 of the 6 activities included in the study7. This is
also supported by a probability-based online survey by the Gallup Panel,
reporting that 70% of Republicans wear a mask in indoor settings,
compared to a rate of 97% in the Democrat population8.

The opposing view regarding the lifting of the mask mandate is that it is
simply too early to make this transition. Those with this view have a variety
of reasons as to why mask use should be continued, the common thread
being safety. As of April 2022, COVID-19 transmission has been
signi�cantly lower; however, cases and COVID-related deaths still occur
regularly9. Furthermore, despite low transmission rates, certain locations
such as gyms, restaurants, and co�ee shops are considered to pose a much
higher risk than others10. Public transportation also ranks high on this list,
with its high risk being associated with the close proximity to others as well
as the exposure to frequently touched surfaces11. Another point presented is
the fact that humans are often asymptomatic carriers of COVID, which
contributes to the high transmissibility of the virus. In these cases, wearing a
mask has been reported to be highly e�ective in mitigating the spread12.

Berkeley Pharma Tech Journal of Medicine | 141



Expert opinions indicate that it is likely too soon to eliminate mask usage
completely13. According to sources from Johns Hopkins University, while
COVID-19 cases and hospitalization rates are declining, there are risks to
consider when assessing the removal of the mask mandate. CRC
vaccinology lead, Dr. William Moss, describes this as a time to practice
“cautious optimism,” the hope being that cases will continue to decrease,
and any additional variants will not overcome the immunity that has been
acquired through natural infection as well as vaccination13. That being said,
it has been shown that around 35% of the population still remains
unvaccinated, despite the U.S. having one of the highest COVID mortality
rates when compared to those of other countries. This discrepancy is
exacerbated by the disparity seen in vaccination between younger and older
populations (Fig 1). Medical director of the Johns Hopkins Biocontainment
Unit, Brian Garibaldi, expresses particular concern over school-aged
children, with reports indicating that only 25% of children between the ages
of 5-11 are fully vaccinated; these numbers are even lower in the younger
cohort13. Considering the FDA approval of COVID-19 booster shots for all
adults in November of 2021, these numbers will likely increase as time goes
on18. Similarly, other populations of concern are the immunocompromised,
those with comorbidities, and the elderly14. Those who are highly
susceptible to respiratory infections would greatly bene�t from masking,
ideally using a KF94 or KN95 mask for maximal protection, despite the
recent lifting of restrictions. Experts have also vocalized the importance of
addressing COVID-19 misinformation. This includes myths such as the
idea that herd immunity makes vaccination unnecessary, or the claim that
heated water supposedly protects one from contracting the virus. Many of
these erroneous claims have been observed on social media platforms,
ultimately adding to the already existing confusion surrounding masking;
these issues can be addressed through the thorough reform of online data
sharing regulations15.

Berkeley Pharma Tech Journal of Medicine | 142



Figure 1. Percentages of fully vaccinated people receiving a first COVID-19 booster dose.

Image credits: covid.cdc.gov

Conclusion
Based on this analysis, it can be concluded that the decision to wear a mask
cannot be adequately addressed using an all-or-nothing approach15. While
cases and COVID-related deaths have been signi�cantly reduced, the
pandemic persists, and the virus remains unpredictable, as it is still evolving
into novel variants14. Currently, due to relatively low transmission rates, it is
the logical choice to provide more autonomy to the public. It is important
to note that this does not mean eliminating mask wearing under every
circumstance, but rather that the decision should be made individually, after
weighing risks and bene�ts. Co-director of the National Preparedness
Leadership Initiative, Dr. Leonard Marcus, reinforces the idea that low risk
is not the equivalent of no risk, which is critical to keep in mind during this
period of transition14. Certain cohorts that are at an increased risk of
contracting the virus, such as immunocompromised individuals or those
with underlying health conditions, should ideally continue to mask at this
time. Vaccination status is also a crucial factor to consider, as increasing
these rates could further reduce the necessity of masking. As of now, the US
has much room to improve in this area. Ultimately, regardless of one’s
stance on masking, it is a practice that is proven to be e�ective in mitigating
the spread of the virus (Fig 2).

Berkeley Pharma Tech Journal of Medicine | 143



Figure 2. Average of new daily COVID-19 cases in non-mask-mandated vs.
mask-mandated counties19. Image credits: cdc.gov

Moving forward, it will be important to address COVID-19
misinformation which has unfortunately plagued the news media and
various other online platforms. Moreover, the importance of making
decisions based on scienti�c fact rather than political opinion should be
emphasized to the public as well. Further research is needed to identify
novel strategies to combat the spread of false information, with the
optimization of online data showing great promise in this regard16.

Berkeley Pharma Tech Journal of Medicine | 144



References

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