Used properly, a mask can be a useful complement to other COVID-19 preventive measures.
Only people with COVID-19 symptoms or those caring for them should wear facemasks, according to the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Surgeon General. But if facemasks work for the sick and the caring, why shouldn’t everyone wear one to help reduce the spread of coronavirus?
Good question. In parts of Asia, health officials are encouraging masks for all. The Czech Republic made nose and mouth coverings mandatory for people who are out in public, according to an article by Kelly Servick in Science, a publication of the American Association for the Advancement of Science.
“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks,” said George Gao, head of the Chinese Center for Disease Control and Prevention.
Meanwhile, citing an anonymous source, the Washington Post reports that the CDC is considering changing its guidance and encouraging people to cover their faces. “This is being critically re-reviewed,” CDC director Dr. Robert Redfield told Atlanta radio station WABE.
“This virus does have the ability to transmit far easier than flu,” Redfield said. “It’s probably now about three times as infectious as flu.”
Arguments for and against
Reasons to advise against the widespread use of facemasks include the fact that healthcare professionals need them badly. Some 200 workers at one New York hospital have become sick, and two nurses have died in city hospitals, all amid a lack of protective gear. Hospitals around the U.S. are asking for donations of masks and other protective gear.
Also, people in general may not use masks properly, and it remains unclear how far droplets infected with COVID-19 travel through the air, and so it’s unclear how effective masks would be if people are already keeping 6 feet apart.
The argument for a mask is simple: It can help prevent infected respiratory droplets from a person who has COVID-19 from becoming airborne and either landing on someone else or on a shopping-cart handle; and to a lesser extent it can help keep such droplets away from the nose and mouth of an uninfected person — if the mask is of sufficient quality, good fit, and if it’s used properly.
“Of course masks work — maybe not perfectly and not all to the same degree, but they provide some protection,” writes Zeynep Tufekci, a professor of information science, in a New York Times opinion piece. “World Health Organization officials wear masks during their news briefings,” she points out.
Evidence that masks work
Importantly, facemasks should not be relied on by anyone in lieu of other preventive measures, including proper handwashing, home sanitizing, staying away from places where people gather or frequent, and physical distancing when you must go out — health experts agree on all that.
But facemasks can be a useful complement, research has shown, helping slow the spread of a viral respiratory disease like COVID-19 (based, though, on studies of the flu virus).
A study back in 2010 of the H1N1 influenza pandemic, reported in the Journal of Infectious Diseases, suggested hand-washing and facemasks together “may reduce respiratory illnesses in shared living settings.” Another study, from 2012 in the journal BMC Infectious Diseases, suggested “household transmission of influenza can be reduced by the use of NPI [non-pharmaceutical interventions], such as facemasks and intensified hand hygiene, when implemented early and used diligently.”
“It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas,” researchers wrote March 20 in the Lancet Respiratory Medicine journal. “As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks.”
“The value of the mask isn’t necessarily to protect you from getting sick, although it may offer some protection,” former FDA Commissioner Scott Gottlieb told CBS News. “It’s to protect you from other people. So when someone who’s infected is wearing a mask, they’re much less likely to transmit infection.”
Homemade masks can work, too
But there are no facemasks to be had, right? And if there were, healthcare professionals need them more than the rest of us, right? True both.
But you can make your own facemask. It likely will not be as effective as a commercially available mask, but it could be better than nothing.
“Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence,” researchers concluded in a 2008 PLoS One study that compared surgical masks to homemade masks.
Another study compared surgical masks to homemade masks made from cotton T-shirts. “Both masks significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask,” they wrote in 2013 in the journal Disaster Medicine and Public Health Preparedness. “Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.”
How to make (and use) a facemask
Vanderbilt University Medical Center has instructions here for making facemasks with elastic, along with instructions for donating them (“Your efforts will help make a difference,” the site states.) The Atlantic Health System has their own instructions, here. Both require some sewing.
Here is another way to make a mask without any sewing (props to New York Times columnist Farhad Manjoo for including this in his opinion piece, It’s Time to Make Your Own Face Mask):
Before you make a mask, know that it must fit well and be clean, and a cotton T-shirt is not going to be as effective as the material used in surgical masks. The World Health Organization (WHO) offer this advice when wearing a disposable surgical mask, showing just how important the tactics are:
- “Before putting on a mask, clean hands with alcohol-based hand rub or soap and water.
- Cover mouth and nose with mask and make sure there are no gaps between your face and the mask.
- Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.
- Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
- To remove the mask: remove it from behind (do not touch the front of mask); discard immediately in a closed bin; clean hands with alcohol-based hand rub or soap and water.”
Another important tip: Reaching inside to scratch an itch largely nullifies a mask’s benefits.
The researchers who wrote the Lancet Respiratory Medicine article say governments need to get beyond the current recommendations from the WHO and the CDC.
“It is time for governments and public health agencies to make rational recommendations on appropriate face mask use to complement their recommendations on other preventive measures, such as hand hygiene,” they write. “Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission. In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available.”