More than 200 Alaska health workers are asking Gov. Mike Dunleavy to require masks in crowded businesses where it’s unrealistic to expect the public to maintain the six-foot social distancing guidelines.
The call comes as Alaska is experiencing a surge in new cases after reopening, surpassing the initial outbreak in cases before the state ordered businesses and schools to close. Alaska currently stands at 593 confirmed cases of COVID-19 in Alaska residents and it reported its 11th death earlier this week tied to an outbreak in a transitional care center in Anchorage.
“The Alaskan physicians and healthcare workers who sign this letter encourage you to mandate the use of masks by customers and employees in businesses open to the public where 6-foot distancing is unrealistic,” explained the letter dated Monday. “We are concerned about the recent and rapid increase in COVID-19 case counts in Alaska. We want a healthy and robust economy in Alaska, and a healthy economy needs healthy consumers and workers. More consumers will feel safe patronizing businesses when they know the risk of infection is reduced. In the absence of mandated masking, many Alaskans will continue to shelter in place rather than risk infection. We also want to avoid another lock-down, which would further harm the economy.”
The group references a study published on June 1 in The Lancet that found the use of masks, social distancing and face shields for health care workers can significantly reduce the risk of new infections.
Dunleavy lifted all state restrictions on business capacity the Friday before Memorial Day weekend and eased much of the travel restrictions last week. The administration has refused to mandate preventative measures, instead recommending that mask and social distancing guidelines be followed.
Alaska legislators have been critical of the state’s approach, arguing that the lax approach and mixed messages have led to a false assumption that the virus is no longer a risk.
“I’ve first-hand witnessed a false sense of security with the easing of various health mandates,” said Rep. Tiffany Zulkosky, the Bethel Democrat who chairs the House Health and Social Services Committee, during a hearing in late May. “There’s a sense that somehow we eradicated COVID’s presence in Alaska enough to ease these health mandates but we also understand that the easing of these health mandates does not make the virus less contagious or the serious cases any less serious.”
Rep. Zack Fields, D-Anchorage, last week called on the governor to mandate face coverings.
“The trend we’re seeing proves that we need immediate action from the administration to keep Alaskans healthy,” he said in a prepared statement.
When the letter from Alaska health workers first started circulating on Monday, it had 160 Alaska health workers. According to the Anchorage Daily News, that numbers has now surpassed 200 and is continuing to grow largely motivated by the jarring lack of masks in many businesses.
“We did this phenomenal job of keeping the transmission of the virus down in Alaska during the lockdown,” Dr. Megan Ritter, of Anchorage, told the paper. “But it turns out than in the absence of a requirement, recommendations are not being followed.”
On Tuesday, the Department of Public Transportation announced that seven total employees of the Alaska Marine Highway System had tested positive for COVID-19 after the M/V Tustumena returned to Homer after one employee tested positive. The state had not required ferry employees or passengers to wear masks.
The full letter:
June 8, 2020
The Honorable Michael J. Dunleavy Governor of Alaska
Dear Governor Dunleavy,
Thank you for taking precautionary measures regarding COVID-19. The Alaskan physicians and healthcare workers who sign this letter encourage you to mandate the use of masks by customers and employees in businesses open to the public where 6-foot distancing is unrealistic. Recent medical studies and real-world evidence support the use of masks to prevent the spread of the virus.
We are concerned about the recent and rapid increase in COVID-19 case counts in Alaska(1). We want a healthy and robust economy in Alaska, and a healthy economy needs healthy consumers and workers. More consumers will feel safe patronizing businesses when they know the risk of infection is reduced. In the absence of mandated masking, many Alaskans will continue to shelter in place rather than risk infection. We also want to avoid another lock-down, which would further harm the economy.
There is now robust scientific evidence that masks play an important role in preventing the spread of the virus. A systematic review published June 1st, 2020 in the Lancet looked at 172 studies and found the most effective ways to decrease transmission of the coronavirus include social distancing and universal mask wearing(2). This is a very inclusive study with the highest quality methodology, and was published in one of the most respected medical journals. We can be confident in the results.
We also have real-time examples of countries that adopted mask wearing and as a result decreased viral infections. In the Czech Republic, masks were mandated in early March for anyone outside their homes. Within two weeks they had an 80% decrease in transmission of the virus(3). Austria had a similar phenomenon with a 90% decrease in infections two weeks after adopting mask mandates(4).
