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Health Experts Urge Americans to Wear Masks

Health Experts Urge Americans to Wear Masks

Face masks really can play a crucial role in curbing the COVID-19 pandemic.

Updated on July 16, 2020 at 2:00pm EST

As the COVID-19 pandemic continues, U.S. and state health officials are advising Americans—whether they have symptoms or not—to wear nonmedical coverings, such as scarves or cloth masks, over their noses and mouths when going out.

This additional preventive measure, they advise, is a critial step everyone can take to help curb the spread of the disease.

Why experts revised their recommendations
When community spread of COVID-19 in the U.S. began in February 2020, it triggered a run on masks and the subsequent hoarding of these and other vital medical supplies. This contributed to price gouging and a critical shortage among healthcare workers who desperately needed them.

At the time, it was also widely believed that masks were most useful for those who’ve already been diagnosed with COVID-19 or have symptoms of the disease. Wearing them would help prevent them from spreading the infection to others. For otherwise healthy people, the focus has been on other preventive measures, such as handwashing and social distancing.

But as confirmed cases in the U.S. continue to surge, mounting evidence suggests that people without any symptoms at all may be spreading the virus unknowingly. Researchers caution that these so-called “silent spreaders” are making the pandemic much more difficult to control since containment strategies to date have focused on the early detection and isolation of people who develop symptoms, such as fever, fatigue, coughing and shortness of breath.

In fact, up to 25 percent of people infected with the new coronavirus may not show symptoms, warned CDC director Robert Redfield, MD, during a March 30 phone interview with Sam Whitehead, a health reporter at WABE in Atlanta.

Since people may be unwittingly passing the infection on to others—even when they feel fine—asking only sick people to wear masks and stay home in isolation likely isn’t enough to “flatten the curve” and slow the spread of COVID-19.

In April, after heated debate, the Centers for Disease Control and Prevention (CDC) and the White House Coronavirus Task Force have reversed course on their advice that only those who are sick or caring for someone who is sick should wear a facemask. The decision came after Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases, and a member of the White House Coronavirus Task Force, argued that in addition to social distancing, Americans should cover their faces if they do go out in public. 

And while handwashing, practicing social distancing and adhering to stay-at-home orders are all still essential, if you do venture out when necessary, you should cover your face. This measure is intended to protect others from you—and not just protect you from the virus. 

Essentially, everyone should assume that they may be a carrier of the new coronavirus. 

Remember masks aren’t foolproof
Wearing a mask doesn't guarantee you protection against COVID-19—or any other serious upper respiratory infection, like the flu or measles.

While it’s true that surgical masks could help protect against airborne pathogens, they were never designed to filter all the air that you breathe in and out with each breath, explains Werner Bischoff, MD, PhD, professor of infectious diseases at the Wake Forest School of Medicine in Winston-Salem, North Carolina. Masks also don’t eliminate the need for other measures, such as avoidance of germs and frequent hand washing. Masks alone certainly don’t guarantee infection prevention, the WHO warns. 

Many experts argue, however, that whatever protection masks do provide is simply better than nothing. 

Keep in mind that some fabrics make for more effective masks than others. When choosing homemade mask material, find a fabric that is as dense as possible that will still allow you to breathe. In recent tests, the New York Times reports that HEPA furnace filters, vacuum cleaner bags, layers of 600-count pillowcases, quilted fabric and material similar to flannel pajamas performed well. Stacked coffee filters were also somewhat effective in capturing virual particles while scarves and bandanna material had lower scores. Remember, air filters could shed small fibers that would be risky to inhale. So, if you use one, sandwich it between two layers of cotton fabric. 

How COVID-19 and other germs spread
There are a few routes that germs that cause respiratory infections take in order to invade the body: Contact, droplet or airborne transmission.

Contact transmission takes place when a person touches a contaminated surface and then touches their mouth, nose or eyes. This is one important mode of transmission for many common respiratory illnesses, including the common cold, the flu, and respiratory syncytial virus, or RSV.

For droplet transmission, contaminated droplets escape the body of a sick person when they cough or sneeze, then land in a nearby person’s mouth or nose. These tiny droplets can travel about six feet from the person before gravity causes them to fall and settle. The flu and the common cold spread this way, as do other coronaviruses, like the ones responsible for Middle Eastern Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). Surgical masks may interrupt droplet transmission but there are no guarantees.

During airborne transmission, microorganisms escape the body in particles that are so small they float through the air for long distances. This is how measles virus and the bacteria that cause tuberculosis spread. Surgical masks do not block these infections.

Researchers believe COVID-19 spreads by droplet and contact transmission but there is some evidence of airborne, or aerosol, spread as well. 

Aside from medical procedures that are known to emit aerosols, such as intubations, airborne transmission of SARS-CoV-2 is still under investigation. On July 9, 2020, the World Health Organization updated its guidelines, noting it could be possible in some other indoor settings.

“Outside of medical facilities, some outbreak reports related to indoor crowded spaces have suggested the possibility of aerosol transmission, combined with droplet transmission, for example, during choir practice, in restaurants or in fitness classes,” the revised guidelines state. “In these events, short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out.”

More research is needed to determine how much airborne transmission may be contributing to the spread of COVID-19.

Complicating matters, surgical masks can gradually become soggy, absorbing water from the humid air and a person’s breath, rendering them ineffective. Meanwhile, masks that do come into contact with contaminated droplets could still spread an infection if someone touches the mask and transfers the virus to their fingers.

