Wearing a surgical face mask over the mouth and nose reduces the spread of Covid-19 in community settings, according to a new study based on real-life evidence. The researchers also found that targeted actions to promote mark-wearing can significantly increase their use, especially in rural and low-income countries.
The study, which has not been peer-reviewed yet, is the largest randomized trial so far to demonstrate how effective surgical masks are to reduce the spread of the coronavirus. While previous work was often done on hospitals and laboratories, the new findings show the efficacy of masks in the real world and on a really massive scale.
Researchers from Bangladesh and the United States tested the effectiveness of surgical masks across 600 villages in Bangladesh and with more than 342,000 adults. After their program ended, encouraging people to use masks, they found an 11.9% decrease in symptomatic Covid-19 symptoms and a 9.3% drop in symptomatic seroprevalence
“We now have evidence from a randomized, controlled trial that mask promotion increases the use of face coverings and prevents the spread of COVID-19,” Stephen Luby, one of the authors, said in a statement. “Importantly, this approach was designed to be scalable in lower- and middle-income countries struggling to get or distribute vaccines.”
Tracking the use of masks
The researchers randomly selected villages in Bangladesh to implement programs to encourage the use of face masks. They handed over free surgical masks, offered information about their importance, and reinforced their overall use in the community. Thanks to this, mask-wearing rose by 30% and the change of behavior lasted for 10 weeks or more.
Wearing face masks more than before didn’t give people a false sense of security that leads to risk-taking behaviors, the findings showed. This used to be a concern during the early days of the pandemic by the World Health Organization. The researchers also reported an increase in physical distancing in public spaces thanks to their campaigns to encourage the use of masks.
“We saw an opportunity to better understand the effect of masks, which can be a very important way for people in low-resource areas to protect themselves while they wait for vaccines,” Laura Kwong, one of the study’s co-authors, said in a statement. “So we collaborated with behavioral scientists, economists, public health experts and religious figures.”
The researchers specifically chose Bangladesh, a highly populated country in South Asia, for specific reasons. Encouraging the use of masks is essential in countries where physical distances can be tricky. Plus, there was already a research framework in the country and local researchers were eager to do a controlled trial of masking.
Despite plenty of evidence over the important role of masks to avoid the spread of the virus, it’s been tricky to increase mask-wearing in many countries, especially those low-resource ones such as Bangladesh. In July 2020, one-fifth of Bangladeshis wore a mask that covered mouth and nose in public areas, despite a nationwide mask mandate.
The findings have big implications for countries that rely on mitigation measures to slow the spread of the virus until they get better access to vaccines, the researchers argued. But there are lessons also applicable for countries with plenty of vaccines, such as the US, where some cities starting to enforce the use of face-mask due to the delta variant.
“Our study provides strong evidence that mask wearing can interrupt the transmission of SARS-CoV-2. It also suggests that filtration efficiency is important. This includes the fit of the mask as well as the materials from which it is made. A cloth mask is certainly better than nothing. But now might be a good time to consider upgrading to a surgical mask,” Luby said in a statement.
It was already a big problem before the Covid-19 pandemic, but plastic waste is now turning into an even larger issue – and face masks, in particular, are not helping the cause. We need them to avoid the spread of the virus but at the same time, there’s no official guidance on how to dispose of them. Most of them just end in the trash, and that needs to change.
An impressive number of face masks are used around the world, with studies estimating 129 billion are used every month. That’s good — we’re preventing a dangerous virus from spreading. But it comes at a cost. Most are made from plastic microfibers and are not properly disposed of, which means they’ll be staying in the environment for centuries to come.
In a recent commentary piece, Elvis Genbo Xu and Zhiyong Jason Ren describe waste plastics as one of the most pervasive environmental pollutants today. Before the pandemic, over 300 million tons of plastics were produced globally per year and most if ended up in nature as waste. Plastic products can’t be readily biodegraded and then fragment into microplastics and nanoplastics.
There’s no official data on how many masks are disposed of, but with billions needed every month the figure is likely to be very high. For the researchers, disposable masks have become as problematic as plastic bottles or even worse. While 25% of the bottles can be recycled, there’s no guidance for mask recycle and most are disposed of as solid waste.
