To Mask or Not To Mask Covid-19

 

As per Centers for Disease Control and Prevention (CDC) & World Health Organization (WHO) , masks for healthy people aren’t necessary, as long as they practice social distancing and stay at least six feet away from each other. 

The agencies have maintained that the virus is transmitted by either direct contact with an infected person, fomites—an infected surface like a door handle—or from droplets that are produced when someone coughs or sneezes. 

But there’s mounting evidence that transmission may occur via aerosols, or viral particles produced during exhalation by way of talking, breathing, singing, and even outdoor exercise. And, some experts and critics of the new CDC guidelines say, there’s little evidence that cloth masks offer much protection from that terrifying possibility. 

45 of the 60 members of a choir group in Washington—none of whom say they shook hands or had physical contact with the other members—tested positive for the novel coronavirus. 

Experts hypothesized that the forceful exhalation of air from singing released enough viral particles to infect a majority of the singers.

A study last month from the University of Nebraska Medical Center found that particles containing traces of the virus’ RNA were found on windowsills and ventilation grates in the rooms of patients with relatively mild symptoms—i.e. likely not consistently producing a lot of droplets through coughing, sneezing, etc. 

Aerosolized particles are primarily a concern in enclosed spaces, with the most significant implications for health-care workers. 

For the general public, it’s fine if wearing a cloth mask makes people feel more comfortable, as long as they understand that such masks haven’t been proven to be very effective at filtering those small particles. 

 

First, many health experts, including the surgeon general of the United States, told the public simultaneously that masks weren’t necessary for protecting the general public and that health care workers needed the dwindling supply. This contradiction confuses an ordinary listener. How do these masks magically protect the wearers only and only if they work in a particular field?

Second, there were attempts to bolster the first message, that ordinary people didn’t need masks, by telling people that masks, especially medical-grade respirator masks (such as the N95 masks), needed proper fitting and that ordinary people without such fitting wouldn’t benefit. This message was also deeply counterproductive. Many people also wash their hands wrong, but we don’t respond to that by telling them not to bother. Instead, we provide instructions; we post signs in bathrooms; we help people sing songs that time their hand-washing. Telling people they can’t possibly figure out how to wear a mask properly isn’t a winning message. Besides, when you tell people that something works only if done right, they think they will be the person who does it right, even if everyone else doesn’t.

Third, of course masks work — maybe not perfectly and not all to the same degree, but they provide some protection. Their use has always been advised as part of the standard response to being around infected people, especially for people who may be vulnerable. World Health Organization officials wear masks during their news briefings. That was the reason I had bought a few in early January — I had been conducting research in Hong Kong, which has a lot of contact with mainland China, and expected to go back. I had studied and taught about the sociology of pandemics and knew from the SARS experience in 2003 that health officials in many high-risk Asian countries had advised wearing masks.

It is of course true that masks don’t work perfectly, that they don’t replace hand-washing and social distancing, and that they work better if they fit properly. And of course, surgical masks (the disposable type that surgeons wear) don’t filter out small viral particles the way medical-grade respirator masks rated N95 and above do. However, even surgical masks protect a bit more than not wearing masks at all. We know from flu research that mask-wearing can help decrease transmission rates along with frequent hand-washing and social-distancing. Now that we are facing a respirator mask shortage, the federal Centers for Disease Control and Prevention is recommending that surgical masks are “an acceptable alternative” for health care workers — again, obviously because some protection, even if imperfect, is better than none. In the face of this, publicly presenting an absolute answer — “You don’t need them” — for something that requires a qualified response just makes people trust authorities even less.

Fourth, the W.H.O. and the C.D.C. told the public to wear masks if they were sick. However, there is increasing evidence of asymptomatic transmission, especially through younger people who have milder cases and don’t know they are sick but are still infectious. Since the W.H.O. and the C.D.C. do say that masks lessen the chances that infected people will infect others, then everyone should use masks. If the public is told that only the sick people are to wear masks, then those who do wear them will be stigmatized and people may well avoid wearing them if it screams “I’m sick.” Further, it’s very difficult to be tested for Covid-19 in the United States. How are people supposed to know for sure when to mask up?

Fifth, places like Hong Kong and Taiwan that jumped to action early with social distancing and universal mask wearing have the pandemic under much greater control, despite having significant travel from mainland China. Hong Kong health officials credit universal mask wearing as part of the solution and recommend universal mask wearing. In fact, Taiwan responded to the coronavirus by immediately ramping up mask production.

Sixth, masks are an important signal that it’s not business as usual as well as an act of solidarity. Pandemics require us to change our behavior — our socialization, hygiene, work and more — collectively, and knowing our fellow citizens are on board is important for all efforts.