How might a mask mandate play out? Look to the battle over seat belt laws

“If public health officials want to get people to wear masks to curb the spread of Covid-19, they might take a lesson what is now a widely accepted aspect of American life: buckling up.

[..] Fred Rivara, an injuries expert and professor of pediatrics at the University of Washington, remembers an unsubstantiated claim that any positive effects would be cancelled out by people dying when they couldn’t escape fiery cars.

[..] After years of pressure, President Johnson signed legislation in 1966 that required seat belts in all passenger vehicles and created a national traffic safety agency.

Rivara credits science for the federal action. “Studies showed that wearing a seat belt improved your risk of surviving a crash,” said Rivara. “That was key.”

[..] “Saving freedom is more important than trying to regulate lives through legislation,” an anti-seat-belt activist wrote in a letter to the Chicago Tribune in 1987.

Still, starting in 1984 with New York, states began passing seat belt mandates. The federal government eventually gave extra highway funding to states with tough laws. Meanwhile, new designs were making seat belts more comfortable and effective.

[..] Today seat belt usage is high — in 2019, it was 91% nationally. States where cops are authorized to pull over drivers not wearing seat belts score higher than states where cops can only ticket if they’ve pulled a driver over for something else. Even in New Hampshire, the only state without any kind of mandate, seat belt use is 71%.

Motorcycle-helmet laws have had a bumpier ride. At one point, in no small part in order to get federal highway construction funds, 48 states required helmets. But after Congress dropped the funding in 1976, half of the states reversed their laws, including Washington.

In 1988, Rivara and his colleagues published a study on the cost of care for motorcyclists who wound up in the ER at a large Seattle hospital. The study found two-thirds of spending on those patients came from state and federal coffers, and the state legislature passed a helmet law the next year. Still, only about half of states now have such a law.

[..] Mandates did not work well for masks in the 1918 influenza epidemic. “There was even an anti-mask league to fight the law,” said Markel. But he noted that there wasn’t any research at the time showing that masks would be protective. And they might not have been, given the use of porous gauze masks.

[..] An October modeling study projected that universal mask-wearing in the US could save 130,000 lives by the end of February.

[..] an August Congressional Research Service report suggests that it might take an act of Congress to get a masking policy that covers the entire nation — much like how Congress tapped federal highway funds to get states to pass seat belt laws.

In the end, what worked with seat belts were efforts by public health advocates, financial incentives, state level mandates, enforcement, solid research, and concerted effective public health messaging — all activities that are possible with masks.”

Full article, Silberner J. STAT 2020.11.10