To mask or not to mask? These days, it’s a loaded question. If you do wear a mask out in public, you might be seen as overly cautious. If you don’t wear one, you might be accused of being selfish. So is there a clear answer?
“I’m wearing a mask anytime we go out because I feel like we have a social contract, to take care of each other,” said Kristina Prevatte, who works for a nonprofit in Maryland. “I am not sure if it ultimately will prevent me from getting sick, but I still think it is worth doing.”
A recent study in the journal “Proceedings of the National Academy of Sciences” suggests that out of all the strategies for reducing transmission of COVID-19, the simple wearing of face masks may in fact be the central factor that determines the spread of coronavirus.
“The difference with and without mandated face covering represents the determinant in shaping the trends of the pandemic,” wrote the research team in the June issue of the journal. The team is made up of researchers from Texas A&M University, the University of Texas at Austin, California Institute of Technology and the University of California San Diego.
Spread Through the Air
COVID-19, the disease caused by the novel coronavirus, is highly contagious, having infected more than 8.3 million people worldwide, killing more than 450,000 since December. In the United States, more than 2 million people have been infected and more than 119,000 have died. Worldwide, more than 4.3 million have recovered.
A study done in May, published in the same National Academy of Sciences journal, showed that just talking loudly in a room released droplets that could hang in the air for eight to 14 minutes. The Centers for Disease Control and Prevention (CDC) has also said air was the main route of infection. Close contact and virus on surfaces are also ways of possible transmission.
And the recommendations for staying distances of 3 to 6 feet apart to lower the risk? Even that might not be enough. Studies have looked at the how respiratory emissions linger and spread in the air, and it’s not a given that droplets can’t spread out further. According to one report in the journal of the American Medical Association, peak exhalation speeds can reach up to 33 to 100 feet per second, creating a cloud that can reach up to 27 feet.
New Studies Mean Different Guidelines
True, when the coronavirus pandemic began, officials ― including the CDC ― advised against wearing masks by the general public, saying they offered no real protection. Older studies show some problems with wearing facial coverings, including increased headaches and airway resistance and carbon dioxide accumulation.
There are other factors to consider as well, such as whether particles can get through certain masks and the fact that many people don’t always wear facial coverings that fit properly. In a 2010 study published by the Society for Risk Analysis, it states that if masks aren’t certified as respiratory protective devices, their exact protective effect against particles is unknown, as is their efficiency.
But as COVID-19 is new, so are many of the studies coming out about it and what can be done to best prevent it. In their study, the Texas/California researchers point out that the CDC and the World Health Organization have focused on contact transmission, not airborne. “The inadequate knowledge on virus transmission has inevitably hindered development of effective mitigation policies and resulted in unstoppable propagation of the COVID-19 pandemic,” they wrote.
Experts didn’t yet know the extent to which people with COVID-19 could spread the virus before symptoms appeared, agreed the Mayo Clinic. “Nor was it known that some people have COVID-19 but don’t have any symptoms. Both groups can unknowingly spread the virus to others.”
According to one study published in the journal “Nature Medicine,” 44 percent of infection transmission happens before someone shows symptoms.
Masks in Action
In May, a research team in Hong Kong performed experiments showing that the transmission rate of the coronavirus via respiratory droplets or airborne particles dropped by as much as 75 percent when surgical masks were used. Newer studies have gone further.
In the study done by the Texas/California team, researchers looked at mitigation measures put in place in the three major centers of the coronavirus outbreak ― Wuhan, China (where the virus originated); Italy and New York City. In NYC, the curve really started to change after masks were mandatory, not after the stay-at-home and social distancing orders. In fact, based on its analysis, the research team calculated that over 66,000 infections were prevented by using a face mask in little over a month in New York City.
“Our study establishes very clearly that using a face mask is not only useful to prevent infected coughing droplets from reaching uninfected persons, but is also crucial for these uninfected persons to avoid breathing the minute atmospheric particles (aerosols) that infected people emit when talking and that can remain in the atmosphere tens of minutes and can travel tens of feet,” said study author Mario Molina, a professor at the University of California-San Diego and a co-recipient of the 1995 Nobel Prize in Chemistry for his role in understanding the threat to the Earth’s ozone layer of man-made halocarbon gases.
