2 months ago, face masks were mandated in Ada County. Did that cause decline in COVID-19 cases?
The coronavirus pandemic hit its peak (so far) in Idaho in mid-July, when new cases statewide climbed as high as the 600s.
On July 16, Idaho reported a record 651 new confirmed infections. As the coronavirus spread unbridled and Idaho at large remained in Stage 4 of the governor’s reopening plan without isolation requirements, several communities around the state turned to face-mask mandates to try to stop it.
“Our case rates were going through the roof,” said Ted Epperly, a Boise physician. “The percent test positivity in the community at that time was about 15%. Our hospitals were starting to see a dramatic increase in hospitalizations. They were very concerned about being overrun in terms of capacity.”
Slowly but surely, the number of new cases of COVID-19 began to decline after those mask mandates began. By mid-September, Idaho was reporting about 230 new confirmed cases each day — still more than the initial outbreak of the disease, but a marked improvement over the summer surge.
Though there’s no hard evidence to tie the various Idaho city and county mask mandates to the decline in cases, public health officials say the mandates were key in quashing the outbreak. And those mandates are not likely to be lifted soon, as they could prove even more vital to Idahoans’ health in fall and winter.
Mask mandates made a dent in Idaho’s COVID outbreak
Face masks help prevent the spread of the coronavirus by containing respiratory droplets emitted by the wearer when breathing, speaking, coughing or sneezing. Because the primary effect is to protect others from the wearer — who may be an asymptomatic carrier of the virus — it’s essential for everyone to wear a mask. Existing research has shown masks are effective in preventing the spread of other airborne illnesses such as the flu, and a growing body of evidence shows masks greatly reduce the risk of spreading COVID-19.
Epperly is the medical expert on the Central District Health Board of Health alongside commissioners from each of the district’s member counties. During the board’s July 14 meeting, Epperly introduced a proposal for a mask mandate for Ada County, the day after officials reported a then-record 285 new COVID-19 cases for the county and 10 days after the city of Boise implemented its own mask mandate. The proposal passed in a 5-1 vote.
In a video interview this month, Epperly said the decision for a mandate was “a no-brainer.”
“The only tool we have, really, to fight the coronavirus at this time are public health initiatives: face coverings, social distancing, good hand washing, social group limitations in size,” he said.
Since then, Ada County’s new daily cases have tapered to about 40 per day. Though health officials haven’t conducted an official study to conclusively link the mask mandate and the case reduction, Epperly said he’s confident the latter is a direct result of the former.
An Idaho Statesman survey this month showed about 90% of customers at six stores across Boise and Meridian were wearing masks.
“There’s no direct evidence, but observationally there was clearly an enhanced compliance in the community,” Epperly said. “And I think that point A leads to point B on that. The reason that we’re seeing decreased cases now in Ada County, in particular, is because of that mandate.”.
The mandate, which is in effect indefinitely, requires individuals to wear a face covering in public places when they can’t maintain 6 feet of distance from others. While it only applies in Ada County, Epperly said he doesn’t believe its positive effects have been limited to Ada. Though neighboring Canyon County hasn’t instituted a similar public health order, its cases have gradually declined since mid-July, too. At its peak, Canyon County hit 170 new confirmed cases daily but has declined to about 25 new cases per day.
“There are a lot of people that go back and forth between the counties on a daily basis,” Epperly said. “Many people from Canyon County, of course, work in Ada County. … For people from Canyon County, when they came here to shop, or when they came here to work, or they came here for other reasons, they needed to put on a mask.”
Blaine County, site of first COVID outbreak, adopted masks early
Mask mandates appear to have worked in several other Idaho areas, including Blaine County, which had one of the worst infection rates in the world early on. The Blaine County Commission voted to implement a public health ordinance to require masks on July 7. The city of Ketchum, located in Blaine County, had implemented its own order the day before and Hailey, the county seat, created one on June 30.
“The leadership comes from the top,” said Jacob Greenberg, chair of the Blaine County Commission, in a phone interview. “So we felt if these were ordinances, business leaders could point to that and have a flyer on their windows (requiring masks). That helped protect them, their employees and their customers.”
Where the small county was once reporting dozens of new cases per day, since its mandates, the case rate has slowed to a trickle. Since mid-May, it has reported about 100 new cases.
“(The mandate has) had an impact on our ability to keep our numbers low,” Greenberg said. “We’re seeing zeroes, ones, twos (reported daily). Most recently, we saw five new cases with schools opening.”
