Face masks during the COVID-19 pandemic in the United States

The wearing of non-medical face masks in public to lessen transmission of COVID-19 in the United States was first recommended by the CDC on April 3, 2020 as supplemental to hygiene and appropriate social distancing. Over the course of the pandemic, various states, counties, and municipalities have issued health orders requiring the wearing of non-medical face coverings — such as cloth masks — in spaces and/or businesses accessible to the public, especially when physical distancing is not possible. Some areas only mandated their use by public-facing employees of businesses, although these narrower orders have since been superseded in multiple states by a general mandate. Federal officials initially discouraged the general public from wearing masks for protecting themselves from COVID-19. In early April, federal officials reversed their guidance, saying that the general public should wear masks to lessen transmission by themselves, particularly from asymptomatic carriers. Public health experts such as Larry Gostin stated that federal officials should have recommended mask-wearing sooner; others noted that US government guidance lagged significantly behind mask recommendations in East Asian countries and likely exacerbated the scale of the pandemic in the United States. In September 2020, it was reported that the government had contemplated leveraging the United States Postal Service to distribute free reusable masks nationwide as early as April, but that it had scrapped the plan due to concerns it could "create concern or panic". The wearing of face masks has become divisive among Americans. Some have considered them to be a sign of vulnerability, while attitudes have also varied along the political spectrum; those on the left have been more receptive to the practice, seeing it as a sign of respect towards others, while those on the right have largely considered mask mandates to be an infringement of their personal liberties, and a symbol of fear, control, and opposition towards President Donald Trump. Likewise, it was observed that Republican-led states were, initially, less likely to impose health orders requiring the wearing of masks than Democratic-led states. Several states, including Arizona, Georgia, and Texas, took actions to block localized health orders requiring masks, but later softened their stances to help control local spikes. Trump largely resisted wearing masks in public media appearances. He has not mandated their use at his rallies and other public 2020 campaign events. After briefly encouraging their use in mid-July, Trump continued to hold campaign events (such as the 2020 Republican National Convention) where masks were not widely used. Trump has mocked and ridiculed Joe Biden, his Democratic opponent in the 2020 presidential election, for wearing face masks in public appearances. Biden, House Speaker Nancy Pelosi, Michigan Attorney General Dana Nessel, and other critics have criticized Trump's refusal, calling it dangerous and irresponsible. A lack of precautions (such as masks) taken during crowded White House ceremonies and receptions by Trump on September 26 were credited with having possibly resulted in a COVID-19 outbreak at the White House, which included Trump himself. Recommendations- Early recommendations against masks to protect the wearer: Initially, the U.S. government did not recommend the use of face masks by the general public outside of medical settings to protect themselves from COVID-19, as to prevent shortages of medical-grade personal protective equipment (PPE) for doctors treating COVID-19 patients. In February 2020, Surgeon General Jerome M. Adams stated that proper hygiene and getting a flu vaccine were appropriate preventive actions to be taken by the public, and stated on Twitter that masks should be saved for healthcare professionals, and that they were "NOT effective in preventing the general public from catching Coronavirus". CDC director Robert R. Redfield also stated that healthy people did not need to wear masks. In a March 8 interview with 60 Minutes, Director of the National Institute of Allergy and Infectious Diseases Anthony Fauci similarly argued that "when you’re in the middle of an outbreak, wearing a mask might make people feel a little bit better and it might even block a droplet, but it's not providing the perfect protection that people think that it is." Fauci again cited the need to conserve supplies of PPE for medical workers and those who were sick. In late March 2020, the Centers for Disease Control and Prevention (CDC) published a recommendation that masks be used by those who are sick, or are caring for someone who is sick and not able to wear a mask themselves, and discouraged their use by healthy members of the general public. This guidance was consistent with that of the World Health Organization (WHO) at the time. Recommendations towards using masks to reduce spread by wearer: In late-March 2020, some government officials began to focus on the wearing of masks to help prevent transmission of COVID-19 as opposed to protecting the wearer; Commissioner of Food and Drugs Scott Gottlieb stated in a report that face masks would be "most effective" at slowing its spread if widely used (citing Hong Kong and South Korea as examples), as "they may help prevent people who are asymptomatically infected from transmitting the disease unknowingly". On March 30, Director of the CDC Robert R. Redfield stated that the organization was evaluating data regarding use of masks by the general public. The next day, President Donald Trump suggested in a White House Coronavirus Task