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COVID-19 Pandemic: Face Mask Mandates, Hospitalization, and Infection Rates in the United States

Face masks have been identified as one of the preventive methods for the control of the 2019 coronavirus disease (COVID-19). Although the World Health Organization (WHO) and the United States Centers for Disease Control and Prevention (CDC) recommend the universal use of face masks, there are controversies in the implementation of a national face mask mandate in the US. This commentary discusses the relationship between facemask mandates and key COVID-19 indicators such as infection rates and hospitalization rates in the US. It also summarizes some of the political issues surrounding the implementation of the national face mask mandate. We conducted an ecological study on the relationship between face mask mandates and key COVID-19 indicators. We searched PubMed and Google Scholar and reviewed 150 English articles related to face mask challenges in the US published from 2005 to 2021. We identified seven challenges associated with face mask wearing - conflicting messaging, individualism, denial, health consequences, lack of a national masking standard, concerns of African American males, and environmental issues. We found that North Dakota, a state without a face mask mandate had the highest COVID-19 prevalence of 13.3%. The mean prevalence for the highest top 10 ranked states without and with a face mask mandate was 11.1% and 10.5%, respectively. We also found that Florida, Arizona and Georgia, states without a face mask mandates, had the highest cumulative hospitalizations of 83,381, 58,670, and 57,911 hospitalizations, respectively. Alabama, Indiana, and Minnesota, which have face mask mandates, had the lowest hospitalization rates of 47,090, 47,787, and 26,651, respectively.