In reaction to the COVID-19 pandemic, many governing bodies have regulated or recommended face coverings. But how do face masks work? Are they actually effective? Is there a wrong way to wear one? What are the arguments against mandatory face masks? Read on to answer all of these questions and learn everything you need to know about the rationale (and science) behind face masks.
The Pitfalls of Various Mask-Types
The World Health Organization’s Advice on the use of masks in the context of COVID-19 interim guide highlights the two most important features of an effective mask: material and shape. The “ideal combination of material for non-medical masks should include an innermost layer of a hydrophilic material…, an outermost layer made of hydrophobic material…, [and] a middle hydrophobic layer” for maximum personal and community fluid filtration/containment. And in terms of shape, the most important note is that you need to avoid masks with “leaks where unfiltered air moves in and out of the mask.”
The traditional mask you have likely been seeing is a disposable surgical mask. Imagine one side is blue and the other is white with thin elastic earpieces and a hidden nose bridge wire. These masks may just seem like a cheap and flimsy emergency option, they have actually been designed very deliberately. The blue (or sometimes green) side of the mask is hydrophobic, or repels water/moisture droplets, while the white interior is a cotton hydrophilic material which absorbs moisture. When worn, moisture from someone else’s cough or sneeze is wicked away while your own (potentially infected) fluids are filtered before they can reach another individual. By World Health Organization (WHO) standards, simple surgical masks, though they do reduce others’ exposure to “saliva and respiratory secretions of the mask wearer”, (Mayo Clinic Staff, 2020) should not be your first choice. The loose fit leaves much to be desired in terms of internal/external air filtration. If this is the only mask you have access to, make the fit tighter by twisting the elastics once on each side before pulling them over your ears and do not reuse masks.
So what is the right choice? What is the very best mask you could buy? Numerous sources cite the N95 disposable respirator given its tight fit and small-particle filtration system, however, it is still not a great option. While it might protect the user, the respiration system allows for exhalations of unfiltered air, meaning that those around you are exposed to your respiratory secretions and transmission is possible. For that reason, countless places have banned these masks and if you want to take care of your neighbors, you should avoid them too. Another important note is that both of the masks previously mentioned are disposable. Given that it is not recommended to re-wear a mask without cleaning it, both N95 and surgical masks can be wasteful and have negative environmental repercussions. In addition, these masks are in low supply, and ought to be reserved as Personal Protective Equipment (PPE) for frontline health workers.
Cloth masks (with three or more layers) are the next step. They are easy to find, make, wash, and reuse. They are effective, accessible, inexpensive, and the material is unlikely to cause any topical irritation. Various sources including the United States Center for Disease Control (CDC) direct individuals to pursue no-sew options made out of household items, likely costing nothing to make. When worn and cleaned correctly (with regular filter replacement if necessary) these masks are a really strong option.
Now that you know which masks to wear, why are some people not wearing any at all?
The movement against government-regulated face coverings is strong and, shockingly, historically rooted. The 1918 influenza pandemic was the breeding ground for a similar group called The Anti-Mask League of San Francisco. Current anti-mask individuals cite a number of sources as to why requiring all persons to cover their mouth and nose in public is unreasonable, unsafe, or unfair. Discussed below are many of the leading arguments against masks, supported or refuted from a scientific perspective.
I have an unspecified medical condition which I am not required to disclose. Many countries have privacy laws preventing required disclosure of any medical condition or personal information. This excuse, however, is one that very few people could legitimately wield. Top physicians recognize that even individuals with “asthma and chronic obstructive pulmonary disease should wear masks in public.” While there have been documented mild complaints from some mask-wearers, there are a number of ways to “make the practice safer and more comfortable”. (Miller, 2020)
I don’t have to wear a mask when I am outside, only in enclosed spaces. While it is true that close quarters and central air can increase likelihood of transmission, being outside does not give you the green light. Beyond the fact that most places still require all individuals in public spaces to don face coverings, if you are within a meter or two of someone else, even if you are both asymptomatic, transmission is still possible. At the end of the day the masks serve mostly to protect others from your own secretions/fluids rather than the other way around.
Masks give people a false sense of confidence and safety, encouraging the breaking of social distancing and other risky behaviors. Masks have always been publicized as an additional measure to social distancing and stay-at-home orders. The World Health Organization (WHO) dealt with the same concerns, however ultimately realized that the benefits outweigh the risks. Their endorsement of face coverings, specifically medical-grade masks for high-risk individuals, speaks to the critical role that masks can play in the eradication of the COVID-19 pandemic and protection of the elderly and vulnerable.
What does this mean? What is coming next?
The pandemic is not over. Now, more than ever, is the time to be educating yourself about your own safety practices and continuing to make improvements. This is a novel challenge testing all of us. As scientists are able to learn about the virus, transmission, and effectiveness of community practices, we have a responsibility to adapt and learn with them. Wearing the right kind of mask, even when face-coverings may become legally optional, is a service to yourself and the safety of your loved ones and community.