Force briefing that scarves or "something else" could be worn as face coverings. COVID-19 response coordinator Deborah Birx stated that the task force was discussing the addition of face masks to its guidance. On April 3, 2020, the CDC issued guidance recommending that non-medical face coverings be worn in public when social distancing is difficult to maintain, such as at grocery stores and pharmacies, and especially in areas with significant amounts of community transmission. The CDC published tutorials on making non-medical face masks, including a design only requiring a t-shirt and rubber bands, and no sewing. When asked by National Public Radio about the April 3 reversal, the CDC cited studies from February and March showing presymptomatic and asymptomatic transmission, and reports from Asian countries regarding the effectiveness of face coverings in this manner. Professor of public health Larry Gostin said that the CDC could have revised its recommendation sooner; by maintaining its initial recommendation throughout March, it had given the public the impression that widespread mask usage was ineffective even though scientific evidence to the contrary was already available. The earlier recommendation damaged the agency's credibility. In a May 27 interview with CNN, Fauci urged Americans to wear face masks in public as a sign of "respect" for others, and stated that he had been doing so himself "because I want to protect myself and protect others, and also because I want to make it be a symbol for people to see that that's the kind of thing you should be doing." On June 5, amid the George Floyd protests, Fauci warned that people not wearing face masks in crowds may "propagate the further spread of infection". On July 12, Surgeon General Adams stated that health officials were trying to "correct" their previous messaging, explaining that it was based on an earlier presumption that those who were asymptomatic were less likely to transmit COVID-19. He explained that Americans needed "to understand we follow the science and when we learn more our recommendations change, but it is hard when people are continuing to talk about things from three, four months ago"; a clip of the aforementioned 60 Minutes interview with Fauci (where he was quoted as saying "There's no reason to be walking around with a mask") has often been presented on social media by opponents of face masks as misinformation in support of their arguments. Fauci's statements were consistent with the CDC's guidance at the time, but do not align with current guidance. On July 14, the CDC published a study indicating that the use of masks by two employees of a Missouri hair salon who showed COVID-19 symptoms and later tested positive, as well as the 139 clients they served before their positive tests, "was likely a contributing factor" in preventing their clients from contracting COVID-19 from the employees. The same day, the Journal of the American Medical Association (JAMA) published an interview with CDC Director Redfield, where he estimated that the epidemic in the U.S. could be brought under control within four to eight weeks "if we could get everybody to wear a mask right now". On September 16, Redfield testified to the Senate Appropriations Committee that masks were the country's "most powerful public health tool", as they had "clear scientific evidence" that they worked, and that a potential COVID-19 vaccine only had an immunogenicity of 70%. Attitudes: Prior to the COVID-19 pandemic, the public wearing of face masks to protect others from oneself was not a widely accepted phenomenon in the Western world, and had historically been more prevalent in East Asian countries. The wearing of masks had historically been considered a symbol of protecting oneself from others. The issue of whether or not to wear a mask in public became, for some, a dividing line in the culture war between the supporters and opponents of President Trump. There have been instances of confrontations and violence among retail patrons refused service for not wearing masks, a Key Largo bus driver was arrested for swinging a metal rod at a passenger who lowered his mask to make a call on his cell phone, and a man was arrested in October 2020 for threatening to kidnap and murder the Mayor of Wichita, Kansas over the city's mask mandate. Opposition to the practice of wearing face masks, and to orders mandating face mask use, has led to historical comparisons with the Anti-Mask League of San Francisco from the Spanish flu pandemic of 1918–19. Political views: Politico described progressives as considering masks "a sign that you take the pandemic seriously and are willing to make a personal sacrifice to save lives". Supporters of the CDC's recommendations derided what they described as their opponents' ignorance, selfishness, antiscience stance, and lack of respect for fellow citizens. Masks have also been cited as a means of controlling COVID-19 without the need to reimpose stay-at-home orders or business closures (which would cause further economic strain). Opponents have invoked conspiracy theories to discredit proponents, and accused them of violating their freedoms, and inhibiting development of herd immunity. The wearing of face masks has been also been seen by opponents as virtue signaling for liberal values, and as a symbol of intimidation, social control, and opposition towards President Trump. While these health orders usually have exceptions for those with medical conditions (such as breathing problems) or disabilities that would make it difficult to wear a mask, false flyers distributed via social media encouraged people to claim to businesses requiring