To wear or not to wear: analyzing the great mask discourse during the pandemic
A brief review of the latest peer-reviewed scholarly publications on wearing masks
Coronavirus disease 19 (COVID-19), a severe respiratory disease caused by infection with the novel SARS-CoV-2 virus, has impacted almost every nation globally, making it a pandemic. More than 4.91 billion doses of vaccines have been administered worldwide, but the number of infections continues to rise. Since the pandemic's beginning, conspiracy theories have brought about an overabundance of misinformation regarding the virus, masks, and vaccines. Take, for instance, the wild theory that Bill Gates, the Microsoft co-founder and billionaire philanthropist, has himself created the virus, patented it, and is now using vaccines as a means to control people. Not surprisingly, as misinformation grew, it led to serious public health consequences and even turned deadly. Last year, tweets claiming the efficacy of chloroquine, an old malaria drug, as an antiviral against COVID‑19, even before the results from randomized trials were published, began to surface on the internet. Despite the obvious lack of evidence, media outlets around the world aired special segments, elected world leaders called the drug “very powerful” at press briefings, and Google searches soared. The matter turned worse when hospitals started reporting chloroquine poisoning among seriously ill patients (with COVID-19) and quoted a direct association with the toxic side effects from pills containing the drug. Additionally, many people who actually needed the drug to treat conditions such as lupus started reporting a worldwide stock crunch.
Despite mask mandates across several states and the CDC’s recent complete reversal from its May 2021 advice that fully vaccinated people could leave their masks at home, many individuals still choose not to wear masks in public and think that masks are a means of “control.” It is also essential to note that we are talking about people (including almost all healthy kids and adults) who should be wearing masks. Based on the CDC’s guidelines,
Cloth face coverings should NOT be worn by children under the age of 2 or anyone who has trouble breathing, is unconscious, incapacitated, or otherwise unable to remove the mask without assistance.
Sometimes this kind of blatant non-adherence to guidelines set by experienced public health experts can be infuriating. Mask-refusers have employed a variety of tactics to spread misinformation and create resentment among the general public. A Facebook post by a San Diego resident calling for the immediate termination of a Starbucks employee who refused to serve her coffee because she wasn’t wearing a mask went viral. A Florida resident, who was asked for her comments ahead of a vote on wearing masks in public places, rejected face masks, saying: “They want to throw God’s wonderful breathing system out.”
So what’s up with these so-called “freedom lovers” who think that masks are a form of “control?” While a separate article aggregating the findings from experts in human behavior is necessary to understand some of the reasons behind this, let us now turn our attention to some of the latest peer-reviewed articles on the effectiveness of wearing masks and the public discourse against wearing them during the pandemic.
(Image Source: Wikipedia)
Wu Lien-teh, a Malaysian physician and a public health expert, pioneered face masks as “the principal means of personal protection” to control the Manchurian plague in 1910, more than a century before the arrival of the COVID-19 pandemic. Wu’s experiments and direct observational evidence among health care workers showed the cotton mask’s efficacy at stopping airborne transmission. In addition to this, he also persuaded the government officials to impose restrictions on travel and advised infected people to self-isolate. Masks have been widely used to control the spread of respiratory infections in East Asia to this date.
There is an abundance of scientific evidence supporting the use of masks, with several recent studies suggesting that they could either reduce the chances of spreading or catching the virus or result in a decreased severity of infection (viral load) among infected people. One observational study [1] focussing on the impact of mask use on reducing secondary transmission of the virus in Beijing found that face masks are 79% effective if used by all household members before the onset of the symptoms. In a systematic review [2] published in Lancet, researchers found that “face mask use could result in a large reduction in risk of infection.” Although not done during the pandemic, a controlled trial [3] of masks used for influenza control in the Australian community found that “in an adjusted analysis of compliant subjects, masks as a group had protective efficacy in excess of 80% against clinical influenza-like illness.”
Anecdotal evidence also helps paint of better picture of the usefulness of wearing masks. Back in June 2020, two hairstylists in Missouri who wore surgical masks while working and were later tested positive for COVID-19 didn’t pass on the infection to their clients [4]. Sometime later in the same month, several children at a Georgia summer camp were infected with the virus because the attendees were not required to wear face coverings [5]. More rigorous analyses [6] found a significant drop in per-capita mortality in places where the government recommended masks compared to other regions.
