Study shows continued face mask use offers economic benefits

Throughout the Covid-19 pandemic, face masks have been required in most public locations. A study led by teams at Baylor College of Medicine and the Public Health Informatics, Computational and Operations Research (PHICOR) at the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH) shows how maintaining face mask use could bring multiple benefits, including saving healthcare costs. The results were published in The Lancet Public Health.

The health benefits of using face masks include fewer Covid-19 illnesses, hospitalizations and subsequent deaths. This usually saves direct medical and indirect costs when face masks cost up to $1.25 per person and when maintained for at least two weeks beyond the date of achieving target vaccination coverage levels. The exact duration varies based on seasonal Covid-19 surges with mask use providing benefits for two weeks past the point of reaching certain target vaccination coverage in the summer and 10 weeks longer in the winter, when transmission tends to be higher.

Even if everyone with active Covid-19 symptoms were to isolate themselves, the findings show that face mask use would still be cost-effective when masks cost up to 50 cents with two-day use.

“The messaging about face mask use has been inconsistent throughout the pandemic as there has been back and forth about their use ,” said Dr. Bruce Y. Lee, professor of health policy and management at the CUNY SPH, executive director of PHICOR and the study’s senior author. “There has been a tendency to focus on one intervention at a time. First there was a focus on social distancing and then the focus turned to face mask wearing. Then, attention turned towards the Covid-19 vaccines once they came out. Instead, as long as the pandemic is continuing, there's a need to consistently layer multiple interventions on top of each other, which in turn will make each intervention even more effective."

The team developed a computer simulation model of the U.S. that simulated the spread of Covid-19, subsequent outcomes of infection (e.g., symptoms, hospitalizations), different vaccination scenarios, face mask use at the levels seen from March-July 2020 and the associated costs along the way. Since face mask use in spring 2020 was not as common as it was later on in the pandemic and in other countries, higher levels of compliance could have resulted in even more benefits.

The emergence of more contagious and infectious variants such as delta and omicron and its subvariant BA.2 has further boosted the value of face masks. Results from the model show when the reproductive number (the virus’ contagion level) of the delta variant is five, maintaining face mask use until 80 percent of the U.S. is fully vaccinated by May 2022 would avert $16.7 billion in societal costs, $2.9 billion in third-party payer costs and 7.66 million cases. When the reproductive number of the omicron variant is 10, maintaining face mask use for an additional month after reaching 70 percent vaccination coverage in March 2022 would avert $1.5 billion in societal costs, $148.6 million in third-party payer costs and 856,000 million cases.

“Vaccines save lives but alone are not enough to get our society to a point where we can safely be free of Covid-19 requirements like face mask use yet,” said Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor and co-author of the study.

“The study’s results show how it could be economically worthwhile for businesses to provide and encourage face mask use,” said Dr. Maria Elena Bottazzi, associate dean of the National School of Tropical Medicine at Baylor College of Medicine and co-author of the study. “The results also provide targets to aim for in which we can drop the mask requirements indoors.”

The study also emphasizes the importance of face mask use across the entire population. The more the model subdivided the U.S. population into groups (i.e., adults and children), the more face masks’ value increased.

This work was supported by the Agency for Healthcare Research and Quality (AHRQ), the National Institute of General Medical Sciences (NIGMS) as part of the Models of Infectious Disease Agent Study network, the National Science Foundation (NSF), the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health and the City University of New York (CUNY) in support of the Pandemic Response Institute (PRI).