masks that they have a medical condition protected under the Americans with Disabilities Act, but that under the Health Insurance Portability and Accountability Act (HIPAA), they are not required to disclose the medical condition. The HIPAA is a data protection law for the health care industry, and does not actually apply in this manner. Opposing views against masks have also been promoted by conservative media outlets such as Fox News, and radio host Rush Limbaugh — who argued that masks were a "required symbol on the left to promote fear, to promote indecision, to promote the notion that we’re nowhere near out of this". Initially in March, Fox News pundits Tucker Carlson and Laura Ingraham endorsed the wearing of masks, with Carlson stating that "masks work", citing that they were "key" to controlling COVID-19 in East Asian countries, and criticizing the CDC for discouraging their purchase by the general public. After the practice became politicized, however, both pundits began to display opposition to masks on-air: in May, Carlson criticized Fauci for his fluctuating guidance on masks, and claimed that there was no scientific basis for a mask mandate issued in Los Angeles (referring to its residents as being "hostages" of Mayor Eric Garcetti). Some Fox News pundits however, including Sean Hannity and Fox & Friends host Steve Doocy, have been more receptive to masks on-air. The Washington Post reported that in an April 2020 poll, 79% of self-identified Democrats stated that they had worn a mask or other face covering in public, as opposed to 59% of Republicans. Those who knew someone who had been infected with COVID-19 were 40% more likely to wear a mask in public than those who didn't. A Gallup poll the same month similarly found that Democrats were more likely to wear masks than Republicans, at 75% to 50%. In a June 2020 survey by Politico and Morning Consult, 60% of those who said they supported the wearing of masks also stated that their opinion of the Trump administration was "very favorable". In late-June 2020, amidst a major surge in cases in multiple states (especially in the Sun Belt), support towards masks abruptly emerged among prominent Senate and House Republicans, in an effort to counter resistance towards the practice from President Trump. A Politico survey in July 2020 found that there was now bipartisan majority support for mask mandates, with 72% of those surveyed saying that they strongly or somewhat supported state-wide mask mandates that that are punishable by fines or jail, with 53% expressing strong support. This included 86% of self-identified Democrats surveyed, 58% of self-identified Republicans surveyed, and 68% of self-identified independents surveyed. During a rally on September 21, 2020, an attempt by Ohio Lieutenant Governor Jon A. Husted to promote Trump 2020 and Make America Great Again-branded face masks as campaign merchandise (as part of a stated goal to "try to make masks in America great again") to the crowd was met with boos, to which he remarked that they had "made their point". Among minorities: Concerns surrounding the politicization of masks have been especially prominent among minority communities, such as African and Asian Americans. Concerns were raised by African Americans that the wearing of masks may encourage racial profiling due to their association with their use by criminals to conceal identity, such as an officer shown handcuffing a black doctor wearing a mask steps from his home, and a police officer in Illinois following two black men wearing surgical masks as they exited a Walmart, and falsely claiming that the city prohibited the wearing of masks. There have also been incidents of discrimination and ethnic violence against Asian Americans who wear masks, as part of ongoing anti-Asian sentiment tied to the pandemic due to its Chinese origin. The April 2020 poll found that 32% of Hispanic and Latino Americans surveyed, and 30% of African Americans surveyed, were concerned that wearing a mask would cause them to be mistaken for a criminal, as opposed to 19% each of Asian Americans and whites. Despite this, larger proportions of people among minority communities said they had worn a mask in public than whites (66%), at 71% of Hispanic and Latino Americans surveyed, 74% of African Americans surveyed, and 82% of Asian Americans surveyed. In late-May and early-June 2020, masks printed with slogans related to the Black Lives Matter and police reform movements (such as "I can't breathe") attracted popularity amidst nationwide protests over the police killing of George Floyd. In June 2020, the United States Postal Inspection Service temporarily seized a shipment of face masks with the slogan "STOP KILLING BLACK PEOPLE", ordered by the Movement for Black Lives for distribution to those attending demonstrations in Minneapolis, New York City, St. Louis, and Washington D.C.. The Service stated that there "were indications that they contained non-mailable matter." Citing these concerns over racial profiling, Lincoln County, Oregon initially announced that it would provide an exemption for people of color from the county's mask mandate. However, following criticism, the county backtracked on June 24. Officials stated that "The expressions of racism regarding the exception has created a ripple of fear throughout our communities of color. The very policy meant to protect them, is now making them a target for further discrimination and harassment." Appearance of vulnerability: Refusal to wear a mask in public may be driven by a fear of being seen as vulnerable and fearful of COVID-19. In a May 2020 survey of 2,459 Americans conducted by Valerio