By JoAnna “Anna” Kauffman, M.D.
and Tobias S. Buckell
FROM BLUFFTON ICON - There are two reasons to wear a mask:
• to protect *yourself* against what's out there, so you can personally try to avoid infection, and
• to protect *others* from what *you* may have so that you don't infect the community.
The second reason is what some doctors and epidemiologists are emphasizing as an important tool for fighting COVID-19. They are not recommending you keep N95 masks.
Right now those are needed for healthcare workers. But simple cloth masks can help prevent the spread of the virus to others, even if they aren’t as effective at stopping the virus from infecting you. It’s to protect our community that we wear a mask, not just ourselves.
The CDC says N95 and higher masks best protect you from the coronavirus. For this reason they are asking people to reserve N95 masks for healthcare workers.
The CDC also recently relaxed it’s messaging about surgical masks to allow them to be used by healthcare professionals. The CDC is asking citizens not to use N95 masks and other medical masks when out and about because there is a shortage, and we need them for our health care professionals. And we should listen!
Source: https://www.washingtonpost.com/health/2020/03/10/face-mask-shortage-prom...
But you'll see some articles and posts suggesting we all wear masks. They’re not suggesting you use N95 or medical masks, they understand those are needed for the hospital workers and key essential workers. But a growing number of doctors and epidemiologists are recommending homemade or purchased cloth masks.
There are articles saying masks that aren't N95 or higher won't entirely protect you from being infected. That’s likely true! It also misses the point that epidemiologists are often trying to make, which is that they're addressing point #2 from above: wearing a mask can prevent the community from getting what you may have.
They're about protecting the individual
CDC guidelines and the mask studies are focused on what kinds of masks to wear in healthcare environments. They’re about protecting the individual.
Epidemiologists and public officials in South Korea and Singapore (who are some of the fastest at being able to bend the curve of infection) are recommending mask wearing because they want to prevent community spread of the virus. Because a person will often have COVID-19 for several days with no symptoms, it can infect others by getting us to go out while we feel ‘great.’
One victim felt so great he ran a marathon the day before hospitalization, so the idea is that if you can get enough people wearing any kind of mask, it might not entirely stop any given individual from getting it because it’s not as effective as an N95 mask, but it may limit how much that person spreads the virus during the stage they don’t realize they have it.
That's what public health officials in nations that have experienced breakouts like this believe, that masks help stop the infected from infecting others.
Recent work examining the transmission of respiratory infections graphically demonstrates how uncovered coughs and sneezes can spread infectious materials over long distances:
https://jamanetwork.com/journals/jama/fullarticle/2763852
So here's a great video showing that with a cough, a cough into your hand, into a sleeve, into a dust mask, and finally a cough into an N95 mask. The amount of air and droplets expelled is more contained by even the dust mask!
https://www.youtube.com/watch?v=MX8InIv0sXs&feature
The focus is something done to help your community
The focus on masks isn’t just about how it can help you, it is something done to help the community. No one infected with coronavirus knows it at first, so you are making sure you reduce the chances of giving it to anyone. And with a disease like this, that's important.
In fact, America in the 1918 pandemic came to the same conclusion. You can see how common mask wearing became in the US back then in these pictures:
https://www.thoughtco.com/1918-spanish-flu-pandemic-pictures-4122588
There is wisdom to be found in how our ancestors faced their pandemics. They focused not just on #1 (will this protect *ME*) but #2 (can I help protect *OTHERS*).
To focus on #2 (community spread) is not to say that one knows better than the CDC, it is just a focus that is different. When making their mask recommendations, the CDC is answering the question of: what is the best mask to prevent a user from getting infected?
In fact, almost every single article about whether to use a mask or not that I've looked at focuses on that. The CDC says 'if you're sick don't go out.' But since COVID-19 can have multiple days of no symptoms, many people are going out while sick. Wearing a mask is another tool in the box of trying to prevent the infected from infecting others.
But that isn’t to say a cloth mask provides no protection for the wearer.
A group of researchers in the Netherlands studied how effective a cloth mask was versus a surgical mask versus an N95 mask. They used a tea cloth to make homemade masks!
An N95 mask was 99% effective at filtering virus-sized particles.
The surgical mask that the CDC is now recommending as suitable for health workers? 78% of virus particles.
A tea cloth mask? 63-68% of particles.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/
University of Cambridge researchers did the same thing and found that a surgical mask got 85% of virus sized particles.
A homemade cotton mask got 71% of the particles.
Source: https://www.researchgate.net/publication/258525804_Testing_the_Efficacy_...
So yes, homemade masks are not going to give you the protection of an N95 mask. They’re an N70 mask, basically, and that is a big difference. The CDC even states that “In settings where facemasks are not available, [Health Care Professionals] might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort.”
And, again, we absolutely need to save N95 masks for our medical workers!
The cloth masks aren’t great, but they’re better than nothing. And reducing the chances of accidentally spreading the virus to those around us because we're not aware for 5 days that we're infected, well that helps everyone by limiting the spread if enough of us choose to do it.
And that is why some doctors are calling for more mask wearing.
Whether you’re ready to wear a cloth mask today or not, I think we can all agree on what comes next: let's hope the factories get up and running making N95 masks as soon as possible, because once we can ALL get those (when the healthcare workers have enough), we should be wearing them when out in social areas until there's a vaccine for COVID-19.
Wearing a mask does not give you license to freely roam
One important thing to note, however, is that wearing a mask does not give one license to freely roam about! Though these masks lessen the risk of infecting others, they don’t fix things. It’s just one more tool! Social distancing is still the strongest tool we have to lessen the spread of this around our community. Use masks to help reduce transmission when you have to venture out for food, medicine, or to care for others, but we must still follow the wise advice to stay at home.
Bend the curve!