Terry O’Connor, an emergency physician at St. Luke’s Wood River Hospital, said he thinks Blaine County’s early outbreak helped contribute to high levels of compliance with the mask mandate.
“It’s hard to forget how quickly this pandemic could overwhelm a health system,” O’Connor said in a phone interview. “It seems so foolish to survive that and not do everything you can to prevent it happening again.”
Even with residents eager to do their part to stop the spread of the coronavirus, O’Connor said he still believes a mandate was crucial to Blaine County’s continued recovery.
“What we’ve always believed in Blaine County is that, as a majority, people have been aligned with doing the right thing to stop a resurgence of this,” O’Connor said. “But that alone wasn’t going to be enough.”
The mandate gave residents — and, perhaps more importantly, visitors — a concrete reason to wear a face mask. Tourism is believed to be what brought the virus to Blaine County in March. So the mandate became especially important as the summer tourism season arrived and people headed to the mountain towns to escape crowded cities.
“We can’t just depend on community sentiment (to enforce mask-wearing) because we’re not an isolated community,” O’Connor said. “We’re not an island anymore.”
And the more people who wear masks, the more likely others are to don one. That snowball effect has led to compliance with the mandate that Greenberg estimated is 90% or better.
Still, Greenberg said he and the other commissioners responsible for the county mandate experienced a bit of blowback — some angry emails and a few meeting attendees who’ve criticized the decision. He said he understands some residents have concerns about their rights or may believe various myths claiming face masks are dangerous or ineffective.
“I get all of those things,” Greenberg said. “I respect that people have those views. I just simply don’t agree with them.”
O’Connor applauded the commission and other local leaders for implementing the public health orders despite public criticism.
“(They took) their own risk of inviting some level of political scrutiny,” he said. “But in the end they were right. It works.”
Mask mandates have produced similar results in scattered counties and cities across the state, including McCall, Valley County, Kootenai County and some East Idaho counties. The Eastern Idaho Public Health district recently implemented additional mandates in Fremont and Madison counties, which continued to see spread as other counties’ infection rates slowed.
Idaho city, county mask mandates won’t end anytime soon
In Blaine County, the mask mandate has brought relief to a community that was bracing for the worst this spring.
“It’s a mixed emotion between gratitude that we’ve made it through the summer so far … but there’s fatigue,” O’Connor said. “People are tired of doing what’s necessary, and that’s understandable.”
Though cases are declining in most of the state, Epperly emphasized that Idaho is not out of the woods with the coronavirus. He said he doesn’t see Central District Health rescinding its Ada County mask mandate anytime soon, lest cases begin to rise again.
“The coronavirus in our community hasn’t gone away,” Epperly said. “It’s still out there working. If we were to immediately relax all (our guidelines), we would see cases go immediately back up.”
Epperly warned that “this will get worse before it gets better” as cold weather approaches, forcing more people indoors.
“We can pretty assuredly predict that we will get significantly impacted by this again, probably sometime in the early November to late March time frame,” he said. “And we may well have to move back to a lockdown situation or to a lower stage to get through it all.
“Yes, we’re going to need to still use masks,” he continued. “But I think after that — come the summer of next year, a year from now — if we get an effective vaccine that’s starting to work, the mask mandate will go away.”
Epperly said his goal isn’t to scare people by painting the picture of another COVID spike. Instead, he wants to educate them, especially as hospitals prepare for the potential double-whammy of flu season and COVID-19. Masks will help keep hospitals from becoming overwhelmed in the fall and winter and having to make impossible decisions about who can receive care.
“The mortality rate of this is about 20 times that of influenza,” Epperly said. “And the infectivity of this is about three times greater than influenza. So we’ve got something that is much more infectious and much more fatal. We don’t want to have that many people get this illness.”
Additionally, Epperly said, research is showing that the coronavirus can have other effects on the body even in seemingly mild cases — effects like myocarditis, when the heart muscle becomes inflamed.
With no end in sight for local mask mandates, O’Connor said Idahoans should look at face masks as “a foundational part of our lives” for the next several months rather than a passing measure.
“Back in April … I resigned myself to the fact that patients might not see my face for the next two years,” O’Connor said.
He said it’s a small sacrifice he’s willing to make given the effectiveness of face masks. Epperly agreed.
“I’ll be the first to tell you, I’d love to see (the mandate) go away,” Epperly said. “I just know that right now, it’s absolutely imperative that we continue to double down on being safe, being careful doing the public health measures, because the virus hasn’t gone away.
“It’s out there waiting to come on in if you’re gonna let it.”
This story was originally published September 20, 2020 at 4:00 AM.