Capraro of Middlesex University London and Hélène Barcelo of the Mathematical Science Research Institute, it was found that men surveyed were more likely to display negative stigmas towards wearing masks in public, including being more likely to agree that it was "uncool", "shameful", and a "sign of weakness". Capraro noted that these stigmas were more prevalent among residents of areas that had mandated the wearing of face masks. Reporting on the study, Ben Boskovich of Esquire wrote that "the phrase toxic masculinity gets thrown around a lot, sometimes more than necessary, if we're being honest. But this thing, this reality, that men are too blinded by their own inherent privilege to acknowledge their vulnerabilities, to admit they're wrong, to let go of the steering wheel, is as real as the president's hats are red.". By the Trump administration- Early views: During the April 3 Coronavirus Task Force briefing, President Trump emphasized that the CDC's new guidance on face coverings was merely a voluntary recommendation, and stated that he would not personally do so. When asked by a reporter about this preference, he replied, "I'm feeling good. I just don't want to be doing that. I don't know. Somehow sitting in the Oval Office behind that beautiful Resolute desk, the great Resolute desk, I think, and wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens, I just don't see it for myself." Trump subsequently avoided being seen wearing face masks during on-camera appearances (such as, in one case, a factory producing face masks). When visiting the Mayo Clinic on April 28, Vice President Mike Pence followed suit, despite the clinic having mandated the wearing of masks by all visitors and staff. Pence stated that he did not wear a mask because he was being regularly tested negative for COVID-19, and that "I thought it'd be a good opportunity for me to be here, to be able to speak to these researchers, these incredible health care personnel, and look them in the eye and say 'thank you'." When visiting a ventilator factory on April 30, however, Pence was seen wearing a mask. When touring a Ford Motor Company plant in Ypsilanti, Michigan for a media event on May 21, Trump wore a cloth mask inscribed with the presidential seal, but took it off before making an on-camera media appearance. Trump explained that he did not want to give the press the "pleasure" of seeing him wearing a mask. Following the visit, Michigan Attorney General Dana Nessel issued a warning to Ford for violations of state health orders requiring masks be worn in all enclosed public spaces. On Twitter, Nessel called Trump a "petulant child" who was "conveying the worst possible message" to the public, and stated that "I hope that the voters of Michigan will remember this when November comes, that he didn't care enough about their safety, he didn't care about their welfare, he didn't respect them enough just to engage in the very simple task, the painless task, the easy task of wearing a mask when he was provided one." Trump responded by calling Nessel the "do-nothing AG of the Great State of Michigan" and accusing her of "taking her anger and stupidity out on Ford Motor". He suggested that Ford "might get upset with you and leave the state, like so many other companies have — until I came along and brought business back to Michigan. JOBS!" After former vice president and presumptive Democratic presidential candidate Joe Biden wore a black mask and sunglasses during a Memorial Day ceremony (his first major out-of-home appearance in two months), Trump shared a Twitter post by Fox News commentator Brit Hume that ridiculed the outfit, captioned "This might help explain why Trump doesn’t like to wear a mask in public." In an interview the next day, Biden criticized Trump for sharing the post, and for being a bad role model for the American public. He argued that "presidents are supposed to lead, not engage in folly and be falsely masculine." During a subsequent media appearance, Trump described Biden's decision as being "very unusual", as "he was standing outside with his wife, perfect conditions, perfect weather." He added, "I thought that was fine. I wasn't criticizing him at all. Why would I do a thing like that?" After a reporter refused a request by Trump to take off his mask because it had muffled his voice, Trump accused him of "wanting to be politically correct." In a June 2020 interview with The Wall Street Journal, Trump argued that some people were wearing masks to "signal disapproval" of him, and said of Biden's use of masks, "It's like he put a knapsack over his face. He probably likes it that way. He feels good that way because he does. He seems to feel good in a mask, you know, feels better than he does without the mask, which is a strange situation." Trump returned to holding public campaign events for his 2020 re-election campaign in mid-June 2020, beginning with a rally in Tulsa, Oklahoma on June 20. Masks were optional, and not worn by the majority of participants, nor was social distancing practiced. Trump then appeared at a Students for Trump event in Phoenix, Arizona on June 23; the state of Arizona had recently become a major hotspot for new COVID-19 cases. Despite Phoenix having enacted a health ordinance requiring the wearing of masks in public, Mayor Kate Gallego stated that the city would "not be focused on enforcement during the rally." The owners of the megachurch where the event took place announced that it had installed an ionizing air purifier system that could "kill 99.9% of the virus", a claim disputed by the media. Once again, the majority of attendees did not wear masks. During a Coronavirus Task