WASHINGTON — The Trump administration is close to recommending that all Americans wear cloth masks if they go out in public, a change in position that reflects new concerns that the coronavirus is being spread by infected people who have no symptoms and new data suggesting the United States is not yet slowing the rate of infections.
At a White House briefing Thursday evening, both President Trump and Vice President Pence said that new guidance on masks would be issued by the Centers for Disease Control and Prevention in the coming days. But the comments of both Mr. Trump and a top official on the administration’s coronavirus response task force during the session suggested that the issue hasn’t been entirely resolved within the administration.
“If people want to wear them, they can,” President Trump said, declaring that while the administration was “coming out with regulations” on mask wearing soon, whether to follow them was a personal choice.
Dr. Deborah Birx, the White House’s coronavirus response coordinator, sounded a sharper note of caution, saying that she did not want Americans to get a false sense of security from wearing masks. Washing hands and keeping six feet away from other people were more protective steps, she said, and suggested that the still-unannounced new guidance remained under debate.
“The eyes are not in the mask. If you are touching things and touching your eyes, you’re exposing yourself in the same way,” Dr. Birx said. “This will be an additive piece if it comes out, rather than saying it is a substitute for it. It is not a substitute for the presidential guidelines that have already gone out.”
During the same briefing, Dr. Birx suggested that despite all the harsh measures such as stay-at-home orders and business closures, the U.S. is not yet flattening the spike in new infections.
“We have to change that slope. We have to change the logarithmic curve that we’re on,” she said of the steep increases in cases in many parts of the country. “We see country after country having done that, what it means in the United States is not everyone is doing it.”
Dr. Birx said that recommendations against gatherings of more than 10 do not mean people should be having dinner parties or cocktail parties of less than 10 people.
“We’re only as strong is every community, every county, every state, every American following the guidelines to a tee,” she said. “And I can tell by the curve, and as it is today that not every American is following it. And so this is really a call to action.”
Her caveats on masks reflect what has been a common view among many public health bodies about the effectiveness of masks for the general public. Until now, the C.D.C., like the World Health Organization, has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason has been to preserve medical-grade masks, including N95 respirator masks, for health care workers who desperately need them at a time when they are in continuously short supply.
Still, as the coronavirus devastates the United States, the C.D.C. has been drafting new guidelines recommending that everyone wear face coverings in public settings, like pharmacies and grocery stores, to avoid unwittingly spreading the virus, according to a federal official.
Public health officials have continued to stress, however, that N95 masks and surgical masks should be saved for front-line doctors and nurses, who have been in dire need of protective gear. In the briefing, President Trump suggested that homemade face coverings, like scarves, would suffice.
On Wednesday, Mayor Eric Garcetti of Los Angeles urged a similar approach, suggesting that all of that city’s residents to wear homemade nonmedical face coverings, or even bandannas, when food shopping or doing other essential errands. Health officials in Riverside County, Calif., made a similar recommendation on Tuesday.
Since the beginning of the coronavirus outbreak, the Trump administration has had shifting positions on whether regular citizens should cover their faces in public.
“Seriously people — STOP BUYING MASKS!” the surgeon general, Dr. Jerome M. Adams, said in a tweet in late February. “They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!”
He was most concerned about widespread hoarding of the tightfitting N95 masks that can stop infectious particles even finer than a micron in diameter, and that even many health care workers have not been able to find.
But earlier this week, Mr. Trump said that broad use of nonmedical masks, at least, was “certainly something we could discuss.”
Dr. Robert Redfield, the director of the C.D.C., confirmed in a radio interview earlier this week that the agency was reviewing its guidelines on who should wear masks. Citing new data that shows high rates of transmission from people who are infected but show no symptoms, he said the guidance on mask wearing was “being critically re-reviewed, to see if there’s potential additional value for individuals that are infected or individuals that may be asymptomatically infected.”
While wearing masks to prevent the spread of disease is a widely accepted practice in many Asian countries, it remains to be seen how Americans would react to such a recommendation. But a growing number of public health experts have been recommending universal mask use.
A recent white paper from the American Enterprise Institute had argued the move could have substantial public health benefits. One of its authors, the former F.D.A. commissioner Scott Gottlieb, had been forcefully advocating for the policy in media appearances.
And a white paper from a group of Yale researchers released on Thursday estimated that universal mask use could reduce infections by around 10 percent, creating a value of $3,000 to $6,000 per American, based on estimates of the value of saved lives. The authors included Sten H. Vermund, the dean of the Yale School of Public Health, and Albert Ko, the chairman of Yale Medical School’s department of epidemiology and microbial diseases.
Both papers recommended that members of the public wear homemade cloth masks, to preserve limited supplies of surgical masks and higher-grade respirators for health care workers.
“It is critically important that public adoption not come at the expense of medical mask availability for health workers,” said Jason Abaluck, an associate professor of economics at the Yale School of Management and a co-author of the paper. “This is why we emphasize universal adoption of cloth masks.”
The researchers emphasized that the primary benefit of mask wearing was to prevent infected people from spreading the virus by expelling infected droplets.
