Medical Masks for All
But until now, the policy discussion in the United States has focused on the use of cloth face masks, as opposed to the more effective medical masks in use across South Korea, Japan, Singapore, and Taiwan, all of which (not coincidentally) have seen lower growth in the spread of the virus. There is compelling evidence that medical masks, such as N95 respirators and surgical masks, are more effective than their cloth counterparts. But a politics of scarcity has locked us into a false dichotomy of choosing to protect supply for health-care workers or mask effectiveness for the general public.
We don’t have to make that choice. The United States has the financial resources to marshal industrial power and create the mask abundance we need through massive government purchase guarantees. This is primarily a question of political will.
Cloth masks are a good and useful DIY approach to public safety, and the general public should be encouraged to use them until medical-mask supplies increase. But contrast the U.S. approach of endorsing cloth masks with that of South Korea, which has set a production goal of two medical masks per person per week, while acknowledging that one per person per day would be the ideal. And for good reason: A randomized trial found that “penetration of cloth masks by particles was almost 97% and medical masks 44%,” and another study found that “the surgical mask was 3 times more effective in blocking transmission than the homemade mask.”
The success of the South Korean approach (which includes a rigorous “test and trace” model in addition to broad public use of surgical masks) has enabled them to begin relaxing their social-distancing measures and return to work as COVID-19 cases decline. If we applied this same production goal to the U.S. population, we come to a figure of 656 million masks per week.
Not all of these need to be the specialized N95 respirators used primarily by health-care workers. For the general public, surgical masks will likely achieve most of the protection benefits at a lower cost than N95 respirators. Surgical masks have fewer production bottlenecks than N95 respirators, which require more-specialized fabric weaves than those used in surgical masks, and fewer regulatory barriers as the FDA waived its normal pre-market-notification requirements on March 25. Based on these factors, it seems more realistic to increase surgical-mask production up to the necessary magnitude. But given urgent shortages for health-care workers, we should still be looking to rapidly scale up the production of both.
As my colleague Alec Stapp and I lay out in a new paper for the Mercatus Center, the best way to do that is through massive government purchase guarantees. One of the biggest deterrents to private production is a huge amount of demand uncertainty. During the H1N1 scare in 2009, U.S. manufacturers thought there would be a boom in face-mask demand and responded by doubling their staff and spending millions in new, expensive factory equipment. But the crisis ended sooner than anticipated and many firms were left holding the bill and on the brink of bankruptcy as mask prices plunged. Similar concerns about the length and breadth of demand are keeping producers from fully exerting themselves to meet this challenge.
If we want manufacturers to increase their production capacity by five, ten, or 20 times to produce the masks we need, they will need some form of a guaranteed market or assurances for how long this period of elevated demand will last. Essentially, the federal government would pledge to buy a large number of masks over a set period of time — say, 656 million per week for at least nine months — at above market prices, if necessary. You could think of this as a large shockwave flowing through the economy using the price system to yell “this thing and all of its inputs are important” as factories and their hosts of supply chains all scramble to retool.
Because the externalities of public mask-wearing are so large (the social benefits of slower viral spread are much larger than any individual benefit from wearing a mask), there is a strong economic case for the government to spend lots of money to ensure a robust mask market and then provide them for free to everyone. St. Louis Federal Reserve president James Bullard estimated recently that the shutdowns cost around $25 billion a day, so there is a lot of financial room to maneuver if it helps us get the virus under control more quickly.
Public mask-wearing might need to continue until we find an effective vaccine or medical treatment for the virus. We’re looking at a range of three to 18 months of surged mask demand. This is a huge amount of uncertainty for individual producers, but not so much for the federal government to handle.
Try to think for a moment — what would it really mean to have “too many” surgical masks in the U.S. strategic supply? They keep fairly well in storage, and it’s become clear that our stockpiles were woefully unprepared for a pandemic like the one we are currently facing. We can partially remedy that for the future through a massive purchase order (in fact, we need a larger effort to increase our stockpiles of critical medical equipment more generally). We can donate any excess masks to low-income countries facing this crisis that don’t have the financial resources of the U.S. government. Either way, it’s an investment worth making.
Think about the practical effects this kind of abundance would create. There wouldn’t be a need to downplay the difference in effectiveness between medical and cloth masks for fear of increasing shortages. No longer would we need to worry about random profiteers trying to hoard mask supplies and sell them online. We could enable humane police enforcement of mandatory-mask laws by simply giving out surplus masks on the street and on the subways. Not to mention the increased manufacturing employment opportunities that could help offset some of the job losses our nation has faced in the last few months.
Whatever path to normalcy we take, it will almost certainly require broad public mask-wearing in tandem with ramped-up testing and contact tracing. But we shouldn’t fool ourselves into thinking that cloth masks are more than a stopgap. Professionally made masks are much better at protecting us than bandanas tied around our mouths. The country that sent a man to the moon can defeat mask scarcity if we’re willing to spend the money.
Image credit: Halfpoint