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By Dr. Peter J. Plantes

May 22, 2020

Whether to wear a mask and what kind of mask to wear may be the most complicated questions I’ve received this month. The answers potentially impact us all, both in our ability to protect ourselves and be best assured we are not spreading virus to others. 

This issue is critical if a person does not realize they have the COVID-19 virus, but are walking out in public spreading it unknowingly to other people. Approximately 40% of those who get COVID-19 are asymptomatic—meaning that they never feel sick, even while they are infectious to others. Everyone else who gets COVID-19 is presymptomatic—infectious to others, but not feeling sick yet—for up to 12 days after they are infected with the virus. 

The best summary of the facts about facemask research and effectiveness is a FactCheck.org article by Jessica MacDonald called, “COVID-19 Face Mask Advice, Explained.” It has hyperlinks to the relevant materials from the CDC, the WHO, and numerous highly respected research studies. This blog post summarizes the article’s essential points, but I recommend reading the article in full to help you decide the best way to protect your family and your community.

The article reviews the sometimes conflicting expert viewpoints about whether healthy people in the general public can limit the spread of coronavirus by wearing masks.

Possible Advantages of Wearing Masks Possible Disadvantages of Wearing Masks
  • Reduces virus exposure from those who are asymptomatic or presymptomatic
  • Reduces the supply of medical masks for those who are sick or those who are treating them
  • Prevents people from touching their faces
  • Causes people to touch their faces or the contaminated masks more
  • Shows that the pandemic is serious and reminds people to follow social distancing guidelines
  • Makes people feel that they are protected, so they don’t have to follow social distancing guidelines

 

Here’s the bottom line:

  • The research is inadequate to be sure that you are receiving adequate protection from cloth masks. All research leans towards that you are not personally protected using a cloth mask, but you are helping to some degree (debatable how much) to protect others from spreading your viral germs to others. The CDC recommends you wear a cloth mask when you are out in your community so more effective mask supplies (surgical and N-95) are reserved for healthcare and frontline professionals.
  • With masks of any type, a tight fit is essential because air flows in the path of least resistance. So whether you exhale or inhale the virus-laden respiratory droplets, they will flow through gaps between the mask and your skin rather than whatever protective material your mask is made out of. 
  • Simple surgical masks, folded horizontal pleats of paper-like material most often in light blue color, provide better protection to you from your inhaled air and to the outside world from your exhaled air. They must fit tightly (see above). I would suggest choosing the “surgical masks” instead for general public use to save N-95 mask availability for medical and frontline professionals. 
  •  N-95 masks/respirators are harder to find and cost a bit more (about $3 a piece), but they are the most effective, reasonably available alternative to protect yourself from breathing in virus particles of any kind, including SARS-CoV-2. However, most experts agree that we should be reserving these limited supply masks for the frontline healthcare workers. 
  • Be careful how you handle the mask as you take it off and put it on (if reusing it). The surfaces of the mask have a concentrated amount of the viruses from the air—that is what the mask has protected you from.  Make sure you wash your hands thoroughly after touching your mask so you do not touch your face and transfer that concentrated blob of virus into your respiratory system. The World Health Organization has a video that demonstrates the proper use of a surgical mask.
  • No matter what kind of mask you wear, and especially if you do not wear a mask (get ready for snippy comments from others), you should:
    • Always maintain safe distancing practices of 6 feet or greater, and 
    • Wash your hands!

The article (reference 1) includes this striking quote from an interview with Elaine Shuo Feng, a statistician and epidemiologist at the University of Oxford and the lead author of The Lancet Respiratory Medicine journal article, “Rational use of face masks in the COVID-19 pandemic is required.” Feng says, “Not enough evidence doesn’t mean the intervention itself is not effective. And in this situation, I think the best way is to rely on all the available non-pharmaceutical interventions.”

References:

  1. McDonald, J. (6 April 2020). COVID-19 Face Mask Advice, Explained. FactCheck.org. https://www.factcheck.org/2020/04/covid-19-face-mask-advice-explained/
  2. Centers for Disease Control and Prevention. (4 April 2020). Cloth Face Coverings: Questions and Answers. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-faq.html
  3. World Health Organization. When and how to wear medical masks to protect against the new coronavirus. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
  4. Feng, S. (March 2020). Rational use of face masks in the COVID-19 pandemic. The Lancet Respiratory Medicine. Elsevier BV. http://doi.org/10.1016/s2213-2600(20)30134-x

About the Author

Peter J. Plantes, M.D. has three decades of experience creating service and delivery solutions that enhance marketplace success and clinical performance for clinical practice groups, academic faculty group practices, hospitals, health systems, and health care organizations. His success stems from his ability to blend and synergize clinical knowledge, operational expertise, financial performance, and collaborative methodology with his deep commitment to serve patients and improve the health of the community. Dr. Plantes has served in CEO & Physician Executive roles for a number of large healthcare clinical delivery networks including regional community networks, academic practices, national hospital networks, international health systems (Chile, Colombia),  and corporate managed care/HMO networks.

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