masking up during the pandemic: is it necessary? is it safe?

In the US, we’re having a big debate about the efficacy and necessity of face masks during the pandemic. Masks are the hip new seasonal accessory for some. Others are literally up in arms protesting their use.

As a physician, this is my conclusion on the debate: Masking up is a no brainer.

Here’s why:

Masking up is not about you, it’s about keeping other people safe.

Those other people might be people you don’t know, like my elderly parents and their spouses in a COVID19 hotspot. (I’d really like to see them alive again.) Those other people may be people you count on — grocery store workers, gas station attendants, your mail carrier, healthcare providers — people who have little to no choice about interacting with you, little to no choice about coming in to work. Those other people may be people you love and thought wouldn’t get really sick — or die — because they are young, able, and so on.

Although most of us will eventually be exposed to SARS-CoV-2, the virus that causes COVID19, we’ll have the best chance of beating it the longer we wait.

We’ve flattened the curve enough that many places have enough hospital beds and maybe even ventilators for the sick. But also, the more time passes, the better we understand how this virus works and how to stop it. Postponing exposure also gives us time to switch up habits that make us more vulnerable, and up our game to build immune resilience. (I’m doing a weekly series of talks on this topic. Register here.)

Masks, including home-made ones, offer imperfect protection — but significantly more protection than nothing. There’s lots of persuasive evidence that community implementation of masking recommendations (or requirements) slows the spread of viruses.

(This review is posted on a preprint site, with mostly excellent discussions of its limitations in the comments. Those are worth reading, too, as it’s scientists weighing in and not the usual flame war.)

Can masks cause harm?

There are two answers to this. If people use masks incorrectly, or if they ignore other protective practices such as physical distancing, that can worsen the risk picture. And yes, some people do have more difficulty breathing in masks. Most folks, though, acclimate quickly. In some cases, masks actually improve respiratory health. Overall, more people wearing masks means more protection for everyone, even if that protection is imperfect.

That doesn’t mean living in a mask 24/7. Physical distancing is still important. Take breaks, outside and away from people, as often as you need and are able.

Some people legitimately suffer in masks, and the rest of us masking up protects them. People with COPD, for instance, may not be able to manage a mask — but they’re also more vulnerable to viral infections. Some people get headaches from masks, some get panic attacks, some see their blood-oxygen levels drop.

If you can’t acclimate to a mask, minimize time in public places, and emphasize outdoor venues rather than indoor ones. Ask friends to mask up around you for your own protection. Ask for help with outings that would increase your risk. It’s imperfect and unpleasant, and you shouldn’t have to do more because you’re only able to do less. But consider the alternative.

We don’t need everyone to wear masks, we just need most people to do so. (If 80 percent of folks use even relatively ineffective masks, it could reduce mortality by as much as 65 percent according to recent models.)

How do face masks work to limit spread of the current virus?

When we breathe, speak, sing, sneeze or cough, we release respiratory droplets that can carry virus out into the world. Some of these droplets are relatively large, and gravity grabs and drops them relatively quickly. That’s where the 6-foot rule for physical distancing comes from.

But smaller droplets, and those propelled by singing, coughing and sneezing, can travel significantly farther and persist in the air for longer.

Having a mask in place catches or slows the droplets (how many depends on the mask material), reducing the risk that someone will catch the virus from you.

Face mask basics:

  • It needs to cover your nose and your mouth.
  • Wash your hands after touching your mask.
  • Launder your masks frequently.

Face mask FAQs:

Will breathing my exhalations make me sicker? No.

But the CDC and WHO were against it before they were for it: Science evolves. The original recommendations against masks were based on 1) concern about sufficient supplies for medical workers and 2) concern that masks would provide a false sense of security. Cloth masks are easily improvised, made or purchased. We’re deep enough into this pandemic to implement hand washing, physical distancing and basic mask hygiene.

But they’re taking away our freedoms! Your freedom has never extended to harming others.

I’m a first generation American and deep believer in the value of freedom and our First Amendment rights. But while opposing masks may be rebellious, it adds nothing to our liberty.

It’s also such old news. What’s happening now is a very clear echo of fights over masking during the 1918 flu pandemic. Anti-mask folks back then trotted out the same arguments we’re hearing today — and they got sicker.

Masks turned out to be helpful then, they look to be helpful now.

The difference is that today we should know better based on that experience, and we are literally shooting the messengers — workers, likely getting paid minimum wage, whose job it is to enforce mask rules put in place by their employers.

One more reason to mask up: If most of us do it, masking up may be as effective as locking down. The sooner we get on board, the sooner we get past this tough time.

P.S. In the weeks since I first wrote this, an avalanche of evidence has come out supporting the efficacy of masks. Here are a few links for you.

• June 13 summary of research in The Washington Post.
“Association of country-wide coronavirus mortality with demographics, testing, lockdowns, and public wearing of masks,” Prepublication article, June 15.
• “Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis” from Travel Medicine and Infectious Disease, May 2020.

P.P.S. And here’s one more article, this from Smithsonian, explaining how to clean your masks.

Photo by Adam Nieścioruk on Unsplash