There is more real-life evidence that the masks work: At a hair salon in Springfield, Missouri, two stylists worked on 140 customers before realizing they were positive for COVID-19. Both stylists wore masks the entire time, and no one else was infected. Health officials credited the safety practices taken by the Great Clips salon, which has also been distancing salon chairs and staggering appointments.
So Should You Wear a Mask?
In many jurisdictions across the country, it’s required. In others, it’s not, leading some businesses to decide their own rules for customers entering their doors. Some people are so diligent, they’re wearing masks while exercising (not always recommended, depending on distancing and the activity) and inside their cars (not necessary, unless you’re sick and driving with another person).
But there are still some people who for various reasons won’t wear masks. Some think the risk is exaggerated. Some find them too hot, restrictive and uncomfortable. Still others find a mask mandate an assault on their personal freedom. In Montgomery, Ala., the city council this week refused to pass an order requiring masks despite pleas from numerous doctors who spoke about a huge surge in cases and full hospital wards.
“At the end of the day, if an illness or a pandemic comes through we do not throw our constitutional rights out the window,” one councilor said.
Consider Your Risk Level … and Others
Dr. Carrie Dolan, an epidemiologist at the College of William & Mary in Virginia, is a mask wearer. But she also believes that people have their own comfort levels based on their perceived level of risk, which she lays out on a scale of 1 to 5. It looks something like this:
1 ― Complete lockdown. You wear the mask, the gloves and maybe goggles.
2 ― You get takeout, have socially distanced picnics and might hang out with a few people, staying 6 feet apart.
3 ― You feel comfortable interacting with a small group of people while taking precautions. Circle is larger than 2’s.
4 ― Having happy hour on your deck and are about to book a summer vacation.
5 ― Ready to jump on a plane with maybe a bottle of hand sanitizer in your backpack.
“Not everyone is facing the same risk level,” Dolan said. “Depending on the risk level we have, our lives look very different. We need to respect where people are with their decision.”
Protecting the Public
Although she considers herself and her family at a 3 on her risk-level scale, Dolan says she wears a mask in public, not only because it’s required in Virginia, but also out of courtesy.
“We do that to protect other people and ourselves,” she said. “There are people who go shopping who have real concerns. I want to do everything I can to protect the public’s health.”
A British research team from Cambridge and Greenwich universities concluded that masks don’t have to be expensive surgical or respirator masks, either. The scientists said homemade coverings, such as the face masks many people are making themselves, that catch even only 50 percent of exhaled droplets would provide a “population-level benefit.”
“In summary, our modeling analyses provide support for the immediate, universal adoption of face masks by the public,” the research team wrote in their study, published in early June in the journal The Royal Society.
Protecting everyone’s health still includes the tried-and-true measures of practicing good hygiene, researchers say. But, said Renyi Zhang, a professor at Texas A&M and the lead researcher on the team study, it has to go beyond that to truly fight the coronavirus. Adopting an “inexpensive practice” ― wearing a face mask ― is the most likely way.
“Social-distancing and washing our hands must continue, but that’s not sufficient enough protection,” Zhang said. “Wearing a face mask as well as practicing good hand hygiene and social distancing will greatly reduce the chances of anyone contracting the COVID-19 virus.”
The Mayo Clinic’s Tips for Wearing Masks
Cloth face masks should be worn in public settings where social distancing measures are difficult to maintain, such as in grocery stores, especially in areas of significant community-based transmission.
- Place your mask over your mouth and nose.
- Tie it behind your head or use ear loops and make sure it’s snug.
- Don’t touch your mask while wearing it.
- If you accidentally touch your mask, wash or sanitize your hands.
- Remove the mask by untying it or lifting off the ear loops without touching the front of the mask or your face.
- Wash your hands immediately after removing your mask.
- Regularly wash your mask with soap and water in the washing machine. It’s fine to launder it with other clothes.
A few face mask precautions:
- Don’t put masks on anyone who has trouble breathing, or is unconscious or otherwise unable to remove the mask without help.
- Don’t put masks on children under 2 years of age.
- Don’t use face masks as a substitute for social distancing.