Disposable masks are usually made of three layers. The outer one is made up of a nonabsorbent material like polyester that protects against liquid splashes. The middle one is non-woven fabrics like polystyrene that prevent droplets and aerosols, while the inner one is made of an absorbent material such as cotton so to absorb vapor. Different polymers are used in manufacturing.
Once in the environment, the mask is subjected to solar radiation and heat. But the degradation can actually take a very long time because of the plastic components, the researchers argued. If they aren’t properly collected, the masks can then be transported from land into freshwater and marine ecosystems by river flows, oceanic currents and surface run-off.
“When breaking down in the environment, the mask may release more micro-sized plastics, easier and faster than bulk plastics like plastic bags. Such impacts can be worsened by a new-generation mask, nanomasks, which directly use nano-sized plastic fibers (e.g., diameter < 1 mm) and add a new source of nanoplastic pollution,” the researchers wrote in the study.
The presence of waste masks has been increasingly reported in different environments since the start of the pandemic, with posts in social media sharing images of wildlife tangled in elastic straps of masks. NGOs in Asia and Europe have collected hundreds of masks on beaches over the past few months, hoping to raise awareness through active campaigns.
For Xu and Ren, it’s urgent to launch coordinated efforts from environmental scientists, medical agencies, and solid waste managing organizations to minimize the negative impacts of disposal masks — eventually preventing it from becoming a problem too big to handle. Plastic waste is already massive and we shouldn’t add masks to that combo.
The researchers recommend a critical rethinking of the way masks are used, manufactured and disposed of. This would include carrying out a life-cycle evaluation on masks’ production and disposal, encouraging people to use washable masks and replacing single-use plastic masks. At the same time, mask-only trash cans could be set up for collection and disposal.
Researchers in Australia have already found one potential solution, developing new recycled material for building roads out of shredded face masks. The road-making material is feasible and meets civil engineering safety standards, with the plastic particles adding stiffness and strength to the final product when used in the base layer for roads and pavements.
Researchers in Australia have developed a new recycled material for building roads out of shredded face masks. The road-making material is feasible and meets civil engineering safety standards, making it ideal for mitigating the growing environmental impact of the COVID-19 pandemic.
Then there’s the issue of single-use face masks, with an estimated 6.8 billion masks being used across the globe every single day.
Rather than ending up in landfills or the oceans where they may harm marine life, researchers at RMIT University in Australia figured out how to recycle the masks for an engineering application with real-world use.
The researchers put their recycled road-making material — a mix of shredded single-use face masks and processed rubble — through a barrage of tests. This analysis showed that the plastic particles help to add stiffness and strength to the final product when used in the base layer for roads and pavements. Besides the base, every road is made of three other layers: subgrade, sub-base, and asphalt on top.
According to the researchers, one kilometer of a two-lane road would use up about 3 million masks, thereby preventing 93 tonnes of waste from going to landfills.
What makes this solution particularly appealing is the fact that it solves two waste problems, simultaneously addressing personal protection equipment (PPE) waste and construction waste. The mix used by RMIT is 1% shredded face masks to 99% recycled concrete aggregate (RCA).
The RMIT team led by Professor Jie Lie also explored the use of shredded disposable face masks as an aggregate material for making concrete, with promising preliminary results so far.
“We know that even if these masks are disposed of properly, they will go to landfill or they’ll be incinerated,” Lie said.
“The COVID-19 pandemic has not only created a global health and economic crisis but has also had dramatic effects on the environment.
“If we can bring circular economy thinking to this massive waste problem, we can develop the smart and sustainable solutions we need.”
Variants of the novel coronavirus are spreading around the world, including the more transmissible one from the UK that has been detected across the US, Europe, and pretty much everywhere in the world. This triggered a discussion among health experts over the quality of face masks, with some, including White House advisor Anthony Fauci, suggesting the use of two masks at once as an extra layer of protection.
There are no specific studies yet on how well face masks work against new variants of the virus — we’re not even sure exactly what makes the new variant more transmissible. But as researchers are trying to unravel these questions, Fauci says that wearing two face masks at once “likely” provides more protection than just wearing one. This hasn’t been recommended yet by the Centers for Disease Control (CDC) at this point.