Force briefing on June 26 amidst major resurgences of cases in California and multiple Southern states (including, most prominently, Arizona, Florida, and Texas), most of the participants wore masks when not at the podium. However, Pence did not wear a mask, nor did he mention the wearing of masks or social distancing when recapping the government's hygiene recommendations. On June 28 in an interview on This Week, House Speaker Nancy Pelosi argued that "the president should be an example. Real men wear masks." Brief change in stance: In a June 28 interview on Face the Nation, Pence recommended that Americans follow the advice of local health officials in regards to wearing masks, as "every state has a unique situation." Other prominent Republicans also began to abruptly support masks and urge Trump to be a role model for his supporters, including chair of the Senate Health, Education, Labor and Pensions Committee Lamar Alexander and Senate majority leader Mitch McConnell. Alexander commented that "this simple lifesaving practice has become part of a political debate that says: If you're for Trump, you don't wear a mask. If you're against Trump, you do", and argued that Trump could "help end this political debate". On July 1 in an interview with Fox Business, Trump stated he was "all for masks", but questioned the implementation of a national mandate since they would apply in "places in the country where people stay very long distance." Trump stated he had "no problem" wearing a mask in public if he were "in a group of people where we're not 10 feet away — but usually I'm not in that position and everyone's tested." On July 3, Trump participated in an Independence Day fireworks event at Mount Rushmore in South Dakota, where masks were once again optional, and social distancing was explicitly left unenforced. On July 5, White House Chief of Staff Mark Meadows stated that a national mandate was "not in order", since they are "used on a location basis when you can't have social distancing". A Trump campaign event in New Hampshire originally scheduled on July 11, by contrast, was to be held outdoors, and the wearing of masks was now listed as "strongly encouraged" (although the event would later be postponed, with the White House citing Tropical Storm Fay as justification). On July 11, Trump publicly wore a mask for the first time when visiting members of the military at Walter Reed Army Medical Center. Prior to the event, Trump told Sean Hannity that "it's fine to wear a mask out if it makes you feel comfortable", and later commented that hospitals were a location where one is generally expected to wear a mask under these conditions. On July 14, First Lady Melania posted a photo of herself wearing a mask on social media, urging her followers to follow CDC guidance since "the more precaution we take now can mean a healthier & safer country in the Fall." In a CBS News interview the same day, Trump stated that "if it's necessary, I would urge Americans to wear a mask and I would say follow the guidelines." On July 20, Trump posted a photo of himself in a mask on Twitter, captioned "We are United in our effort to defeat the Invisible China Virus, and many people say that it is Patriotic to wear a face mask when you can’t socially distance. There is nobody more Patriotic than me, your favorite President!" The next day during a press briefing, Trump again encouraged the wearing of masks by Americans, stating "whether you like the mask or not, they have an impact." It was reported that Trump's advisers had recommended this shift in order to re-gain public approval for his handling of the pandemic. Continued downplaying: During the 2020 Republican National Convention, speeches were held on the South Lawn of the White House. A crowd of 1,500 invited guests were present for Trump's acceptance speech on the final night, who did not wear masks or practice social distancing. When questioned by CNN about the crowd, an official argued that "everybody is going to catch this thing eventually." Although Washington D.C. currently prohibits gatherings of more than 50 people, this does not extend to federal property. At a campaign rally on September 3 in Latrobe, Pennsylvania, Trump continued to mock Biden for wearing masks during campaign appearances — suggesting that it gave him a "feeling of security", but that "If I were a psychiatrist, I'd say this guy has some big issues." He asked the audience, "did you ever see a man that likes a mask as much as him?' On September 17, 2020, the Washington Post published a report on documents from the United States Postal Service retrieved by American Oversight under the Freedom of Information Act, which included a draft press release dated April 2020 announcing that it planned to distribute 650 million reusable masks in five-packs to each residential address in the United States (beginning with areas identified as being hot spots, including New York City and parts of Louisiana and Washington). An anonymous senior official told the Post that the proposed program had been scrapped due to "concern from some in the White House Domestic Policy Council and the office of the vice president that households receiving masks might create concern or panic." On September 21, 2020, William Crews, a public affairs official at the National Institute of Allergy and Infectious Diseases (NIAID), stepped down from his position after The Daily Beast published a report that identified him as a pseudonymous managing editor of the conservative website RedState. He had authored several posts promoting COVID-19 disinformation and criticizing masks, which argued they were a "political statement", and