US should consider national mask mandate for the winter, former FDA commissioner writes in op-ed

As the US reports its second-highest day of new Covid-19 cases amid the continuing fall surge, a former commissioner of the US Food and Drug Administration says it may be time for a national mask mandate.

Alice Arnold wearing a hat: Salt Lake County Health Department public health nurses look on during coronavirus testing outside the Salt Lake County Health Department Friday, Oct. 23, 2020, in Salt Lake City, Utah. (Rick Bowmer/AP)

© Rick Bowmer/AP
Salt Lake County Health Department public health nurses look on during coronavirus testing outside the Salt Lake County Health Department Friday, Oct. 23, 2020, in Salt Lake City, Utah. (Rick Bowmer/AP)

In an op-ed for The Wall Street Journal, Dr. Scott Gottlieb wrote the mandate could be “limited and temporary.”

“A mandate can be expressly limited to the next two months,” Gottlieb wrote, adding that it’s easier to wear a mask in the winter than the summer. “The inconvenience would allow the country to preserve health-care capacity and keep more schools and businesses open.”

With deaths expected to rise this winter, policymakers will have to make moves to slow the spread, Gottlieb wrote. There already is no support for reinstating the stay-at-home orders from the spring.

If 95% of Americans wore masks in public, more than 100,000 lives could be saved in the United States through February, according to data released Friday by the Institute for Health Metrics and Evaluation at the University of Washington.

“If people are not wearing masks, then maybe we should be mandating it,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN’s Erin Burnett on Friday.

Gottlieb wrote the concern about needing fines to enforce the mandate leading to confrontations with police isn’t necessarily true.

“States should be able to choose how to enforce a mandate, but the goal should be to make masks a social and cultural norm, not a political statement,” he wrote. “Mandating masks has become divisive only because it was framed that way by some politicians and commentators.”

Gottlieb was appointed FDA commissioner by President Trump and served from May 2017 to May 2019. He is now a resident fellow at the American Enterprise Institute, a think tank in Washington, DC.

Saturday saw 83,718 new Covid-19 cases, just 39 cases shy of the all-time record that was reported Friday. Already, national cases total more than 8.6 million and 225,212 people have died, according to Johns Hopkins.

“We’re at a dangerous tipping point right now,” Gottlieb told Margaret Brennan Sunday on CBS’s “Face the Nation.” “We’re entering what’s going to be the steep slope of the curve, of the epidemic curve.”

Social gatherings and family events moving indoors to avoid the colder weather is largely to blame for the high rates of spread, officials said over the weekend.

In Maryland, the governor said this week family gatherings were the No. 1 source of transmission in the state, followed by house parties. In North Carolina, health officials reported its highest daily case count Friday and said they continue to see clusters “from social and religious gatherings.”

At least 35 states report rise in cases

The Florida Department of Health on Sunday reported 2,385 additional coronavirus cases and

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Op-Ed: COVID and Chronic Pain

The COVID-19 pandemic has made access to crucial healthcare services a challenge for many patients, especially those with chronic pain.

According to the CDC, chronic pain is one of the most common reasons adults seek medical care. In the United States, an estimated 20.4% (50 million) of adults had chronic pain according to 2016 National Health Interview Survey data.

Chronic pain has been linked to a lack of mobility and daily activity, socioeconomic status, access to healthcare, and opioid dependence. These correlations have recently been intensified as the pandemic has exacerbated income inequity, lack of access to affordable healthcare, and physical and emotional isolation making the treatment of chronic pain even more challenging.

The consequences of not seeking essential medical treatment for chronic pain can be dire. Patients waiting for a medical assessment often report high levels of pain that interfere with their ability to function and reports of severe pain are associated with increased levels of depression in 50% of patients and suicidal thinking in 34.6% of patients. In addition, as chronic pain patients are increasingly isolated many of them are at a higher risk for opioid addiction or overdose.

The pandemic has highlighted the necessity for patient care to encompass an individualized, multi-disciplinary, and multimodal approach that can include both telehealth and in-person care. And the multidimensional complexity of chronic pain with both pathophysiologic and psychosocial issues reinforces the need for patients to receive pain care under a physician-led team. Pain medicine physicians are specifically trained over many years through medical school, residency, and subspecialty training to diagnose and manage complex acute and chronic pain conditions, including those with life-threatening illnesses.

Many patients who are prescribed opioids need access to in-person medical treatment as monitoring opioid use is difficult through telemedicine and administering urine drug screenings are most effective and accurate in person. When in-person care is not feasible, it is important for physicians in California, for example, to meet state medical board mandates by documenting a patient’s inability to receive drug testing during the pandemic.

For other patients, telemedicine is a good option — especially those with low mobility or comorbidities — as long as there is a focus on ensuring equitable access as disadvantaged groups, older adults, and people with disabilities tend to use technology less often.

Future legislation must not create barriers for chronic pain patients to receive safe, effective treatment. The CDC has already issued guidelines for both opioid and nonopioid treatments for chronic pain. Regulations need to ensure and allow for individualized pain management strategies for patients dealing with chronic pain. Those patients who are stable and functional on opioids should be allowed continued access to opioids, just as all patients seeking nonopioid treatments, including interventional pain treatments, such as spinal cord stimulation, peripheral nerve stimulation, and others with high-quality evidence, should be allowed access to those therapies.

As noted in the journal PAIN: “Not treating chronic pain will have consequences for individuals, healthcare systems, and providers in the short- and long-term, increasing

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