A Libertarian Case for a Temporary, Partial Face Mask Mandate During the COVID-19 Pandemic

In a democratic society, crises are not only a stress test for our institutions, but they test how much freedom we truly have, even in a pandemic. Fear is one of the greatest enemies of freedom. In the middle of a pandemic and millions panicking, it becomes more difficult to discern which measures are legitimate precautions in which the inconvenience is justifiable and which measures encroach on our right to life, liberty, and the pursuit of happiness. Wearing a mask in public, although it is hardly the most inconvenient measure throughout this pandemic, has become symbolic of the political polarization in this country. The divide is similar to that we see in terms of who wants to keep the lockdowns going and who wants to lift them. Look at the poll results from an Ipsos poll showing the difference of 22 percentage points in mask usage between Republicans and Democrats. Those who are against the masks see those wearing masks partaking in virtue-signaling and overreacting. I heard one such individual recently ask, "If the masks are so effective, why do we need the lockdown?" Those who are for the masks see those choosing not to wear the masks as reckless individuals who are part of the problem. Below are two memes to illustrate the pro-mask side.

Part of what makes the face mask debate confusing is the inconsistent and contradictory guidance that is out there. In late February, the Surgeon General advised against face masks before changing his mind because of all of the pre-symptomatic and asymptomatic cases of COVID-19. The CDC subsequently recommended in early April that people wear masks when going out. If that were not enough, the World Health Organization (WHO) in early April said that "no evidence that wearing a mask (whether medical or other types) by healthy persons in the wider community setting, including universal community masking, can prevent them from infection with respiratory viruses, including COVID-19." The advice of the Belgian Federal Public Service of Health is that masks have value when in a hospital or laboratory, but generally wearing it in public provides no value. Professor Ben Cowling at the Hong Kong School of Public Policy opines that masking the healthy would unlikely help stop the spread of COVID-19. If the science were really that intuitive and straight-forward, I don't think there would be need for the debate. That is why trying to get past the confusion is helping in guiding public policy and best practices in these matters.

Given that COVID-19 is primarily spread through respiratory droplets, it would make sense that masks could stop the spread of COVID-19. Also, the number of asymptomatic or pre-symptomatic individuals could provide a basis for the masks. However, as McGill University points out, there is little evidence that non-medical cloth masks work. According to Professor Paul Hunter from Britain University, it is difficult to conduct a proper clinical trial because of the number of variables involved. Research on previous respiratory diseases does not provide us definitive answers, as we see below.

Research Supporting Masks

• A randomized trial from Berlin shows that household transmission of influenza can be reduced by face masks (Suess et al., 2012).
• A systematic review from Cambridge said that there is some evidence of the effectiveness of wearing masks to protect others, but fewer data to support the idea that it prevents becoming infected (Cowling et al., 2010).
• Another systematic review shows how N95 and surgical masks are the among the most consistently successful of physical interventions for preventing respiratory infections (Jefferson et al., 2011; also see Jefferson et al., 2008 and Leung et al., 2020).
• A couple of dozen laboratory simulations show that N95 and surgical masks can prevent viral particles from getting through (Smith et al., 2016). However, this study also showed the N95 masks do not fare better than surgical masks. 
• One study found that surgical masks are three times as effective as home-made cloth masks, but that cloth masks are still effective in preventing spread (Davies et al., 2013).
• Tangentially, I could cite an additional concern about moral hazard since a false sense of security could either incentivize abandoning other preventative measures or give people greater incentive to go to places where they could be more likely to contract COVID-19.  At the same time, no research suggests that moral hazard would play a strong enough role to argue against face masks.

Research Not Supporting Masks

• A randomized control trial goes as far as saying that there is no effect of N95 masks (MacIntyre et al., 2010). 
• One study shows that there a 97 percent penetration rate of cloth masks, as opposed to the 44 percent for surgical masks. (MacIntyre et al., 2015). This study also points out that cloth masks carry the extra risk of trapping virus-containing droplets. 
• Another study shows that a filtering face piece (FFP) mask is about 50 times more effective at protection than a cloth mask (van der Sande et al., 2008), which implies that cloth masks cannot be more than two percent effective.
• A randomized trial of mask use among college students from the 2006-07 influenza season. While there was a reduction in influenza, the authors could not contribute it to mask usage alone (Aiello et al., 2010). 
• A paper as recently as this April used 14 randomized trials. It found that there was no reduction in influenza-like cases for influenza in the general population, nor amongst healthcare workers (Jefferson et al, 2020). 
• It also depends on how often the masks are used and washed. If they are not laundered regularly, it could actually be worse to wear a mask (MacIntyre et al., 2020).
• A randomized open-label trial of pilgrims attending Mecca in Saudi Arabia found no difference in viral respiratory infection between mask wearers and those who weren't wearing masks (Alfelali et al., 2019).

