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What you don’t know about wearing a mask, but probably should!

With COVID-19 causing fear and panic around the world, the discussion surrounding whether or not to wear masks has become increasingly polarized and unproductive. You either hear, “Please wear a mask! It helps!” or “Please stop wearing masks! You don’t need one!” The question remains: “Should I wear a mask?”
 
If you’re like me, you may feel confused and conflicted about this mixed messaging. Is wearing a mask actually unproductive for me, or does it simply help the collective society by leaving the masks for the people who need it more? Why do authorities tell us that we do not need to wear them, but at the same time tell us that the masks are so important for certain people?
 
How effective are masks?
 
Let’s start with an analysis on the effectiveness of masks.
Research from Emerging Infectious Diseases called “Face Mask Use and Control of Respiratory Virus Transmission in Household” had the following conclusion from their work:
 
“Although our study suggests that community use of face masks is unlikely to be an effective control policy for seasonal respiratory diseases, adherent mask users had a significant reduction in the risk for clinical infection. […] If adherence were greater, mask use might reduce transmission during a severe influenza pandemic.”
 
Research from Disaster Medicine and Public Health Preparedness called “Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?” had similar conclusions:
 
“[homemade masks made from cotton T-shirts and surgical masks] significantly reduced the number of microorganisms expelled by volunteers, although the surgical mask was 3 times more effective in blocking transmission than the homemade mask. Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.”
 
COVID-19 is running rampant in South Korea, Italy, and Iran. However, despite having a very strong connection with China, both Taiwan and Hong Kong stand out in that their total number of COVID-19 cases has plateaued very quickly. 
 
They have been commended for their ability to take action early to prevent the spread of COVID-19 in their communities. How did they do it? Dr. Tufekci, an associate professor of information science at the University of North Carolina, wrote an article in the New York Times called “Why Telling People They Don’t Need Masks Backfired”, where she states that:
 
“Hong Kong health officials credit universal mask wearing as part of the solution and recommend universal mask wearing. In fact, Taiwan responded to the coronavirus by immediately ramping up mask production.”
 
It is strongly recommended by authorities to wear a mask if you have COVID-19 symptoms to prevent tiny droplets from spreading when you cough or sneeze. However, COVID-19 does not only spread from people who have visible symptoms. Several studies have concluded that asymptomatic transmission of the virus is not only possible, but likely. 
 
Studies estimate the proportion of pre-symptomatic transmission for COVID-19 to be somewhere between 10–68%. Therefore, spending time in public places near people who appear asymptomatic can still put you at risk for catching the virus.
 
The question remains: Why should people with visible COVID-19 symptoms wear a mask to prevent transmission, but people without symptoms should not, even when a large portion of COVID-19 transmission is spreading from people who do not have symptoms?
 
Why do authorities tell us not to wear a mask?
 
Although wearing masks will not completely halt the spread of COVID-19, the research suggests that wearing a mask is better than wearing nothing. So why do authorities tell us not to wear masks?
 
The truth is masks are currently in a massive global shortage for healthcare workers, who are not only the people who must stay healthy to be able to continue caring for patients with or without COVID-19, but are also the people who could potentially be vectors for transmission of the disease between patients and community members. 
 
This is why it is important for healthcare workers to wear masks, but not so much for the general public, as non-frontline workers should be social distancing and practising good hygiene.
 
Just how bad is the global mask shortage?
 
When WuHan China was the epicentre of the outbreak, over 3,000 medical staff were infected by COVID-19 as stated by the China National Health commission. These infections were likely due to a lack of personal protective equipment (PPE).
 
Some sources estimate that the US will run out of N95 masks in only two weeks. Italy needs at least 10 million more masks in order to prevent its medical system from collapsing. Canada is facing a national mask shortage as well as a desperate need for PPE for its healthcare workers. 
 
Additionally, roughly 55 million N95 masks that were stored in Ontario after the 2003 SARS epidemic have been found to be expired, thus putting Ontario health care workers at risk.
 
As of March 10th, the CDC updated its guidelines stating that the current supply chain of respirators cannot meet demand. The US ordered 500 million respirators but it could take over 18 months to be delivered. Many frontline healthcare workers both in the United States and Canada are forced to reuse personal protective equipment that are supposed to be single-use.
 
It is crucial for frontline healthcare workers to have access to proper protective gear in order to lower the risk of contracting COVID-19. However, because the mask supply is depleting so rapidly, the Centre for Disease Control and Prevention has suggested the use of homemade masks as a last resort when proper PPE is not available.
 
Unfortunately, this shortage of PPE worsened when civilians began to hoard masks and respirators due to news of the pandemic spread in late February. If you have additional masks that you and your family are not using due to recent public closures and regulations around social distancing, please consider donating your personal protective gear, as it can really help to protect our healthcare workers.
 
Takeaway
 
Again, the question is: should you wear a mask?
 
If you are an individual who does not have COVID-19 symptoms (ie. fever and dry cough), AND you are not directly caring for someone with a respiratory illness, the short answer is: no. The full answer is that wearing a mask can be better than wearing nothing, but it cannot substitute social distancing and good hygiene practices (ie. hand-washing, refraining from touching your face). 
 
Due to the terribly short supply, the masks should be saved for the healthcare workers who are at the greatest risk and are trained to put on and take off masks correctly.
 
However, a good alternative is to make a homemade cloth face covering, as this provides protection that is similar to that of surgical masks, while not affecting the supply of masks for health care workers (instructions to make your own cloth face covering can be found here).

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