referred to Anthony Fauci as a "mask nazi". White House outbreak and aftermath: On September 26, 2020, Trump held an outdoor ceremony at the White House Rose Garden to unveil Amy Coney Barrett as his nomination to fill a vacancy in the Supreme Court, left by Ruth Bader Ginsburg following her death on September 18. It was observed that social distancing was not practiced, and a large number of the 150 participants (including several senior officials) did not wear masks. Secretary of Health and Human Services Alex Azar was an exception, but was then seen taking off his mask and physically interacting with others as he left. The HHS stated that Azar and the people he interacted with had all tested negative prior to the event. Two indoor receptions were also held. Despite a spokesperson stating that all attendees in proximity to Trump had been tested before the event, guests from Barrett's alma mater Notre Dame (who were seated in the front row) reported that they were not, and stated that they were not told by the White House that tests were a prerequisite. Furthermore, the White House stated that attendees did not need to wear masks if they had tested negative. At the first presidential debate on September 29, First Lady Melania and other members of Trump's family were seen taking off masks after seating themselves in the audience—violating health protocols specified by the Cleveland Clinic that had been agreed upon by both parties, calling for masks to be worn at the debate by all attendees (excluding the two candidates and the moderator when on-stage). During the debate, Trump once again mocked Biden for his use of face masks, stating "I don't wear a mask like him. Every time you see him, he's got a mask. He could be speaking 200 feet away from them, and he shows up with the biggest mask I've ever seen." Debate moderator Chris Wallace later stated that Trump and his personnel were not tested prior to the debate in Cleveland since they arrived late, and that they were admitted under "an honor system". On September 30, Trump's senior counselor Hope Hicks (who had travelled with Trump) tested positive for COVID-19, but the case was not publicized until an interview with Trump on Fox News's Hannity the next evening. During the interview, Trump stated that he and Melania had just been tested. Several hours later, Trump announced on Twitter that he and Melania had both tested positive. By October 2, at least seven attendees of the ceremony had tested positive, also including senators Mike Lee and Thom Tilli, former New Jersey governor Chris Christie, former White House adviser Kellyanne Conway, University of Notre Dame president John I. Jenkins (who had apologized after the event for his failure to wear a mask), and an unnamed journalist. This resulted in scrutiny of the ceremony as a superspreader event by the media and local officials, due to the lack of precautions generally taken by its participants. Infectious disease physician Robert L. Murphy argued that if the ceremony was responsible for the White House outbreak, general use of masks and social distancing could have prevented it. In an October 2020 town hall held by NBC News, President Trump incorrectly claimed a CDC study found that 85% of people who wore masks had still contracted COVID-19. The data originated from a "Morbidity and Mortality Weekly Report" published by the CDC, which contained a survey on behaviors exhibited by COVID patients and a control group of those who tested negative: While around 70% of both groups surveyed did say they always wore a mask, the COVID-positive patients were more likely to have engaged in close contact and activities "where mask use and social distancing are difficult to maintain" within the 14 days prior to the onset of symptoms, such as visiting a bar or restaurant. Misinformation related to this report has also been promoted by social network posts and Fox News pundit Tucker Carlson. During a rally on October 29, Trump made remarks to the crowd promoting mask use when social distancing is not possible; "If you get close, wear a mask. 'Oh, it's controversial.' It's not controversial to me." Mask use and policies by state: By Mid-November 2020, 37 states had some sort of health order requiring the wearing of face masks or a similar non-medical face covering when in public spaces or specific types of establishments. Absent a state-level mandate, some municipalities and counties have instituted their own mandates via localized by-laws. These orders usually have exceptions for younger children, as well as those with medical conditions (such as breathing problems) or disabilities that would make it difficult to wear a mask. They are also usually considered an exception to prohibitions on the wearing of masks in public for the purpose of identity concealment, such as general anti-mask laws, and restrictions on wearing masks while carrying a concealed firearm. Some states, such as Louisiana, Oregon, and Washington, at first only mandated the wearing of masks by the public-facing employees of businesses, but did not formally require they be worn by the general public (notwithstanding mask mandates enforced by individual businesses or companies as a corporate policy). All three states have since enacted mandates for the general public. Enforcement and challenges: Violations of mandatory mask orders have often classified as a misdemeanor offence, with some states threatening fines for individuals who do not comply. Some states expressly require businesses to enforce mask mandates, with failure to do so also punishable by fines, and in some cases, being ordered to temporarily close, or have their business