Wear a Mask

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You should wear a mask when you leave the house. In East Asia and the Czech Republic, huge numbers of people now wear masks, and that has greatly reduced the spread of coronavirus. Mask-wearing is a key reason why the virus spread less in East Asia than in Western countries like Italy, Spain, and the United States.
“More Americans should probably wear masks for protection,” notes the New York Times. “Places like Hong Kong and Taiwan that jumped to action early with social distancing and universal mask wearing have gotten their cases under much greater control.” The Times quotes Dr. Neil Fishman, the chief medical officer of the University of Pennsylvania hospital, explaining that “if everyone in the community wears a mask, it could decrease transmission.”
You don’t need a medical-grade mask to reduce the odds of spreading coronavirus — if you can’t find one on the market, you can even make your own at home, as many Czech people did. As Jeremy Howard notes, “The community response in Czech Republic was amazing. People made their own masks at home, and then hung them on ‘mask trees’ for anyone in their community to use.”
Such a home-made mask won’t provide as much protection as a medical-grade mask, but it will protect you better than wearing no mask at all. Most of the benefit from a home-made mask is in keeping wearers who are sick, or not yet sick but unknowingly carrying a virus, from giving the virus to other people. But such a mask also protects the wearer a little against catching the virus.
As Science Magazine notes, “Health authorities in parts of Asia have encouraged all citizens to wear masks in public to prevent the spread of the virus, regardless of whether they have symptoms. And the Czech Republic took the uncommon step last week of making nose and mouth coverings mandatory in public spaces, prompting a grassroots drive to hand make masks.”
Western health officials are belatedly admitting that people should wear masks when they go out in public. “After months of denial, German medical officials now call on people to wear makeshift masks in public to reduce contagion,” notes Bojan Pancevksi. Former FDA Commissioner Scott Gottlieb says the federal government “should consider telling people to wear masks in areas of epidemic spread.” For those “consumers who don’t already have masks,” Dr. Gottlieb suggested that the Centers for Disease Control provide guidance “on how” they can “make cotton masks.”
But earlier, when coronavirus was less widespread, Western health officials sang a different tune. For example, on February 27, the CDC told ordinary people they didn’t need to wear masks. It tweeted, “CDC does not currently recommend the use of facemasks to help prevent novel #coronavirus. Take everyday preventive actions, like staying home when you are sick and washing hands with soap and water, to help slow the spread of respiratory illness.”
This was an odd recommendation, because the public does benefit from ordinary people wearing masks. Research shows wearers do get some protection from masks, even when they are not medical-grade. More importantly, people around mask wearers benefit a lot, if the person wearing a mask is sick, or asymptomatic (carries a virus, but does not know it or have symptoms yet). The CDC is widely believed to have downplayed the need for masks, despite their usefulness in protecting against infection, as a way to keep ordinary people from buying up medical-grade masks needed by doctors and nurses.
Healthcare workers clearly do benefit from masks. As Quartz points out, the scientific “literature is unequivocal on one point: Masks protect healthcare workers from high levels of viral pathogens. From the lowly paper mask to ultra-high filtration N-95 masks designed to stop aerosols, decades of studies show masks stop healthcare workers from getting infected in hospitals, and prevent sick people from spreading disease to others.”
Ordinary people benefit from wearing masks, too, although not as much as healthcare workers. As Dr. Zeynep Tufekci notes in the New York Times.
Masks work — maybe not perfectly and not all to the same degree, but they provide some protection. Their use has always been advised as part of the standard response to being around infected people, especially for people who may be vulnerable. World Health Organization officials wear masks during their news briefings….health officials in many high-risk Asian countries had advised wearing masks…
It is of course true that masks don’t work perfectly, that they don’t replace hand-washing and social distancing, and that they work better if they fit properly. And of course, surgical masks (the disposable type that surgeons wear) don’t filter out small viral particles the way medical-grade respirator masks rated N-95 and above do. However, even surgical masks protect a bit more than not wearing masks at all. We know from flu research that mask-wearing can help decrease transmission rates along with frequent hand-washing and social-distancing. Now that we are facing a respirator mask shortage, the federal Centers for Disease Control and Prevention is recommending that surgical masks are “an acceptable alternative” for health care workers — again, obviously because some protection, even if imperfect, is better than none….