A mask “is a physical covering to prevent droplets,” Fauci told NBC’s TODAY show. “So, if you have a physical covering with one layer, you put another layer on, it just makes common sense that it likely would be more effective. That’s the reason why you see people either double masking or doing a version of an N95.”
The practice suggested by Fauci generated buzz when people were seen wearing two masks at president Joe Biden’s inauguration Wednesday. Pete Buttigieg, who is Biden’s nominee to run the Transportation Department, and poet Amanda Gorman, were seen wearing surgical masks underneath cloth masks, among others.
Doing so actually provides larger protection, according to a commentary on mask-wearing published earlier this month. The surgical mask acts as a filter and the cloth adds an extra layer and helps with fit. Wearing two masks would especially help in places where it’s difficult to keep social distance, such as a store.
Other experts agreed with Fauci. “The more layers you have covering your nose and mouth means less virus you’re able to disseminate into the population. And then the more layers you have between you and the environment, the fewer viral particles are going to get into your system,” Thomas Duszynski, head of epidemiology education at Indiana University, told Huffington Post.
Previous studies from last year showed multilayer cloth masks can block up to 50%-70% of fine droplets and particles and limit the spread of the virus. The CDC has so far recommended people to wear masks with at least two layers of tightly woven cotton fabric, such as quilting fabric or cotton sheets.
Disposable surgical masks, made from a plastic-derived material, have been reported to be more effective at filtering particles than most cloth masks. Meanwhile, N95 respirators, designed to fit close to the face, filters 95% of airborne particles. But they aren’t recommended for the general public and should be reserved for health workers.
The key is to strike a balance between comfort and effectiveness, scientists argue. “If you put three or four masks on, it’s going to filter better because it’s more layers of cloth,” Dr. Scott Segal, chair of anesthesiology at Wake Forest Baptist Health in Winston-Salem, North Carolina, told NBC. “But you’ll be taking it off because it’s uncomfortable.”
Fauci’s suggestion comes at a time of changes in the US regarding the face mask policy. As soon as he took office, President Biden signed a set of executive orders that orders to wear masks on federal property, as well as on airplanes, trains, buses, and airports. “Masks have become a partisan issue, unfortunately, but it’s a patriotic act,” Biden said.
Acceptance of face coverings has come a long way over the past year, as US citizens increasingly use them. A survey in December by the Kaiser Family Foundation showed more than 70% of those surveyed report wearing masks every time they leave their home. This is 21 percentage points higher than a similar survey done in May.
Face masks made from layered common fabric can help filter ultrafine particles and provide some protection when commercial face masks are unavailable, according to a new study. The researchers hope the results will help inform makers when choosing which fabric to use for masks.
The pandemic has left many countries without sufficient quantities of face masks for the protection of medical staff, let alone for the general population. However, policies requiring individuals to wear face masks when they leave their homes have been implemented in most countries.
This has made home-sewn face masks a necessity for many, either as an affordable option or to meet the excess demand. Although widespread online resources are available to help home sewers and makers create masks, scientific guidance on the most suitable materials is currently limited.
Although not as effective as surgical masks, home-made face masks have been shown to provide benefit in filtering viral and bacterial particles, according to previous studies. Their main purpose is to limit the spread of viral particles from respiratory activity, rather than blocking the inhalation of any contagious particles.
A team of researchers from the University of Cambridge and Northwestern University tested the effectiveness of different fabrics at filtering particles the size of most viruses such as COVID-19. They did so at high speeds, comparable to coughing or heavy breathing. They also tested N95 and surgical masks.
“Fabric masks have become a new necessity for many of us since the start of the COVID-19 pandemic,” said first author Eugenia O’Kelly. “In the early stages, when N95 masks were in extremely short supply, many sewers and makers started making their own fabric masks, meeting the demands that couldn’t be met by supply chains.”
For the study, the researchers built a device consisting of sections of tubing, with a fabric sample in the middle. Aerosolised particles were generated at one end of the apparatus, and their levels were measured before and after they passed through the fabric sample at a speed similar to coughing. They also consulted with online sewing communities to find out what types of fabric they were using to make masks. Due to the severe shortage of N95 masks at the time, several of the sewers reported that they were experimenting with inserting vacuum bags with HEPA filters into masks.
