Dear Governor Lee,

Across the country, Covid-19 infection rates are rising.  This has become particularly severe in many of the states where limitations on high risk situations have been lifted. Predictably, the visible impact has been delayed for weeks and months, but the SARS-CoV-2 virus has been spreading exponentially. In Tennessee, we have seen outbreaks associated with factories, nursing homes, jails and with school reopenings. Since the beginning of October, the infection rates have been increasing and our curve is going up again, trending toward another, possibly higher, peak than we saw in July. The hospitalization rate for Covid-19 infections in Tennessee recently reached a new record high. Many hospitals in the state are feeling the strain of these increased hospitalizations in the intensive care units, regular inpatient floors and emergency departments.

Currently there is no vaccine and there are no miracle treatments for COVID-19. The disease is devastating to older patients but is also indiscriminate in killing younger patients and does impact children. We do not yet know if there are long-term health impacts to those who have recovered from COVID-19.

Non-pharmaceutical interventions including stay-at-home orders, school shutdowns, remote work, time-intensive contact tracing and isolation are all ways to lower the R0, or reproduction number. By lowering the R0, transmission can be incrementally driven down and disease outbreaks can be contained. Collectively, these interventions avoid excess mortality. They prevent exponential spread and waves from overwhelming our healthcare system. Slowing spread makes it manageable to implement contact tracing and isolation. Decreasing the rate of spread gives time to identify and develop more effective therapies to decrease mortality. Several promising vaccines are being tested and, by delaying spread until a vaccine is in place, these interventions may prevent countless infections and unnecessary deaths. Mitigation of COVID-19 in the community allows those with other necessary hospital needs to be cared for in a timely manner, adequately and without added risk.

The evidence is clear: universal masking is an intervention that could effectively delay spread of COVID-19. Universal masking is safe, inexpensive and can be quickly accomplished. The following references strongly support universal masking:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31183-1/fulltext?fbclid=IwAR0TSoh6w_Pl54K5ZmmNU6p_cIBo2EoP9BmSxY5Pu2K0aV95IPwk5T53Q6s

https://www.npr.org/sections/health-shots/2020/06/21/880832213/yes-wearing-masks-helps-heres-why

https://www.sfgate.com/science/article/Study-100-face-mask-use-could-crush-second-15333170.php?

https://www.sciencedirect.com/science/article/pii/S2468042720300117?via%3Dihub

http://ftp.iza.org/dp13319.pdf?fbclid=IwAR1jlcs2PjDIvg3AjqxMucwVPfexpxRDOt5T3k24MzNYmTCIE0Resziaeto

https://www.nbcnews.com/news/us-news/no-new-covid-19-cases-reported-after-infected-hair-stylists-n1230346

https://www.healthaffairs.org/do/10.1377/hblog20201002.655610/full/

https://voxeu.org/article/face-mask-mandates-slowed-spread-covid-19-canada

https://news.mit.edu/2020/masks-mandates-impact-deaths-0805

https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2020.00818?casa_token=WtLfh8AtpYQAAAAA:heZqTIkM_Y5vHA2Gw9hUdgwGQDwCZISKDXsx9baSum2IxSXFZBRkSrh0AxYp-1JQu7dy_mBskT8

https://www.sciencedirect.com/science/article/pii/S1477893920302301?via%3Dihub

https://gh.bmj.com/content/5/5/e002794

https://www.acpjournals.org/doi/10.7326/M20-3213

Many counties in Tennessee have instituted mask mandates but many have not. Worryingly, several counties: Humphreys, Montgomery, Robertson, Rutherford, Sumner, Williamson and Wilson, had let their mask mandates expire. A few have reinstated these mandates. The executive order instituted by the governor allowing individual county governments in Tennessee to institute mask mandates county wide is set to expire on October 30th.

We write to urge you: Please issue a state-wide mandate requiring universal masking in public for those 2 years old and above. There is sufficient, clear, scientific evidence that wearing masks is one way to decrease the spread of COVID-19.  We believe that universal mask wearing is ONE very effective and important strategy to continue the fight against COVID-19.

There are many reasons this simple act of wearing a non-vented mask can help the greater good and we have a tradition of implementing similar safety measures to save lives. Wearing a mask decreases harm and protects the community in the same manner as requiring passengers to wear seatbelts in a car, forbidding texting while driving, ending indoor smoking, outlawing jaywalking and requiring life vests on a boat. If the simple act of wearing masks can decrease the transmission and save lives, it should be mandated.

Keeping the economy going while maintaining universal masking and social distancing is a WIN-WIN for every member of the community, regardless of political views, in that it balances economics with public health.

Please stand with the frontline healthcare workers who risk their lives to care for COVID-19 patients every day.  Help us educate, as well as protect, those who do not understand just how vital universal masking is at this critical time. Help communicate to all Tennesseans that it is out of respect for others, respect for humanity, respect for our great country, respect for our businesses and respect for the American way of life that mandating mask usage for this specific period in time is essential to not only decrease the number of unnecessary deaths but also allow our businesses to remain open.

Sincerely,

- Board Certified (and Board Eligible) Medical Doctors, Doctors of Osteopathy, Physician Assistants, Nurse Practitioners, RNs
- Tennessee business owners
- Tennessee teachers
- Your constituents and citizens of Tennessee
- List of Cosigners to be inserted here