Wearing Masks

New CDC Advice as of April 3

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.

It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus.  CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.  Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.

Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission

Discussion

We should all be wearing improvised cloth masks when we go out in public places, to reduce our risk of catching COVID-19 and our risk of transmitting COVID-19.

Wearing an improvised mask is not an alternative to staying six feet away from other people. It just helps further reduce risk.

It is now officially recognized that we can spread the virus when we don’t know we have it, either because we have no symptoms yet or because our symptoms are too mild to pay attention to. We all have the responsibility to help others by reducing the spread.

Any mask, even a well-wrapped T-shirt, makes it easier for us to follow the standard advice to “avoid touching your eyes, nose and mouth with unwashed hands“. Following that advice makes us less likely to transfer the virus from our hands to a point that the virus can actually enter our body. It also makes us less likely to put the virus on our hands and transfer it to surfaces for others to pick up. Eyes are not usually covered by a mask, but a mask can help us remember not to rub our eyes.

Any mask can also reduce the extent to which we spread droplets of saliva and mucus when we speak enthusiastically, clear our throats, or cough or sneeze.

At the beginning of the epidemic, the official advice was contrary: the general public should not be wearing masks. The underlying motivation for that order was clear: People working on the front lines of the battle against the virus are at vastly greater risk than the general public and have a vastly greater need for professional grade personal protective equipment (“PPE”). Only a properly-applied professional-grade mask can fully protect a person from fine particles containing virus that could be in the air near an infected person.

Right now there is a world-wide shortage of PPE that is putting health care workers at acute personal risk. If the general public were advised to use PPE, then affluent people who go out only to shop would stock up on scarce professional-grade PPE for their own self care. This would make it harder to supply the necessary PPE for doctors, nurses, EMTs, and others who are in constant close contact with very sick people.

Massachusetts’ leaders have put procurement of PPE for health care workers at the very top of their daily priority list and we are making progress. Governor Baker scored a huge breakthrough working with the Kraft family to bring 1 million masks from China. Partners Healthcare acquired a machine that can recycle 80,000 masks per day.

I am hopeful that as the surge of sick patients washes into the hospitals, our front-line workers will have the equipment they need, but we are nowhere close to having professional grade equipment for all seven million Masssachusetts citizens. It would be a safety improvement for everyone on the street to be wearing professional grade masks. Maybe in a few months, as American manufacturing ramps up, we can get to that place: If you think about the volume of disposable food packaging we use, reasonable quality masks for everyone is not out of reach in the future.

For now, the Center for Disease Control is saying that we should all be doing our part by wearing what we have or can make at home: a ski mask or scarf, a cut up T-shirt, the old dust masks we may have from our last home improvement project, or, if we have the skills, a nicer mask made from any of the many patterns popping up on the internet now.

Personally, my biggest reluctance to wear a mask is that it could send a message that I am afraid of or unwelcoming towards other people. But if more people start wearing masks, my hope is that we can start to hear a different message from a mask: I care enough about you to take the risk of looking silly.

Will it really help?

As can be seen from the resources listed below, public health authorities are divided, with U.S. and European official authorities leaning against recommending masks but Asian authorities recommending them. The differences in policy may partly reflect immediate availability of domestic manufacturing capacity for masks or may reflect cultural differences.

Disease transmission is complicated and the science may not offer clear guidance for public policy. For example, a recent WHO study of non-pharmaceutical interventions in influenza pandemics endorsed the following often repeated recommendations despite finding no specific evidence of their effectiveness in reducing influenza transmission:

  • Hand hygiene (“[randomized controlled trials] have not found that hand hygiene is effective in reducing transmission of laboratory-confirmed influenza”)
  • Respiratory etiquette (“no evidence that this is effective in reducing influenza transmission”)
  • Surface and object cleaning (“no evidence that this is effective in reducing transmission”)
  • Face masks (“no evidence that this is effective in reducing transmission”)

The point is not that these recommendations are not valid. Rather that “mechanistic plausibility” plays an important role in public health decision making. The absence of evidence for the effectiveness of a measure is not the same as evidence of absence of effectiveness.

It is “mechanistically plausible” to believe that home-made cloth masks might reduce the probability of transmission of COVID-19 by some material amount. In the dismal mathematics of our current pandemic, the possibility of even a slight reduction in transmission rates seems worth the very modest effort involved in improvising and wearing masks.

Resources

Do it yourself guides

Official Advice from our Health Authorities

Official Advice from other Health Authorities

Critiques of and Expected Evolution of Domestic Official Advice

Discussions/Reviews

Published by Will Brownsberger

Will Brownsberger is State Senator from the Second Suffolk and Middlesex District.

Join the Conversation

34 Comments

  1. Will, thank you for this. Your comments are always thoughtful. I do want you to know how angry the trajectory of CDC’s recommendations have made me. I am 73. Covid-19 is a life or death matter for me. I’ve abjured masks up to now because I respected the CDC’s advice. Now I realize that that reliance was misplaced. Of course, I would not compete with caregivers for masks. My daughter is a nurse, and she and her family are in the front line. But ordinary people are not trying to use the N95 masks that she needs. Now I realize: (a) while masks may not be “protective” to the wearer, they probably help, and (b) masks certainly help protect others from the wearer. So, where is one to find masks now? People with less trust in the CDC than I had have purchased them all. I have the feeling of a pawn in a chess game whose players have little concern for me.