license revoked. Whether these mandates are actually enforced may vary; some sheriffs in California, Nevada, North Carolina, and Washington state have publicly stated that they would not enforce the orders; one such sheriff in Lewis County, Washington announced to a crowd outside a church, "don't be a sheep". In California, Governor Gavin Newsom threatened to withhold COVID-19 relief funding from counties that do not sufficiently enforce state health orders, including its mask mandate. In late-June 2020, Governor of South Carolina Henry McMaster argued that the inability to effectively enforce such an order influenced his decision to not implement an order at that time, stating that "there's no power on Earth that can follow everyone in the state around to be sure that they are following the rules." However, on July 29, McMaster reversed his prior stance and issued a state-wide mandate, as part of an order taking affect August 3 that also allowed more businesses to resume operations. Opponents of mask mandates have sometimes argued that they are unconstitutional; the American Bar Association cited that there was precedent under the Tenth Amendment (which states that any powers not granted to the federal government via the Constitution are reserved to states) that state governments "have the primary authority to control the spread of dangerous diseases within their jurisdictions." Jacobson v. Massachusetts has also been cited as case law supporting mask orders; it found that the use of police power by states to enforce health orders designed to maintain the safety of their communities (such as, in this case, mandatory vaccinations for smallpox), did not violate individual liberties under the Fourteenth Amendment. On October 2, the Michigan Supreme Court unanimously ruled that Governor Gretchen Whitmer had violated the state Emergency Management Act of 1976 by redeclaring a state of emergency to bypass the Republican-controlled Legislature after it declined to renew it. In a split decision, they ruled that the Emergency Powers of Governor Act of 1945 was unconstitutional because it violated the nondelegation doctrine. Governor Whitmer has argued that the decision was still subject to a 21-day reconsideration period, during which the orders still stand, and later accused the Court of undermining her efforts to control the pandemic. On October 4, Michigan Attorney General Dana Nessel stated that she would stop enforcing COVID-19-related executive orders. On October 12, the Court denied a notion requested by Governor Whitmer for a transition period, thereby voiding all executive orders issued pursuant to the claimed state of emergency. The state Department of Health and Human Services (MDHHS) had already begun to issue its own orders to supplant Whitmer's voided orders, under powers that give its director the authority to "establish procedures" and restrict gatherings during an epidemic. In turn, the MDHHS was sued by a chiropractor (one which had faced warnings from local officials for defying the mask mandate), claiming it did not have the authority to mandate masks. In Wisconsin, Governor Tony Evers similarly re-declared a public health emergency (which is similarly limited to 60 days without legislative approval) to extend its mask mandate beyond its original period (which began August 1). It was challenged in a state court by the Wisconsin Institute for Law and Liberty, who requested a temporary injunction. Judge Michael Waterman ruled in favor of Governor Evers, stating that "the 60-day limit provides an important check against run-away executive power, but it does not prevent the governor from issuing a new executive order when the emergency conditions continue to exist." Political stances: In June 2020, The Hill noted that Democratic-led and coastal states had been more likely to have implemented or considered such mandates over Republican-led states (especially in the conservative South)—which have cited desires to preserve individual liberties, and, in some cases, have also taken steps to overrule local health orders that are stricter than those imposed by the state (including mask mandates). Not all Republican-led states have refused to do so, however, with noted early examples including Maryland and Massachusetts. Following a major spike in mid-June attributed to the rushed lifting of mitigations around the Memorial Day weekend, Arizona and Texas began to backpedal on their outright prohibition of local orders on the wearing of masks, and Governor of Texas Greg Abbott then issued a state-wide mandate on July 2. On July 15, Governor of Georgia Brian Kemp signed an executive order to prohibit any county or municipality from enacting or enforcing a health order requiring the wearing of masks in public spaces. He also filed a lawsuit against Mayor of Atlanta Keisha Lance Bottoms and her city council over a local health order requiring masks and having voluntarily rolled back to "Phase 1" guidelines (discouraging dine-in restaurants), asserting that she "does not have the legal authority to modify, change or ignore Governor Kemp's executive orders." On August 13, however, Kemp dropped the lawsuit, and announced the next day that localized mask mandates would be allowed if certain "health metrics" and other guidelines are met, and requiring business owners to consent if the mandate is to apply to businesses. In Kansas, a July 2020 mask mandate by Democratic governor Laura Kelly included the ability for counties to opt out if they (per consultation with health officials) assert that it is not medically necessary; the provision was described as a "bipartisan compromise" to gain support from