Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, United States of America.
PLoS One. 2024 May 15;19(5):e0302199. doi: 10.1371/journal.pone.0302199. eCollection 2024.
Community-based mask wearing has been shown to reduce the transmission of SARS-CoV-2. However, few studies have conducted an economic evaluation of mask mandates, specifically in public transportation settings. This study evaluated the cost-effectiveness of implementing mask mandates for subway passengers in the United States by evaluating its potential to reduce COVID-19 transmission during subway travel.
We assessed the health impacts and costs of subway mask mandates compared to mask recommendations based on the number of infections that would occur during subway travel in the U.S. Using a combined box and Wells-Riley infection model, we estimated monthly infections, hospitalizations, and deaths averted under a mask mandate scenario as compared to a mask recommendation scenario. The analysis included costs of implementing mask mandates and COVID-19 treatment from a limited societal perspective. The cost-effectiveness (net cost per averted death) of mandates was estimated for three different periods based on dominant SARS-CoV-2 variants: Alpha, Beta, and Gamma (November 2020 to February 2021); Delta (July to October 2021); and early Omicron (January to March 2022).
Compared with mask recommendations only, mask mandates were cost-effective across all periods, with costs per averted death less than a threshold of $11.4 million (ranging from cost-saving to $3 million per averted death). Additionally, mask mandates were more cost-effective during the early Omicron period than the other two periods and were cost saving in January 2022. Our findings showed that mandates remained cost-effective when accounting for uncertainties in input parameters (e.g., even if mandates only resulted in small increases in mask usage by subway ridership).
The findings highlight the economic value of mask mandates on subways, particularly during high virus transmissibility periods, during the COVID-19 pandemic. This study may inform stakeholders on mask mandate decisions during future outbreaks of novel viral respiratory diseases.
社区内佩戴口罩已被证明可降低 SARS-CoV-2 的传播。然而，很少有研究对口罩强制令进行经济评估，特别是在公共交通环境中。本研究通过评估其在地铁出行期间减少 COVID-19 传播的潜力，评估了在美国对地铁乘客实施口罩强制令的成本效益。
我们评估了与口罩推荐相比，地铁口罩强制令在减少美国地铁出行期间感染的潜在健康影响和成本。使用组合箱和 Wells-Riley 感染模型，我们根据在口罩强制令情景下与口罩推荐情景下地铁旅行期间发生的感染数量，估计了每月可避免的感染、住院和死亡人数。该分析包括从有限的社会角度来看，实施口罩强制令和 COVID-19 治疗的成本。根据主要的 SARS-CoV-2 变体，我们基于三个不同时期（2020 年 11 月至 2 月的 Alpha、Beta 和 Gamma 时期；2021 年 7 月至 10 月的 Delta 时期；以及 2022 年 1 月至 3 月的早期 Omicron 时期），估计了口罩强制令的成本效益（每避免一例死亡的净成本）。
与仅推荐口罩相比，在所有时期，口罩强制令都具有成本效益，每避免一例死亡的成本均低于 1140 万美元的阈值（从节省成本到每避免一例死亡节省 300 万美元）。此外，在早期 Omicron 时期，口罩强制令比其他两个时期更具成本效益，并且在 2022 年 1 月是节省成本的。我们的研究结果表明，即使考虑到输入参数的不确定性（例如，口罩强制令仅导致地铁乘客的口罩使用率略有增加），口罩强制令仍然具有成本效益。
这些发现突显了在 COVID-19 大流行期间，地铁口罩强制令的经济价值，尤其是在病毒传播率较高的时期。本研究可能为未来新型病毒性呼吸道疾病爆发期间的口罩强制令决策提供信息。