Clinical trials showed the vaccines were highly safe and effective in preventing symptomatic COVID-19, including serious disease. However, vaccinated people may still be able to spread the virus. Until we learn more, it is important to wear a mask & socially distance. — Dr. Anthony Fauci
How the virus travels through the air and spreads infection is still an active area of research. Sometimes it helps to see why.
The virus itself is 0.1 µm in diameter. Since it cannot leave the body or travel on its own, it is more essential to stop the droplets and the aerosols transporting the pathogens (size: 0.2 µm to hundreds of micrometers) [7]. Asymptotic transmission, with the viruses typically riding out on coughs or sneezes, is much more dangerous. Aerosols can be an important vehicle, and it's worth prioritizing masks that can stop aerosols.
Below are some of the factors that increase the effectiveness of masks to stop transmission.
The type of the mask
Not all masks are created equal. An N95 mask is qualitatively different from a regular surgical mask. An N95 respirator can cut down up to 90% of incoming aerosols. In a recent review [8], a team of researchers has found out that both surgical and cloth masks provide around 67% protection from the virus. According to unpublished research, masks with plastic valves on the outside should be avoided since it allows more particles in or out.
How you wear your mask — a solid fit is a key factor.
Cover your mouth while coughing and sneezing — sometimes even talking releases small spit particles in the air.
The researchers from the University of New South Wales published this video showing how cloth and surgical masks do the trick.
A face shield is not a replacement for mask-wearing
Although face shields can catch most of the droplets released during a cough, smaller aerosol-sized droplets remain suspended in the air. This is mainly due to the presence of “large gaps below and alongside the face, where your respiratory droplets may escape and reach others around you” [10].
This brief discussion shows that there is an over-abundance of information from various sources, and it is often confusing to stick to one particular set of guidelines. Controversial studies and mixed messages further cloud our judgment and lead to resentment and distrust. According to Angela Rasmussen, a virologist at Columbia University’s Mailman School of Public Health in New York City,
There’s a lot of information out there, but it’s confusing to put all the lines of evidence together,”… When it comes down to it, we still don’t know a lot.
The question of wearing/not wearing masks transcends biology, epidemiology, or physics. Ultimately human behavior will be a key deciding factor to gauge the effectiveness of masks in the real world. Researchers [11] have shown that wearing a face mask often encourages the wearer and those around him to practice safety measures such as social distancing. Masks are a constant reminder of one of the deadly weapons we possess to stop the pandemic in its tracks — a sense of shared responsibility. Despite the mixed messages, most scientists are confident that “they can say something prescriptive about wearing masks” [7]. According to Paul Digard, a virologist at the University of Edinburgh, UK,
Masks work, but they are not infallible. And, therefore, keep your distance.
References
[1] Y. Wang et al., Reduction of secondary transmission of SARS-CoV-2 in households by face mask use, disinfection, and social distancing: A cohort study in Beijing, China. BMJ Global Health 5, e002794 (2020).
[2] D. K. Chu et al., Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. Lancet 395, P1973–P1987 (2020).
[3] C. R. MacIntyre et al., The first randomized, controlled clinical trial of mask use in households to prevent respiratory virus transmission. Int. J. Infect. Dis. 12, e328 (2008).
[4] Hendrix, M. J., Walde, C., Findley, K. & Trotman, R. Morb. Mortal. Wkly Rep. 69, 930–932 (2020).
[5] Szablewski, C. M. et al. Morb. Mortal. Wkly Rep. 69, 1023–1025 (2020).
[6] Leffler, C. T. et al. Preprint at medRxiv https://doi.org/10.1101/2020.05.22.20109231 (2020).
[7] Face masks: what the data say. https://www.nature.com/articles/d41586-020-02801-8
[8] Chu, D. K. et al. Lancet 395, 1973–1987 (2020).
[9] https://aip.scitation.org/doi/10.1063/5.0022968
[10] https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
[11] Marchiori, M. Preprint at https://arxiv.org/abs/2005.12446 (2020).