    1. Yup. A lot of people feel that way. It’s common sense that a mask helps in conjunction with all the other good advice.

      I suppose they thought they were doing the right thing by discouraging hoarding. But the advice now is make your own. Just don’t be trying to be compete with the health care system for the stuff they need.

      1. At least one of the major news sources has advised washing every time you return home and take off the mask — and has pointed out that the mask doesn’t do much good if you touch it before it has been washed. (Instead, handle it by the strings holding the mask in place.)

        1. Washing will work for cloth, I suppose. Hand wash? Water temperature (my washer has a “sanitize” setting, but I can’t be putting a single mask in every cycle)? And what about the dust masks Will suggests–I have a couple around–which are made of some kind of stiff synthetic?

  2. Hi Will, Thank you for sharing your thoughts, research, and resources. Here are some more links for everyone from the Center for Infectious Disease Research and Policy at the University of Minnesota:

    https://www.cidrap.umn.edu/news-perspective/2020/04/commentary-masks-all-covid-19-not-based-sound-data

    https://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science

    https://www.cidrap.umn.edu/covid-19

    I wish everyone good health every day!

  3. WHO is very highly suspect. Everyone else is saying hand washing, cleaning surfaces, and respiratory etiquette are the right things to do. WHO seems to be in the pocket of Big Pharma. I will keep doing, and trusting, these methods that have been promoted all along for weeks.

    1. Mary, WHO is endorsing all those measures. The point is that they are endorsing them without perfect scientific evidence, more based on judgment and common sense and that is OK. Lack of a definitive scientific study should not hold us back from moving forward.

    2. The problem is that these are only “common sense” measures; the little bit of rigorous testing that has been done doesn’t show them making a clear difference. The CDC is going for “best practices” in the hope those practices will make a difference. And note that Big Pharma is a strongly U.S. phenomenon that much of the rest of the world has been fighting; ISTM extremely unlikely that the \\World// Health Organization would be in their pocket. The CDC has been doing its best, but in recent years it has been gagged by Republican Congresses and had its budget cut to boot.

  4. The picture is gold!
    Public officials wearing facial masks will send a strong message and change the public attitude.

  5. Very helpful and informative!!! Thank you so much Will for all your hard work and for all these invaluable resources! And by the way, you look very dashing in your mask and not silly at all!!! I got a good laugh, partly because I shared the same hesitation, and because until this advisory I was afraid I would scare other people.

    Thanks so much, and let’s hope cooperative effort will hasten getting a grip on this disease.

    Best to you,
    Lizzie

  6. We should have been told to wear masks from moment one. We should have never been told not to wear masks which is what all officials have been insisting on up till now.

  7. Thank you for this!

    I currently live in Asia (although am still registered to vote in MA!) and I’ll note that wearing a mask takes a bit to get used to – they’re sweaty, awkward if you’re wearing glasses, and can feel uncomfortable when interacting with others. I’m learning how to smile with my eyes, because I know people can’t see my mouth, and resisting the urge to pull it down when I’m talking to people.

    You can do it! I believe in Massachusetts!

  8. “Governor Baker scored a huge breakthrough working with the Kraft family to bring 1 million masks from China. Partners Healthcare acquired a machine that can recycle 80,000 masks per day.”

    It’s sad that the states are now reduced to a Hunger Games like contest in their search for essential medical supplies. The absence of meaningful leadership at the national level can never be offset by the well meaning gestures of celebrity millionaires like the Kraft family.

  9. Hi Will,
    I started wearing a mask yesterday when I went to CVS on Trapelo Road. There weren’t many customers, but about half were wearing them. Nobody looked at me in a funny way. I noticed that the company put up plastic barriers to protect the clerks in addition to the six-foot line.

    The only problem I had was that my breath was clouding my glasses, so I drove with extra care.

    The crisis hit home when my brother, an attorney in New York, told me that a colleague died from the virus. He was as man in his sixties. My brother saw him two weeks ago, and he seemed healthy.

  10. Will, your mask looks as bulky as my first attempt. I guess we’ll have to try again. At least Im in good company

    Sue

  11. In my humble opinion as a mere layperson there are foods and various supplements that MAY help to ward off or ameliorate colds, flu, and, who knows, maybe even Covid-19.
    I am sure that many people are using them, but no one is reporting that. Very strange.
    Go try to find certain vitamins and supplements in stores during this pandemic. They’re all out.

    But medical “authorities” will not suggest them.
    Are we to believe that diet and certain substances have NO positive effect on disease?
    Some people are eating candy bars, potato chips, and drinking Coke for their diet.
    Is that a good diet for Covid-19? I don’t think so.
    When was the last time your doctor offered you nutritional advice?
    Never? Yes, never.

  12. “Personally, my biggest reluctance to wear a mask is that it could send a message that I am afraid of or unwelcoming towards other people. But if more people start wearing masks, my hope is that we can start to hear a different message from a mask: I care enough about you to take the risk of looking silly.”

    Well said!

  13. For what it is worth, I just got back from a rare excursion to the grocery store (in Brighton) and I would say over 75% of the shoppers had some sort of face covering. It is nice to see people are heeding advice and willing to adjust their practices even as the recommendations change.

  14. Wearing a mask is a great idea, but the general public won’t be convinced until they see our national leaders wearing masks in public. No one is wearing a mask at today’s (Sat) briefing – neither on-stage or the reporters asking questions.

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