My opinion

By Dr. Deepak Gupta , Dr. Shushovan Chakrabortty
Corresponding Author Dr. Deepak Gupta
Wayne State University, - United States of America 48201
Submitting Author Dr. Deepak Gupta
Other Authors Dr. Shushovan Chakrabortty
Wayne State University, Anesthesiology, - United States of America


Masks; Fatalities; COVID-19; CDC; WHO; Pandemic

Gupta D, Chakrabortty S. Are There Fatalities Due To Delayed Statewide Mandatory Mask Use Orders?. WebmedCentral PUBLIC HEALTH 2020;11(8):WMC005621

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 01 Aug 2020 08:28:09 PM GMT
Published on: 17 Aug 2020 07:56:58 AM GMT

My opinion

It is a Pandora’s Box which Yehya et al [1] and Auger et al [2] have opened in the midst of global pandemic because although SARS-CoV-2 as a pathogen knows and follows no boundaries, local, regional and national policies may have created non-scientific boundaries with fractured global response becoming an obstacle to contain pandemic. Although Yehya et al [1] and Auger et al [2] focused on quantifying risk for fatalities secondary to delays in social distancing interventions (emergency declarations and school closures), this assessment is not complete until fatality risk of delays in statewide mandatory mask use orders has been investigated because social distancing is not complete without mask use. Although prevention of future deaths with universal mask use has been predicted [3], the medical literature should also document [4] number of lives already lost secondary to delays in universal mask use even if such quantification may counterproductively risk providing fodder for litigations by survivors of the deceased.


The highly transmissible SARS-CoV-2 has forced population to tolerate masks for now despite their physiological intolerance to masks secondary to thermal stress of hot and humid in-mask microclimates [5-8]. Thus, uniform and consistent practice of mask use by populations may not be physiologically achievable despite statewide mandatory mask use orders; this is in contrast to population’s inability to undo state-wide emergency declarations and school closures whose associations were investigated by Yehya et al [1] and Auger et al [2]. Additionally, the statewide orders heterogeneously exclude some public spaces from mandatory mask use further confusing population and delaying their acceptance of universal mask use. This inescapable heterogeneity in the actual universality of mask use may affect validity of quantifying COVID-19 mortality (if any) as associated with delays in statewide mandatory mask use orders. However, Yehya et al [1] and Auger et al [2] can consider investigating the association (if any) of all-cause excess mortality [9] with delays in statewide mandatory mask use orders because it may not be an overestimation if all excess deaths in COVID-19 pandemic era are counted either as direct consequence of SARS-CoV-2 itself or as collateral damage secondary to fractured mitigation measures against pandemic. Therefore, while awaiting COVID-19 pandemic era’s all-cause excess mortality getting permanently resolved with vaccines and therapeutics against SARS-CoV-2, humanity may have to live in the interim accepting and practicing universal mask use whenever and wherever there is a risk of airborne exposure by human contact while in public spaces or at homes [10].


  1. Yehya N, Venkataramani A, Harhay MO. Statewide Interventions and Covid-19 Mortality in the United States: An Observational Study [published online ahead of print, 2020 Jul 8]. Clin Infect Dis 2020; ciaa923.
  2. Auger KA, Shah SS, Richardson T, et al. Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US [published online ahead of print, 2020 Jul 29]. JAMA 2020; 10.1001/jama.2020.14348.
  3. Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now [published online ahead of print, 2020 Jul 14]. JAMA 2020; 10.1001/jama.2020.13107.
  4. Lyu W, Wehby GL. Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US [published online ahead of print, 2020 Jun 16]. Health Aff (Millwood) 2020; 101377hlthaff202000818.
  5. Gupta D. Living with in-mask micro-climate [published online ahead of print, 2020 Jun 19]. Med Hypotheses 2020; 144:110010.
  6. Cherrie JW, Wang S, Mueller W, Wendelboe-Nelson C, Loh M. In-mask temperature and humidity can validate respirator wear-time and indicate lung health status. J Expo Sci Environ Epidemiol 2019; 29:578–583.
  7. Gupta D. Transnasal cooling: a Pandora's box of transnasal patho-physiology. Med Hypotheses 2011; 77:275–277.
  8. Li Y, Tokura H, Guo YP, et al. Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. Int Arch Occup Environ Health 2005; 78:501-509.
  9. Weinberger DM, Chen J, Cohen T, et al. Estimation of Excess Deaths Associated With the COVID-19 Pandemic in the United States, March to May 2020 [published online ahead of print, 2020 Jul 1]. JAMA Intern Med 2020; e203391.
  10. Wang Y, Tian H, Zhang L, et al. Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection and social distancing: a cohort study in Beijing, China. BMJ Glob Health 2020; 5:e002794.

Source(s) of Funding


Competing Interests


0 reviews posted so far

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)