Coronavirus: To wear or not to wear a mask?

Bandannas, exam masks and slim neoprene masks I’ve been using are better than nothing but not very good

As a professional health writer and concerned citizen, the ache in my heart deepens with each new report of the devastation wrought by the novel coronavirus, the cause of immeasurable — and still increasing — personal and economic pain for people caught in its deadly spikes.

In a recent five-week period, 100,000 Americans died from complications of Covid-19, a toll that took the country four months to reach last spring.

My distress is magnified by the knowledge that it didn’t have to be this bad. One simple measure — consistent wearing of face coverings in public — could have helped to stem the agony. In December, the Centers for Disease Control and Prevention reiterated advice first given in July: “Wear a mask over your nose and mouth. Everyone should wear a mask in public settings and when around people who don’t live in your household, especially when other social distancing measures are difficult to maintain.”

Masks, the agency emphasized, protect both the wearer and those the wearer encounters in the course of daily life.

Now, with the emergence of a highly contagious variant of the virus and the chaotic attempts to distribute and administer vaccines to hundreds of millions of vulnerable Americans, short of a total lockdown, universal mask-wearing is the most effective way to slow the relentless rise in hospitalizations and deaths from Covid-19.

It will take many months to immunize everyone willing and able to get a COVID vaccine. Meanwhile, we’re facing another tsunami of deadly coronavirus infections as the new variant sweeps through swaths of still-unprotected millions.

As with many other measures not taken by the last administration to minimize the spread of Covid-19, mask-wearing was left up to the states to mandate and enforce. Masks became a political football, and the former president publicly ridiculed opponents who wore them. Some elected officials even made the ridiculous, baseless claim that masks not only don’t thwart the spread of the virus, they actually enhance it. I wonder if they also ignored parents and teachers who told them to cover their mouths when they coughed or sneezed.

I also wonder about the economic savvy of our former president and the governors who have resisted issuing mask mandates, some of whom got COVID-19 themselves yet clamored to open the economy. Goldman Sachs estimated last June that implementing a nationwide mask mandate could have a potential impact on the U.S. GDP of $1 trillion.

Lately, as I await my second vaccine shot, I’ve become increasingly aware of how many people walk, run or cycle without a mask or, if they have a mask, wear it ineffectively. I’ve taken to speaking up more often: “Please wear your mask” or “The mask should cover your nose and mouth.” Among the ignorant responses: “I don’t need a mask when I’m outside,” “I already had COVID so I can’t get it again or give it to you,” and my favorite while walking on a 4-foot-wide path, “I stay 6 feet away from people.”

Although 6-foot social distancing is not totally arbitrary, it’s based on limited evidence among airline passengers and may not apply at all, for example, to the unmasked cyclists shouting to one another as they ride past me or to the heavy-breathing runners I pass.

I’ve also heard a few people say, “I already got the vaccine, so I don’t need a mask.” This may be the most dangerous excuse of all. First, although the vaccines are good, they’re not perfect, and chances are these vaccine recipients haven’t been checked for strong antibodies to the virus. Second, we don’t yet know if the vaccines, while highly effective in preventing sickness and death, will also prevent asymptomatic infection that can spread the virus to others.

As Jeremy Howard, a data scientist at the University of San Francisco, said of mask refusers: “How would you feel if you made your best friend sick, or killed your friend’s mother?”

Last February, after the World Health Organization, with no supporting data, advised against wearing a mask unless you were already sick, Howard amassed an international team of 19 scientists to review the evidence for mask-wearing, expecting to find “that masks were a waste of time,” he said in an interview. Instead, he said, the team found that “the data on the benefit of masks is really compelling.” The results of their exhaustive study were published recently in PNAS, the peer-reviewed Proceedings of the National Academy of Sciences.

Howard said that preliminary reports of their findings resulted “in all sorts of abuse, including death threats” from mask resisters. But that has not kept him from repeating that “wearing any kind of mask will greatly help to keep you from accidentally infecting others, which is important for the community and the economy. About half of coronavirus infections are spread by people who don’t know they’re sick, and the new variant is much more transmissible.”

A Chinese study found that the viral load in the upper respiratory tracts of infected people without symptoms can be just as high as those with symptoms, and simply talking and breathing can spread virus-laden droplets and aerosols. And because the virus resides in high amounts in the nose and throat, sneezing can spew an infectious cloud 10 or more times farther than coughing.

Which brings me to the question of whether the face coverings most people use are sufficiently protective. I now know that the bandannas, exam masks and the slim neoprene masks I’ve been using for the last 11 months are better than nothing but not very good. They provide too many routes for virus-carrying particles to reach an unsuspecting nose or mouth.

I should have followed the advice my colleague Tara Parker-Pope offered months ago on upgrading your mask.

“Masks,” Howard said, “need a nose wire to provide a close fit and proper filtration material, like a nanofiber, that filters very small particles.”

He and his co-authors concluded that for most of us, KN95 masks, especially those with bands that fit around the head, are currently the best to prevent contracting and spreading the virus.

Another option is the KF94 mask or, if it’s not too uncomfortable, doubling up on masks for added protection.

KN95 masks meet foreign certification standards and are designed to filter out 95% of particles down to 0.3 microns in size. (The gold standard N95 masks, which meet U.S. certification standards, should be reserved for health care and emergency personnel who are most likely to interact with COVID-infected individuals.)

Powecom KN95 masks have an emergency use authorization from the Food and Drug Administration. I just ordered a packet of 11 on Amazon for $23.80, and I expect to be using them for many months after I’m vaccine-protected. I might still be able to transmit the virus, and I want to set a good example for my fellow citizens.