The W.H.O. and the C.D.C. told the people to wear masks if they knew they were sick. However, there is increasing evidence of asymptomatic transmission, especially through younger people who have milder cases and don’t know they are sick but are still infectious. Since the W.H.O. and the C.D.C. do say that masks lessen the chances that infected people will infect others, then everyone should use masks. If the public is told that only the sick people are to wear masks, then those who do wear them will be stigmatized and people may well avoid wearing them if it screams, “I’m sick.” Further, it’s very difficult to be tested for COVID-19 in the United States. How are people supposed to know for sure when to mask up?
… Places like Hong Kong and Taiwan that jumped to action early with social distancing and universal mask wearing have the pandemic under much greater control, despite having significant travel from mainland China. 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.
Given the clear benefit of wearing masks, why did some health officials downplay the benefit of wearing them?
As Alex Nowrasteh of the Cato Institute notes, “The arguments against mass use of face masks were noble lies intended for the good reason of attempting … to conserve them for healthcare workers. However, they backfired quickly [and that] will cause even more harm down the line.”
Similarly, Dr. Tufekci says, “Many health experts, no doubt motivated by the sensible and urgent aim of preserving the remaining masks for health care workers, started telling people that they didn’t need masks or that they wouldn’t know how to wear them.”
But as Nowrasteh notes,
Those claims were simply untrue. Yes, healthcare workers need masks, but masks also reduce transmission outside of hospitals and clinics. Sick people who wear masks reduce their likelihood of transmitting the virus and healthy people who wear them reduce their likelihood of becoming infected. Tufecki pointed out the obvious contradiction: If masks don’t work, why do healthcare workers need them?
Yet some people in the West have an ingrained bias against wearing masks. As one woman put it on Twitter, “Baffled by people walking around our local grocery store with masks on. If you have symptoms or are at risk, get the hell out of the grocery store.”
But refusal to wear masks will cost many lives. As Market Urbanism notes, the West may “decimate” its “elderly population because we’re too pig-headed to learn anything from Asian countries that’ve already” curbed coronavirus by wearing masks. “Please don’t go shopping in the midst of a respiratory virus pandemic without covering your mouth and nose!”
Don’t worry about running out of masks. Masks can be reused. As Jeremy Howard observes, “you can reuse your masks. Stanford University research shows that you can just pop them in the oven at 70C (160F) for 30 mins, and they’re good to go.” By reusing masks, or making your own, you won’t be using up the supply of masks needed by doctors.
For all these reasons, health officials should stop minimizing the benefit of wearing masks. As Nowrasteh observes, “Experts lying about COVID-19, such as saying that facemasks don’t make a difference, do far more harm than they realize. Don’t lie, even if you think it is for noble purposes.”
Minimizing the benefit of masks is hardly the biggest blunder of the Centers for Disease Control. As the New York Times chronicles, the CDC’s bureaucratic bungling delayed a meaningful response to the spread of coronavirus by a crucial month, enabling the disease to get a foothold in many parts of the United States. As the New Yorker notes, “The three-week delay caused by the CDC’s failure to get working test kits into the hands of the public-health labs came at a crucial time. In the early stages of an outbreak, contact tracing, isolation, and individual quarantines are regularly deployed to contain the spread of a disease. But these tools are useless if suspected cases of a disease cannot be tested. The void created by the CDC’s faulty tests made it impossible for public-health authorities to get an accurate picture of how far and how fast the disease was spreading. In hotspots like Seattle, and probably elsewhere, COVID-19 spread undetected for several weeks.”
As the Times explains, bureaucrats at the CDC and FDA stymied private and academic development of diagnostic tests that might have provided an early warning and a head start on controlling the epidemic that is now spreading across the country. Seattle infectious disease expert Dr. Helen Chu had, by January, collected a huge number of nasal swabs from local residents who were experiencing symptoms. She proposed testing those samples for coronavirus infections. But the CDC told Chu she could not test the samples unless her laboratory test was approved by the FDA. The FDA refused to approve Chu’s test on the grounds that her lab “was not certified as a clinical laboratory under regulations established by the Centers for Medicare & Medicaid Services, a process that could take months.”
In the meantime, the CDC required that public health officials could only use the diagnostic test designed by the CDC itself. That test turned out to be badly flawed. The CDC’s demand for centralized control over the testing process greatly slowed down the process of disease detection.
Hans Bader, a former Competitive Enterprise Institute scholar, is an attorney living in Northern Virginia. A version of this commentary was originally published in the April 1, 2020 online Bacon’s Rebellion.
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