By Tom Fontana, MSPT
A terrible joke circulating the internet goes something like this, “Did you hear that Starbucks is telling their employees not to wear masks? Instead, they should refer to them as cough-y filters.” There are other equally horrific puns and jokes involving Jim Carey’s The Mask or bank robberies but it’s good to have something to laugh (or groan) about surrounding mask-wearing. Otherwise, it has unfortunately become a controversial topic. Let’s try to make some sense of it.
It didn’t help matters that, initially, people were advised NOT to wear masks because they did not substantially prevent an individual from getting infected. A couple of things to keep in mind (and, the first is solely MY opinion as I have no facts to prove this).
First, remember that initially there was HUGE concern (justifiable in some instances) that critical healthcare workers would not have sufficient protective equipment. Remember when you couldn’t find a mask anywhere? I believe that telling average citizens to forego wearing masks was motivated primarily by the desire to make sure they went to those most in need of them, not because they offered no protection for average citizens. It worked, but it had lasting consequences.
Second, while it appears to be true that wearing a mask does little to protect the mask-wearer from getting infected, more recent research seems to indicate that wearing a mask is an effective way for infected people (whether symptomatic or not) to prevent infecting other people. So, wearing a mask is not so much a recommendation to protect each individual from getting infected but to protect communities of people. So, this is why it is a public health recommendation (and requirement in some places).
At FPTS, staff began wearing masks in late March along CDC guidelines since we deal with many patients and we wanted to make sure we weren’t infecting them in case we were infected. By the end of April, we asked our patients to wear masks to protect US, based on emerging evidence and updated CDC recommendations (these recommendations are continually updated—easily accessed by doing an internet search for “Considerations for Wearing Cloth Face Coverings”–and 15 of 16 citations, as of this writing, are from 2020).
I think we can all agree that there is much we still don’t know about this virus. When all is said and done, we may look back and see that many of the things we did accomplished much less than we thought, were ineffective or maybe even caused harm (hydrochloroquine?). So, I consider the downside of doing the wrong thing and ask others to do the same.
Let’s say it turns out wearing masks does nothing or has negligible effectiveness in slowing transmission but we all wore them. The downside? We all walked around with masks for several months, some of our skin breaking out, getting overheated, having painful ears (man, mine hurt!!) and otherwise feeling like we looked foolish and were annoyed.
But, what’s the downside if it IS effective and we don’t wear masks? Many thousands or even millions of people will become infected and some percentage (1%? 5%?–currently there is a 4.8% fatality rate in the U.S.) of them will die. If we reach 60-70% “herd immunity” WITHOUT the help of a vaccine, that will mean 197 – 229 million people will get infected and between 2 and 11 million people will die. Some number will die despite what we do but if we slow infection until there is a vaccine or more effective treatment, many who would otherwise die won’t. If being wrong one way means looking like an idiot and being inconvenienced and being wrong the other leads to millions of unnecessary deaths, it seems like a no-brainer for me even if you’re 80% sure this is all overblown. But, maybe that’s why I got into health care in the first place.
Postscript: Though this study is neither a clinically informative study about how much of a cough/breath has to get in your eyes, mouth or nose for you to get infected nor how saturated a cough/breath needs to be with to infect you, Florida Atlantic University’s Department of Ocean and Mechanical Engineering conducted a study recently (with super-easy to understand visuals!) that illustrates the basic science of various face coverings restricting the spread of a wearer’s cough: (https://www.fau.edu/newsdesk/articles/efficacy-facemasks-coronavirus.php). Regardless of how many particles of virus you might need to get infected, doesn’t it just seem like a good idea to breath in less of everyone else’s breath?