March 24, 2022

Experts call to create standardized criteria for mask mandates based on objective data; 5 criteria proposed

Medical masks

Throughout the COVID-19 pandemic, mask mandates have been met with confusion, disagreement and a lack of knowledge about the risks and benefits. Health and legal experts are calling for a move toward an evidence-based approach to instituting masking policies.

In an article forthcoming in the University of Dayton Law Review, the authors from Regenstrief Institute, the U.S. Department of Veterans Affairs, Indiana University School of Medicine, Brooklyn Law School and the University of Iowa propose applying five criteria to signal that a communicable disease poses significant risk to public health. Once those criteria are reached, local, state, and federal governments should introduce mask-wearing mandates.

“The creation, implementation, and enforcement of mask mandates have varied widely at all levels of government during this pandemic,” said author Michael Weiner, M.D., MPH, Regenstrief research scientist, director of the VA Health Services Research and Development Center for Health Information and Communication and professor of medicine at Indiana University School of Medicine. “This inconsistency has created many questions, doubts and frustrations. We believe that decision-making surrounding these policies needs to be more structured and objective.”

Face masks have been shown to protect both the people wearing them and the people nearby, decreasing the spread of infection. However, clear and justified criteria for requirements to wear masks indoors do not exist.

The authors proposed five criteria for mandates, with average seasonal influenza during 2010-2019 as a point of reference. They chose flu because the disease’s longevity has yielded common and accepted practices over many years. The five suggested data points are:

  • Contagiousness (R0 or the speed at which the disease spreads)
  • Vulnerability of communities to infection (rate of growth in the percentage of the national population that is infected)
  • Harm caused by the disease (cumulative deaths per week)
  • Severity of harm (infection fatality rate)
  • Direction of harm (percentage change in cumulative deaths per week)

Each criterion would be scored, and once the combined score becomes higher than that of seasonal influenza, masking policies would be put into place.

“There are many details to be worked out with this proposal,” continued Dr. Weiner. “But our goal with this article is to generate conversation so that when our country is facing this type of public health crisis, we are ready to make policy decisions based on data.”

“Index-Based Policy to Guide Mask-Wearing for SARS-CoV-2 and Other Pandemic” is available online ahead of print.

The other authors of the article are Sandeep Puri, MPP of Brooklyn Law School, and Eli N. Perencevich, M.D., M.S. of The University of Iowa and the VA Iowa City Healthcare System.

About Michael Weiner, M.D., MPH

In addition to his role at Regenstrief, Michael Weiner, M.D., MPH, is the principal investigator and director of the VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, and a professor of medicine at Indiana University School of Medicine.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About the VA Health Services Research and Development Center for Health Information and Communication

The Health Services Research and Development (HSR&D) Center for Health Information and Communication (CHIC) hosts a diverse cadre of researchers joining together to transform the healthcare system, both within and outside the VA, so that every patient receives consistent, high-quality care.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability.

  • Michael Weiner, MD, MPH

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