Question

Considering the pandemic/CDC guidelines/the public and political response in the United States in which masks have become a political statement, do you think paternalistic interventions [by the state or other authorities] … can be ethically justified if they infringe general moral considerations such as respect for autonomy, including liberty of action?

Answer 1

The Covid-19 pandemic has been extremely costly in lives, human suffering, and economic terms. Millions have died, many others have had, or are having, a painful and lengthy recovery, hundreds of million had seen their life dramatically impoverished, and the world economy has its second worse recession in a century. The countries that had fare the

best applied early measures of identifying, tracing, and isolating infected

people; rapid and decisive national and selected lockdowns; and social

distancing, hand washing and masks. In the absence of a vaccine, all of these measures have been required to maintain the pandemic under control. There are however significant differences in these measures. National lockdowns are very expensive both in social and economic terms; while masks, social distancing and hand washing are almost free of costs.

The countries that fare the worst were the ones that started the policy

responses latter on, and which refuse the generalized usage of masks.

The countries that have fare the best can be divided in two groups, the ones that rely early in intensive identifying, tracing, and isolating such as Germany, Norway and Denmark; and the group of Asian countries that have had a very high percentage of masks usage since the beginning,

Of the two, the second group has been more efficient, it has had less

deaths and lower social and economic costs3.

Masks by themselves are not the solution to maintain under control the Covid-19 pandemic, other several measures as mentioned before are required. However, the generalized usage of masks, in addition to the other measures, have proven to make a significant difference in:1) More lives

saved; 2) less Covid-19 survivors with long term health consequences; and

3) Less intensive lockdowns with the corresponding diminution in all the negative socio-psychological consequences that they imply; 4) Less crowded hospitals which imply nor only better attention to Covid-19 patients, but

also to patients with other health problems, which with crowded hospitals

are left unattended; 5) A meaningful reduction in economic costs.
There is not known precise way to estimate all of the above men-
tioned benefits, however we do have indicators that can help us. We will
discuss two methods to get an idea of the benefits involved on mandatory masks. First method: there is literature that reviews the efficiency of masks in reducing contagion, which together with calculations as to the number of people infected can give us an idea of the probability of getting infected with and without mandatory masks. The calculation of people infected in both scenarios is a critical indicator because: 1) Deaths and survivors are related to the % of people infected; 2) Lockdowns are related to the % of people that results positive in open testing, when this number is high lockdowns are required, when it goes down substantially it is possible to open the economy to normal activities. Therefore, the percentage of people infected is related to the necessity of lockdowns which increase the
social and economic costs of the pandemic; 3) The less people is infected the less crowded the hospital will be. Second method: Country and regional comparisons between those that have had high use of masks and the ones with low use. In what follows we will discuss both methods.