the state's Republican-majority government. By July 9, 90 of Kansas's 105 counties had opted out, while several cities in counties that did opt out, such as Manhattan, Wichita, and Winfield, would enact municipal mandates. Out of a sample of counties, 15 counties that chose to enforce the order were shown to have a reduced rate of new cases than those which opted out. Research released in October 2020 by the University of Kansas found that these trends had continued in the (by-then) 21 counties that implemented the order. Republican governor of South Dakota Kristi Noem has discredited studies and research that support the use of face masks, claiming that they have produced "very mixed" outcomes, and arguing that "the science has not proven what's effective and what isn't and what type of mask. We have to stay objective when we look at it". Federal policies: The United States Department of Health and Human Services organized a program known as "Project: America Strong", to fund the distribution of reusable masks to "critical infrastructure sectors, companies, healthcare facilities, and faith-based and community organizations." There have been calls for a mask mandate to be implemented nationwide at the federal level: the Retail Industry Leaders Association criticized the patchwork of differing regulations (or lack thereof) between regions, and argued that "despite compliance from the majority of Americans, retailers are alarmed with the instances of hostility and violence front-line employees are experiencing by a vocal minority of customers who are under the misguided impression that wearing a mask is a violation of their civil liberties." Goldman Sachs projected that such a mandate "could potentially substitute for lockdowns that would otherwise subtract nearly 5% from GDP." The Public Health Service Act grants the secretary of the Department of Health and Human Services authority to implement regulations to "prevent the introduction, transmission, or spread of communicable diseases" into U.S. states or possessions, but it is unclear whether this could be used to implement a general mask mandate. On June 28, House Speaker Pelosi stated that such a mandate was "long overdue", but that the CDC did not issue one as to not "offend the president." On July 1, Trump questioned the appropriateness of a national mandate since they would apply in "places in the country where people stay very long distance." On July 5, White House Chief of Staff Mark Meadows stated that a national mandate was "not in order", arguing that masks were "used on a location basis when you can't have social distancing". On July 12, Surgeon General Adams similarly argued that "if we are going to have a mask mandate we need to understand that works best at the local and state level along with education", and questioned if a national order could be reasonably enforced without "having a situation where you're giving people one more reason to arrest a black man." On July 14, the House Committee on Appropriations adopted an amendment to its Transportation, Housing and Urban Development, and Related Agencies funding bill for fiscal year 2021, which would include a mandate for passengers and employees of air travel, Amtrak, and "large transit agencies" to wear masks. The bill is scheduled to be voted on by the House of Representatives later in the month. On July 15, Senator Dianne Feinstein proposed that economic stimulus funding be withheld from states that do not adopt a health order requiring the wearing of masks in public. In an interview with Fox News Sunday aired July 19, Trump told Chris Wallace that he was a "believer" in masks, but that he did not intend to enact a federal mandate (leaving it to state governors) because "I want people to have a certain freedom". He also disagreed with CDC Director Redfield's suggestion that the use of masks nationwide could bring the U.S. epidemic under control within weeks, and accused federal health officials of having been inconsistent with their guidance on masks over the course of the pandemic. On July 30, Senator Bernie Sanders and Representative of California Ro Khanna introduced the Masks for All Act, a proposed bill that would invoke the Defense Production Act to produce "high-quality", reusable face masks for nationwide distribution at no charge (via mail distribution and public pickup locations), with a goal to give three masks each to every individual in the country, and a particular focus on serving the homeless and people who live in communal environments. The total cost of the bill was estimated to be $5 billion, with Khanna noting that "If we can afford a $740 billion defense budget, we can afford to send every American a face mask. And if we’re asking folks to wear a mask, which is absolutely essential, it’s on us to provide one." On July 31, Peter DeFazio and Rick Larsen introduced the Healthy Flights Act, which would authorize the FAA to mandate the wearing of face masks at airports and while on flights. During an August 2020 campaign appearance, Democratic presidential nominee Joe Biden proposed a national mask mandate of at least three months as part of his platform, explaining that it could "save over 40,000 lives if people act responsibly", and that "it's not about your rights, it's about your responsibilities as an American." On September 16, Biden stated that he believed the president had the legal authority to mandate masks nationwide via an executive order. However, during a CNN town hall the next day, Biden stated that he could not mandate masks nationwide, but could do so on federal property, and that he would urge governors to follow suit at the state level.