Consensus advice from the medical community
Facial coverings are a safe, simple and low-cost public health measure that have been proven to reduce transmission of COVID-19 as recommended by both the CDC and WHO as of April and June 2020 respectively. Facial coverings are essential in the mitigation of transmission, especially while the virus remains active in our communities. Facial coverings are in fact the strongest protection found to date to mitigate the spread of the virus. Facial coverings are especially important in settings where people gather indoors because they reduce the concentration of the virus that accumulates in the air, thereby protecting others and allow indoor gatherings to be safer. They remind us to social distance and of our shared responsibility to protect one another and ourselves since facial coverings have also been shown to reduce the amount of virus inhaled.
As elected officials, your science-based decisions to institute local County mask orders were critical in helping flatten the curve, which allowed the collective community response to safely reopen schools, retail establishments and entertainment venues. The common approach taken by the leadership of the counties that comprise the Tampa Bay region has provided confidence to consumers and consistent expectations for businesses, which allowed businesses to resume safe operations. It is this careful balance – promoting health and safety while also promoting economic stability and growth – that will help this region stay on top of this crisis and emerge a stronger community.
It is critical that consistent orders requiring face coverings be maintained across our region until there is minimal community transmission of COVID with no evidence of exposure in large communal settings. That said, facial coverings will continue to be recommended as the most powerful public health tool we have against COVID-19 long after there is no longer a need for the face covering orders to continue. Facial coverings should still be required in high-risk congregate settings such as long-term care facilities and schools.
The following evidence-based thresholds, when achieved, would indicate that transmission of the virus is occurring at a level low enough to support relaxing existing face covering orders. A decision to relax these orders would also be based on reviewing all the available data, such as: testing volume and additional epidemiologic metrics that are important early indicators of viral transmission, such as emergency room visits for influenza-like illness, or of an increase in illness severity, such as hospital admissions for COVID-19. The two thresholds recommended represent positive indicators of the success of ongoing mitigation measures and once achieved and sustained, should inspire further confidence in the public that it is safe to fully re-engage the economy. The two indicators, Incidence rate and Test Positivity rate are easily reported, well understood and provide a robust estimate of the level of community transmission. Of note, the thresholds recommended approximate where we were as a region as of June 1, 2020. And, as was the case earlier, if these numbers increase and exceed these thresholds, the mitigation measures should be re-instituted in order to once again flatten the curve.
Evidence-based Thresholds that are recommended be met across the Tampa Bay Region (Hillsborough, Pasco and Pinellas Counties) to support consideration of rescinding the mask order for any County.
- Incidence rate (the rate of occurrence of new cases) is at or below three new cases per 100,000 population per day on a seven-day rolling average over four consecutive seven-day periods (two incubation periods) as reported by FDOH each Sunday.
For clarification, this would mean no more than an average of 45 new cases a day in Hillsborough, 14 new c-Cases a day in Pasco and 30 new cases a day in Pinellas.
- Test Positivity rate: three % or less on a rolling seven-day average for four consecutive weeks (two incubation periods) as reported by FDOH each Sunday.
References
Threshold Metrics
- Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission
- Indicators for Dynamic School Decision-Making
- Key Metrics for COVID Suppression
Facial Coverings: Effectiveness
- Considerations for Wearing Masks
- Coronavirus disease (COVID-19) advice for the public: When and how to use masks
- Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020
- Face Masks Against COVID-19: An Evidence Review.
- Identifying airborne transmission as the dominant route for the spread of COVID-19
- Physical Distancing, face masks, and eye protection to prevent person-to person transmission of SARS-CoV2 and COVID-19: a systematic review and meta analysis
- What The data Say About Wearing Face Masks
- Respiratory virus shedding in exhaled breath and efficacy of face masks
- Surgical Mask Partition Reduces the Risk of Noncontact Transmission in a Golden Syrian Hamster Model for Coronavirus Disease 2019 (COVID-19)
- Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020
Facial Coverings: Impact on PH and Economy
- Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US
- Face Masks and GDP
- Trends in COVID-19 Incidence After Implementation of Mitigation Measures — Arizona, January 22–August 7, 2020
- Association between SARS-CoV-2 infection, exposure risk and mental health among a cohort of essential retail workers in the USA
Contributors
Doug Ardoin, MD, AdventHealth
Margarita Cancio, MD. Infectious Disease Associates of Tampa Bay
Ulyee Choe, DO, FDOH- Pinellas
Michael Cromer, MD, Hillsborough County Medical Association
John Curran, MD, Hillsborough County Healthcare Plan Advisory Board
Patty Emmanuel, MD, USF- College of Medicine and Advisory Group Hillsborough County Public Schools
Claudia Espinosa, MD, USF- College of Medicine and Advisory Group Hillsborough County Public Schools
Sandra Gompf, MD, James A Haley VA
John Greene, MD, Moffit Cancer Center
Douglas Holt, MD, FDOH- Hillsborough
Rachel Irby, MD, HCA Healthcare
Seetha Lakshmi, MD, Tampa General Hospital and USF College of Medicine
Marissa Levine, MD, USF-College of Public Health
Allison Messina, MD, Pediatric Infectious Disease and Medical Advisory Group for Pinellas Schools
Mike Napier, FDOH- Pasco
Dean Donna Petersen, ScD, USF-College of Public Health
Edward Rafalski, Ph.D., BayCare Health System
Tom Unnasch, Ph.D., USF- College of Public Health
