Coronavirus (COVID-19) masks: To wear or not to wear?

Filed Under: Costs, Patients, Providers

(Updated April 9) Coronavirus (COVID-19) masks: Should or shouldn’t healthy people wear face masks when outside to protect both themselves and others?

In the last few weeks, the number of people wearing face masks when out in public seems to have exploded. With emerging reports from official health organizations now recommending the use of face masks, one can now see more people on the streets wearing masks than not – the exact opposite of just last week.

The seemingly simple question of whether or not healthy people should wear face masks to protect themselves and others when out in public has been a topic of hot debate in the U.S. as COVID-19 continues to sweep through the nation. Answers from official sources have been conflicted for some time. As of April 4th, both the World Health Organization and the Centers for Disease Control and Prevention websites still stated that “if you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.” However, there has been a surge of new thinking on the potential benefit of masks in slowing the spread of coronavirus. While the stance on the World Health Organization’s website has not yet changed (as of April 9th), the CDC website now states that, “in light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

However, there has been a surge of new thinking on the potential benefit of masks in slowing the spread of coronavirus, and the C.D.C. says “it is now reviewing its policy and may be considering a recommendation to encourage broader use.”

The general public was initially told that wearing masks was not a helpful measure. They were discouraged from mask usage altogether in order to save the dwindling supply of masks for health care workers. But this strategy sends a confusing message. How could masks somehow only work for people in a specific field? Masks either work in helping slow the spread of infection or they do not, and we know from research on the flu and other highly infectious diseases that masks can indeed help decrease transmission rates, when used in conjunction with diligent hand-washing and social distancing.

In light of new information, the C.D.C. now warns that “as many as 25% of people infected with the new coronavirus may not show symptoms.” Furthermore, according to Dr. Jeffrey Shaman, an infectious diseases expert at Columbia University, it’s been estimated that, in China, “between 20% and 40% of transmission events occurred before symptoms ever appeared.”

This means that seemingly healthy people could be walking around and spreading the virus without even knowing it. While wearing a mask can help protect you to some degree (it seems that the kind of mask is very important in asking and answering this question), it is incredibly important in reducing airborne viral spread you may spew onto to others.

Susannah Fox

Certainly, medical-grade masks are in very limited supply, and they should be reserved for healthcare workers, but even homemade cloth masks can help civilians play a role in diminishing transmission. Articles are popping up, including this one from The New York Times, teaching individuals how to sew cloth masks at home from common household materials. This development is somewhat reminiscent of reports from the 1918-19 influenza pandemic, in which civilians were encouraged to fashion their own masks — both for themselves and in support of medical personnel — and wearing a mask was considered, to some extent, a symbol of patriotism.

Of course, masks can only play their part if used correctly, and they should NOT be used to replace social distancing and hand-washing. Using all three practices in combination seems to be the most effective way to fight virus transmission. According to surgeon Mitchell A. Fremling, quoted in The New York Times, many people who wear masks do so incorrectly and actually increase their chances of infection by continuously touching the mask, pulling it down to talk, etc.

He explains that, if you decide to wear a mask, here are the best ways to ensure it does what it is supposed to do:

“(1) Start with a clean mask. If you are reusing a mask, make sure that you keep it clean when you are not wearing it.
“(2) Wash your hands well with soap and water, for a minimum of 20 seconds but preferably more.
“(3) Place your mask and get it adjusted perfectly. It may help to do this in front of a mirror.
“(4) Now wash your hands again. You are doing this to protect everyone else since you have contaminated your hands by touching your face.
“(5) Do not ever touch the mask or any part of your face again unless you repeat steps 2 to 4.”


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Mask habits and rules are changing as we speak. Our friend Akiva Zablocki, founder of the Hyper IGM foundation, is familiar with compromised immune systems because his son had the Hyper IGM Syndrome. He wrote April 2 on his Facebook page: “Groceries Run. 50% of people have N95 masks in the street. Another 30% have regular surgical masks. How am I the only sucker that did not buy masks before this started? Oh right. Cause I was preaching for no masks. In the words of the great Rick Perry: ‘whoops?'”

Our friend Susannah Fox, formerly Chief Technology Office of the Department of Health and Human Services, wrote on her blog that she’d been asked about mask wearing. “Yes, I am starting to wear a mask when I am likely to run into groups of people or go into a store. It’s mostly to remind myself not to touch my face when I’m out, but also to remind people to keep their distance,” she wrote. “George Gao, director-general of the Chinese Center for Disease Control and Prevention, was asked what mistakes other countries are making. His answer? ‘The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks.’ Read the full article in Science — it’s excellent.” Here is a picture of Susannah with a mask she made out of an old T-shirt.

Our friend Whitney Bowman-Zatzkin, executive director at Raredots.org, posted a picture of herself on Facebook wearing a BaseCamp Particulate Respirator.   She  wrote, “I ordered these in early Jan (figuring I wouldn’t need them and we’d use them for painting the deck) and these aren’t NIOSH listed as approved though they claimed to be.”

If you have a sewing machine, you can make a mask with fabric and elastic. If not, you can make one out of a T-shirt (see diagram). Obviously, one layer of fabric is of some protection, but if you can add a second layer, that’s better — or even make a two-layer mask with a pocket for a third layer to be added.

In our Westchester village this afternoon, we noticed that maybe 20 percent of the people walking on the street were wearing masks. In CVS, it was more like 90 percent of the people.