Widespread mask use is so effective because viral transmission often occurs through respiratory droplets (coughs, sneezes, exhales)(5). If people infected with the virus wear masks, then these respiratory droplets are trapped in the mask material. This is especially important in the case of asymptomatic carriers. In fact, up to half of the people who spread the virus are infected but don’t know it yet(6).
The takeaway is this: a sick person wearing a mask will spread fewer viral particles. A healthy person wearing a mask will have some protection from sick people around them. The combination of both people wearing masks provides the greatest amount of protection.
Masks are a very low-risk intervention. Masks are safe for the vast majority of people. They are not recommended for certain groups, such as children under two years old, or some people with serious underlying lung conditions under the advice of their clinician(7). There is no solid
evidence for carbon dioxide build-up or mental status changes from long-term cloth mask use in the general public. Many people, like healthcare workers, use masks on a daily basis for years.
Moreover, masks are available. Initially the public was told to not wear masks in order to conserve them for medical use due to shortages. Now there are non-medical grade masks available for the public. The use of masks is recommended by the CDC, the World Health Organization, and by our own State (8,9,10). Unfortunately, this recommendation appears insufficient to effect the behavioral change needed to protect Alaskans, limit viral spread, and successfully launch our economy. In the United States, as of June 5th, the majority of States and the District of Columbia have face mask requirements (11).
As we’ve seen, if universal masking in businesses is not mandated, it becomes difficult for individual businesses to ask customers to wear them. This is especially concerning in light of the recent rise in case counts this past week. At the beginning of the pandemic in March, cases were clustered in just a few communities. Now we are seeing cases widespread throughout Alaska. Without a mandate for mask wearing, this trend may accelerate.
In addition to supporting our economy, we need to do everything we can to continue to reduce viral transmission so we don’t overwhelm Alaska medical systems, which is still a possibility. We thank you for the early lock-down order for Alaska. Because of this, we flattened the curve. We now need to take the next steps to bridge our communities to a vaccine or better treatment options. This requires a new way of living, and we recognize masks are part of this new reality. We strongly urge you to enact the appropriate Health Mandate requiring universal mask wearing in businesses.
Aaron Kusano, MD, SM Alexander von Hafften, MD Alexandria Gallagher Alison Sarasin, RN Allison Gibbs, MD Allison Kelliher, MD Ann Ehret, DO Anne Hanley, DO Amber Stubbs, DPT Ashley Lundgren Strum, MD Ashley Widmer, MS1 Barbara Norton, CNM, APRN Bartholomew Grabman, MS2 Becky Taylor, DO Bradley K. Cruz, MD Bethanee Gibson,NCMA Brian J McMahon MD Brigette L. Hofmann
Brooke Dudley, DPT Bruce Chandler, MD Carol Paredes, MD Cathy Wick, PharmD Charles M Herndon, MD Chris Kottra, MD Christina Darby, MD Christy Tuomi, DO Cindy Knall, PhD Claire Stoltz, MD Colleen Curley, CRNA Corrine Leistikow, MD Courtney Stroh, MS1 Cynthia Mildbrand, MD Daron Dykema, MD David Williams, MD Dax Cvancara, MS1 E Peek Ehlinger, MD Elizabeth Pietralczyk, MD Erin Royal, MD Evan Gross, MS1 Eve Wiggins, MS2 Ferritha Leoncio, MD Frances Wilson, MD Gail B Kottra, RT Gina Wilson-Ramirez, MD, MPH Grayson T Westfall, MD Haley Yerxa, CNM Heather Alvarado, MS, PA ASCP Heather Merkouris, MS Holly Fisk, ANP Holly Martinson, PhD Hope Spargo, MS1 I. de Anzola Ian van Tets, PhD Jacqueline Hoffman, MLS Jaime Butler, MD Jane A. Heisel, MD Janice Koval, MD Janine D. Miller, MD Jean Snyder, MD
