Back when there were only few confirmed cases of coronavirus in the U.S., the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services and the U.S. Surgeon General all pled with the public urging them not to wear face masks unless they were sick or caring for someone who was sick.
Today, there are thousands of cases of COVID-19 across America — and a growing movement to encourage mask usage in the U.S., even as health-care professionals grapple a severe shortage of protective equipment, including face masks and gowns as they treat coronavirus patients.
On social media, the #Masks4All campaign was started by Jeremy Howard, a distinguished research scientist at the University of San Francisco and a member of the World Economic Forum’s Global AI Council. The #Masks4All movement doesn’t just push for people to wear masks, but also to make their own face masks at home to ensure that health-care workers have access to supplies.
In an opinion piece for the Washington Post, Howard said, “The senseless and unscientific push for the general public to avoid wearing masks” should rank among the worst missteps made by policy makers.
That perspective was echoed by George Gao, director-general of the Chinese Center for Disease Control and Prevention in an interview with Science magazine.
“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks,” Gao said.
“This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth,” Gao continued. “Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”
Multiple studies have indicated that people may display few symptoms but have the coronavirus, while others may be contagious before they begin to display symptoms. These asymptomatic individuals have complicated government efforts to contain the spread of the coronavirus across the globe.
Some previous research has concluded that face masks have helped reduce contagion by reducing droplets being sprayed into the air during flu season; another Japanese-based study says this works when paired with vaccination, not an option in this case. This study says N95 medical-grade masks do help filter viruses that are larger than 0.1 micrometers (One micrometer, um, is one millionth of a meter.) The coronavirus is 0.125 um.
Proponents of face masks also point to the anecdotal evidence from countries in East and Southeast Asia, including South Korea and Taiwan, that have been able to slow the spread of the novel coronavirus and flatten the curve more effectively than in countries like the U.S., Spain and Italy.
Mask usage is more ubiquitous in these countries in general as a hygienic practice even outside of instances of global disease outbreaks. “In all of these countries, all of which were hit hard by the SARS respiratory virus outbreak in 2002 and 2003, everyone is wearing masks in public,” Howard wrote.
Recently, some Western countries have required residents to wear face masks. The Czech Republic, Slovakia and Bosnia-Herzegovina now require people to wear masks in public, while nearby Austria requires their use in grocery stores.
KK Cheng, a public-health expert and professor at the University of Birmingham in the U.K, said he wears a mask when he goes to the supermarket and supports Austria’s decision to mandate masks there.
“I think it’s a good idea because trips to the supermarket are the main exposure to the virus,” especially in areas where they are the only businesses that are open, he said.
The World Health Organization and the CDC continue to stand by their recommendations from earlier in the coronavirus outbreak. They argue that mask usage should be limited to people who have COVID-19 or may have contracted the illness and their caregivers, including health-care workers.
“There is no specific evidence to suggest that the wearing of masks by the mass population has any particular benefit,”
“There is no specific evidence to suggest that the wearing of masks by the mass population has any particular benefit,” Dr. Michael Ryan, WHO’s top emergencies expert, said during a press conference Monday.
Similarly, the CDC still “does not recommend that people who are well wear a face mask to protect themselves from respiratory illnesses, including COVID-19.”
“You should only wear a mask if a health-care professional recommends it,” the CDC said in a statement online. “A face mask should be used by people who have COVID-19 and are showing symptoms. This is to protect others from the risk of getting infected.”
But in a comment published in The Lancet, a medical publication, a group of researchers from Hong Kong argued that the lack of studies proving masks to be effective didn’t mean they weren’t.
“There is an essential distinction between absence of evidence and evidence of absence,” they wrote. “Face masks are widely used by medical workers as part of droplet precautions when caring for patients with respiratory infections. It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas.”
While face masks may help protect people, they are hard to come by
In many countries, including the U.S., a shortage of masks has endangered doctors and nurses treating patients with COVID-19. Health-care professionals have warned that they may need to reuse masks as a result, which can reduce their effectiveness. Multiple fashion designers have even lent their services in making masks to combat this shortage.
“We have a massive global shortage,” Ryan said. “Right now, the people most at risk from this virus are frontline health workers who are exposed to the virus, every second of every day. The thought of them not having masks is horrific. So we have to be very careful.”
A spokesman for the CDC noted that officials could reserve face masks for health-care workers, meaning they are less likely to be available for non-health care. “You may need to improvise a face mask using a scarf or bandana,” the CDC said in a post which was last updated on March 25. (Balaclavas may also provide some protection.)
N95 masks, however, are tighter-fitting than surgical masks and protect against small particles and large droplets, according to the CDC. These types of masks offer the most protection from viruses similar to coronavirus.
For health-care professionals who cannot be six feet apart from patients with COVID-19, there are few substitutes to N95 masks. Surgical masks, the CDC says, should be worn if N95 masks are “so limited that routinely practiced standards of care for wearing N95 respirators and equivalent or higher level of protection respirators are no longer possible.”
As a last resort if both surgical and N95 masks aren’t available, the CDC says it “may be necessary” for them to use homemade masks that haven’t been approved by the National Institute for Occupational Safety and Health.
Proponents of face-mask usage have suggested that people fashion their own protective gear. “A homemade DIY mask would be better than nothing,” in terms of limiting transmission of coronavirus, Cheng said.
It’s not clear whether people making masks at home should choose certain materials over others. “If the WHO and other authorities think it’s a good thing for the public to wear masks,” Cheng said health authorities around the world would likely investigate which materials offer the best protection for a DIY mask.