And it’s important to note: Surgical masks do nothing to protect the eyes. Some viruses, including the flu, can travel along the tear ducts and drain into the back of the throat, Dr. Bischoff explains. It’s still unclear if COVID-19 can travel through the tear ducts.

Reserve these masks for healthcare workers
When it comes to face masks, many people may envision the familiar, inexpensive, disposable surgical mask. Also called a medical mask, this guard covers the lower face and may be pleated, cuplike or duckbill-shaped. Surgeons and other health professionals wear them in the operating room and during other types of procedures, and hospitals and doctors’ offices ask symptomatic patients to put them on to protect others.

Some people may also have heard about N95 masks, also called disposable N95 respirators. “These higher-quality face masks used in healthcare settings provide a face seal that allows only filtered air to reach the person,” Bischoff says. “This provides a high degree of protection against airborne pathogens.”

With their ability to block 95 percent of airborne particles, N95s can reduce the risk for the transmission of germs via both the droplet and airborne routes—if they fit correctly. 

These masks need to form a tight seal around their edges, fitting so closely that when wearers inhale, they feel the mask pull inward slightly. A person with a small face who wears a large mask will not be able to form that tight seal and the mask won’t offer enough protection. Even when properly fitted, N95s are uncomfortable, and they’re not appropriate for some people with respiratory difficulties.

For these reasons, they are mainly worn by healthcare professionals. The CDC recommends that personnel caring for people with the novel coronavirus wear a properly fitted N95 respirator, along with gloves and other personal protective equipment.

The “right way” to use a facemask
Using a face mask could increase the risk for infection among those who aren't trained to use them properly. People who wear masks, for example, may tend to touch their face more often—with contaminated hands.

For those who do wear a medical mask to protect against a respiratory infection, there is a right and a wrong way to do so. If you are going to wear one, take the following steps:

  • First, wash or sanitize your hands.
  • Put the mask on, with the absorbent side facing your skin. (This side is usually white, with the colored side out.)
  • Minimize gaps between its edges and your skin. Mold the stiff edge so it follows the contours of your nose.
  • While you’re wearing the mask, try not to touch it. If you do, wash your hands afterward.
  • Replace masks after they’ve become damp. If they’re intended for single use, discard them.
  • To take off the mask, remove it from behind—don’t touch the front, which may contain virus. Then throw it into an enclosed trash can. Finally, wash your hands.

Anyone who uses a cloth mask should be sure it's clean and wash their hands well with soap and water before putting it on and after taking it off. Other safety precautions to take:

  • If the mask has ties, secure the bottom ones first with a bow behind your neck. Then, pull it up over your nose and mouth and secure the upper tied around your head.
  • Wash your hand every time you touch the mask while you are wearing it.
  • Once you take the mask off, assume it's contaminated on both sides. If it's not disposable, isolate it in a secure place until it can be washed.

Nondisposable masks should be washed in hot water after use. The CDC provides these guidelines on how to sanitize clothing, towels, linens and other laundry items:

  • Wash fabrics according to the manufacturer’s instructions, using the warmest water setting possible.
  • Be sure to dry the item completely.
  • Wear disposable gloves when handling dirty laundry, particularly from someone who is sick.

Avoidance and clean hands are still essential
Masks can offer a false sense of security, leading people to, say, skip handwashing. To prevent the spread of COVID-19, aside from social distancing, the CDC recommends the same infection-prevention techniques that it does for other respiratory infections, including:

  • Wash your hands well and often with soap and water for at least 20 seconds.
  • Use an alcohol-based hand sanitizer (if soap and water aren’t available).
  • Avoid touching your face with unwashed hands.
  • Stay home from work or school if you are sick or have symptoms.
  • Cover coughs and sneezes with tissues that you then put in the trash.
  • Frequently disinfect surfaces with cleaning spray or wipes.

Anyone who thinks they may have COVID-19 or has been in contact with anyone who’s been diagnosed should isolate themselves immediately and take steps to ensure they don’t spread the infection to others, including:

  • Be monitored at home for 14 days
  • Take their temperature daily
  • Be on the lookout for symptoms, such as fever, cough or trouble breathing

Those who develop these warning signs of infection should call their healthcare provider (HCP) or local health department for instructions. You can also use Sharecare's COVID-19 testing site locator to find one closest to you. Before going to a doctor’s office, emergency room or testing location, they should call ahead and inform the medical staff that they may have been exposed to COVID-19.

Medically reviewed in April 2020.

Sources:
World Health Organization. “Advice on the use of masks in the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak.”
World Health Organization. “Q&A on coronaviruses.”
Centers for Disease Control and Prevention. “2019-nCoV: What the Public Should Do.”
Centers for Disease Control and Prevention. “How Infections Spread.”
Centers for Disease Control and Prevention. “How 2019-nCoV Spreads.”
Centers for Disease Control and Prevention. “NIOSH-Approved N95 Particulate Filtering Facepiece Respirators.”
Centers for Disease Control and Prevention. “Interim Infection Prevention and Control Recommendations for Patients with Confirmed 2019 Novel Coronavirus (2019-nCoV) or Persons Under Investigation for 2019-nCoV in Healthcare Settings.”
San Francisco Department of Public Health. “How to Put on and Remove a Face Mask.”
Centers for Disease Control and Prevention. “2019 Novel Coronavirus: Prevention & Treatment.”
World Health Organization. "WHO Director-General's opening remarks at the media briefing on COVID-19 - 3 March 2020."

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