Jean Tsigonis, MD, MPH Jennifer Sheasley, MS1 Jenny Lessner, MD Jess Sotelo, MD Jessica Panko, MD Jill Klein, MS John Bramante, MD, FACP John J Kottra, MD John Naylor, MD Johnna Kohl, MD Joshua Hejl Joy Warth, LPN Juiana Shields, MD Julia Franklin, MD Julie Sicilia, MD Kahnaz Khari, MD Karen McLane, FNP Karin Harp, MD Kate Lukshin, MS1 Kathy McCue, MD Katie Naylor, MD Keira Stroh, CNA Keira Stroh, CNA Kelly Murphy, RN, MSN Kendrick D. Blais, DO Kimberly Houghton, MD Kirsten Reinbold, MD Kristen Burdette Kristen Wood, LAc Kristin M Mitchell, MD, FACP Kristina James, MD Laura Levoy, MD Laura Schroder, PhD Laura Schulz, MD Laurie Montano, MD LaVerne Saccheus, RN Leif Lunøe, MD Leiza O. Johnson, RN Leslie Cayco-Travis, DO Lily Lou, MD
Lisa Alexia, PA-C Lisa Rabinowitz, MD Lisa Wolff, MD Lorraine Kottra, MD Mackenzie French, MS2 Maggie Hejl, LMT Maren Gaul, DO Maria E Mandich MD Marie E McQueen, RN, ARNP Marin Granholm, MD Mary Ann Foland, MD Mary Geist, MS1 Max Kullberg, PhD Max Rabinowitz, MD Megan Engler, PA-C Megan Ritter, MD Melinda M. Rathkopf, MD Melissa Bruesch, RN Melissa Hardesty, MD, MPH Melissa Sundberg, DPT Merijeanne Moore, DO Michael Mraz, MD Michelle Hensel, MD Michael Swenson, MD Mikhail Barson, RN Monica Gaupp, MD Natalie Velasquz, MD Neil Murphy, MD Owen Hanley DO, MPH Peter Hulman, MD Peter Schaab, MD Priscilla Natcher, MS1 Rachel Samuelson, MD Rande Lucas, LAc Rhonda M. Johnson, DrPH Robert Bundtzen, MD Robin Holmes, MD Roderic Smith, MD, PhD Ronald Kim, MD Ronald D Poole, MD, MPH
Roxanne Chan, RN, LAc Sara Kozup-Evon, ANP Sara Rutz, MS1 Sarah McCutcheon, MD Sarah Murphy, MD Sargam Kapoor, MD Sean Cardinal, MD Shannon Green, OT Shannon Uffenbeck, PhD Sharon Hulman, RN, MPH Stephanie Eklund, MD, FACOG Stephanie Wilson, LMT Steven Compton, MD Summer Engler, MD Susannah Ølnes, MD Tamara Dietrich Tanya Leinicke, MD Therese Tomasoski, MD Thomas C. Wood, MD Thomas Quimby, MD Tiffany Peterson, MD Tim Hinterberger, PhD Tina Tomsen, MD, FACOG Toby Currin, DO Toni Biskup, MD, MPH, FACP, FAAP Tonya L Caylor, MD, FAAFP Tracy Slager, DO Victoria Murdock, MD
Sources: 1. Coronavirus cases in Alaska 2. Lancet Systematic Review & Meta Analysis https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142- 9/fulltext?fbclid=IwAR2keqNtu2z4uSqLHXxftRScHjymNK_GqqRM2RQ- 2__2w9Oa7yQHaPPCXt8 3. Masks Mandate in the Czech Republic: https://www.theguardian.com/world/2020/mar/30/czechs-get-to-work-making-masks-after- government-decree-coronavirus 4. Mask Mandate in Austria: https://www.sciencetimes.com/articles/25410/20200421/austria-90- drop-coronavirus-cases-requiring-people-wear-face-masks.htm 5. Transmission of SARS-CoV-2: https://www.cdc.gov/coronavirus/2019-ncov/faq.html#How- COVID-19-Spreads 6. Asymptomatic Carrier spread: https://www.healthline.com/health-news/50-percent-of-people- with-covid19-not-aware-have-virus#How-transmission-works 7. AAP recommendations on face coverings and children: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Cloth-Face- Coverings-for-Children-During-COVID-19.aspx 8. CDC Recommendations to wear masks: https://www.cdc.gov/coronavirus/2019-ncov/prevent- getting-sick/diy-cloth-face-coverings.html 9. Press release about WHO Recommendation to wear masks 6/5/20: https://www.reuters.com/article/us-health-coronavirus-who-masks/wear-masks-in-public-says- who-in-update-of-covid-19-advice-idUSKBN23C27Y 10. State of Alaska Recommendation to wear masks: http://dhss.alaska.gov/dph/Epi/id/Pages/COVID- 19/coveryourface.aspx#:~:text=recommendations%20regarding%20the%20use%20of,care%20w orkers%20and%20first%20responders. 11. List of States with Mask Wearing Requirements: https://www.littler.com/publication- press/publication/facing-your-face-mask-duties-list-statewide-orders