At a time we need clarity, we have confusion and contradictory findings within the research for masks. Rather than say "a case could be made in either direction," let us not forget that poor evidence quality is not the same as no evidence. There is a stronger case to be made for N95 masks and surgical masks than there is for cloth face masks. Additionally, as Johns Hopkins infectious disease specialist Dr. Amesh Adalja brings up, COVID-19 is not airborne; you need droplets to transmit it from one person to another. Consequently, there is a stronger argument for face masks in closed spaces indoors (e.g., the grocery store, public transit) than is for the outdoors. As a matter of fact, the benefits of going outside without a mask outweigh the potential costs, especially since germs simultaneously dilute and decay with outdoor air.

Another point worth mentioning is that there is more evidence, especially for cloth face masks, that face masks slow the rate of transmission than there is evidence that they prevent catching the respiratory disease. Failing to meet one of those criteria does not disqualify the argument for masks. As a matter of fact, I made an argument about having a brief waiting period for purchasing a gun. Although there really isn't evidence that waiting periods lower the homicide rate, they do lower the suicide rate, which is why I was okay with a temporary inconvenience in that instance.

As someone who identifies as libertarian, I have argued on numerous occasions that one should be able to live their life as long as they are not harming others. Believe me when I understand the sentiment behind "life, liberty, and pursuit of happiness." At the same time, when there is an overriding public health concern in which your decisions could very well affect another, that is a different discussion. Back in 2013, I laid out the case for a partial smoking ban [in indoor public places] on the grounds that second-hand smoke is a negative externality that affects other people's health.

I can make a similar argument for face masks in the middle of this pandemic, and I am not the only libertarian to do so. Human beings have control over one's actions, but we do not have control over what pathogens do, whether we contract a certain pathogen, or whether we transmit a certain pathogen. Unlike the unnecessary lockdowns, there is not a clear economic cost. As a matter of fact, one study shows that face masks actually contribute to a net positive economic benefit (Tracht et al., 2012). As far as convenience goes, face masks are nowhere in the magnitude of the lockdowns causing people to stay at home and lose their livelihoods. There is a clear public health justification that justifies wearing masks: stop the pandemic from getting worse.

If an individual voluntarily decides to wear a face mask, I certainly don't take issue. If a business voluntarily decides to require a face mask for entry to its establishment, I don't mind. After all, "no shirt, no shoes, no service" has existed for quite some time. Where I struggle a bit is whether there should be a mandate.  

As the Foundation for Economic Education (FEE) reminds us, "Good ideas generally don't require force." Normally, I would agree and say that voluntary wearing of masks would be adequate. At the same time, communications from public health officials has been unhelpful and confusing, so FEE's argument doesn't work so well in this case. I also have concerns about enforcement, not to mention the poor evidence quality for the face masks (particularly cloth face masks).

Even so, I think my bottom line is the following. As you can imagine, I am generally not a fan of government mandates. After all, look at all of the government regulations that existed prior to the pandemic that made our response to COVID-19 worse than it needed to be. The research quality on face masks is far from being as definitive as I would like. At the same time, the lack of economic cost and potential public health benefits outweigh the inconvenience of having to wear a mask. As such, I think there is an argument to be made for a partial face mask mandate for certain indoor spaces. I would also caveat it by saying that this temporary mandate should be in place as long as the rate of transmission [R0] is still high (we can argue about that, but I would say any R0 greater than 1.0, but maybe a bit lower to be sure).

Face masks are not a silver bullet. They are not going to make the pandemic go away, but they are part of the goal of flattening the curve in order to slow the rate of transmission and to not overwhelm hospitals. Masks should be accompanied with other such measures as washing your hands and social distancing. Under normal circumstances, I would sympathize with the anti-authoritarian sentiments and say "my body, my choice" or "don't tell me what to do with my life." However, these are far from normal times. We are in the middle of a pandemic, and pathogens do not play by the same rules as we do. There could end up being some disconcerting policy decisions that would make me leery, but wearing face masks is not a slippery slope into an Orwellian dystopia. Defiantly not wearing masks is not a sign of freedom. Freedom comes with choice, but it also comes with the responsibility for the consequences of your actions. In this case, we need to wear masks to make sure that we do not violate another's right to life, liberty, and pursuit of happiness. Let's wear the masks and slow the transmission of COVID-19 so we can resume some semblance of normal living soon.