The findings showed that most of the fabrics commonly used for non-clinical face masks are effective at filtering ultrafine particles. N95 masks were highly effective, although a reusable HEPA vacuum bag actually exceeded the N95 performance in some respects.
Homemade masks made of multiple layers of fabric were more effective, while those that also incorporated interfacing, normally used to stiffen collars, showed a significant improvement in performance. Nevertheless, this improvement in performance also made them more difficult to breathe through than an N95 mask.
The researchers also looked at the performance of different fabrics when damp, and after they had gone through a normal washing and drying cycle. They found that the fabrics worked well while damp and worked sufficiently after one laundry cycle. However, they caution masks shouldn’t be used indefinitely.
“We’ve shown that in an emergency situation where N95 masks are not available, such as in the early days of this pandemic, fabric masks are surprisingly effective at filtering particles which may contain viruses, even at high speeds,” said O’Kelly in a statement, hopeful over the implications of the study.
Masks save lives. It’s not a motivational campaign, it’s the conclusion of a new study published in the journal Nature Medicine. According to the new analysis, nearly 130,000 Americans would be saved if 95% of the population would wear a mask.
How to save a life
As winter dawns on North America, we’re back to where we started over 6 months ago: cases are rising and scientists are still strying to convince people to wear masks. There’s another similarity to the pandemic spring –we’re back to looking at modelling predictions to know what we can expect.
Dr. Christopher Murray of the University of Washington and colleagues made estimates and quantified several scenarios. In what they described as the worst-case scenario, COVID-19 could kill over a million Americans between September 2020 and February 2021. This is under the “current pattern of easing” restriction in several states, and if mandating masks doesn’t become widespread.
But if in the second scenario masks are also introduced to the equation, it makes a big difference. If 95% of the population were to don face coverings, there would be 130,000 less victims, researchers estimate. Even if 85% of Americans wear masks, it could still save 96,000 lives.
But if in the second scenario masks are also introduced to the equation, it makes a big difference. If 95% of the population were to don face coverings, there would be 130,000 less victims, researchers estimate. Even if 85% of Americans wear masks, it could still save 96,000 lives.
Of course, the usefulness of these models is limited and they serve more to offer an indication as to what might happen. In this case, the model indicates that a higher percentage of mask wearing will make a big dent in disease transmission.
“It is unreasonable to expect any model to do everything well, so each model makes compromises to serve a purpose, while maintaining computational tractability,” researchers wrote.
More science, same misinformation
There’s one thing that has changed: our understanding of the virus is significantly better. That’s not to say that we know everything there is about the virus — the questions still abound, but we’ve nailed a few things down.
Among them, the fact that masks, imperfect as they may be, really help. reduce viral spread — we’re already seeing that states with a higher percentage of mask-wearing have a lower percentage of people who know someone with COVID-19 symptoms.
But one thing that’s stayed the same is the prevalence of misinformation, including misinformation linked to leading echelons of US policymaking. The most recent case is an assertion by Dr. Scott W. Atlas, the president’s science adviser.
Atlas, a radiologist who has advocated herd immunity, Tweeted that masks are ineffective — a tweet that was later taken down by Twitter for spreading misinformation.
Although Atlas is not an expert in public health or epidemiology, he was chosen by President Trump to serve as a COVID-19 advisor. Atlas has advocated for less testing on the virus — a position that goes against the guidance from all health organizations and epidemiology experts — and has even stated that “children almost never transmit the disease”, which is demonstrably false. While Atlas seems to agree with Trump’s personal preferences, he goes against what the science is saying.
In September 2020, 78 of Atlas’s former colleagues at the Stanford Medical School signed an open letter criticizing Atlas, writing that he had made “falsehoods and misrepresentations of science” that “run counter to established science” and “undermine public health authorities and the credible science that guides effective public health policy.”
Resistance to mask-wearing is owed in part to this type of misinformation. In the current situation, it seems increasingly unlikely to see 95% or even 85% of Americans wearing masks.
Most health organizations have argued that wearing a face mask helps slow the spread of the COVID-19. Still, some critics have argued masks can cause carbon dioxide poisoning by trapping CO2. Now, a new study showed this is actually very unlikely to happen, with the researchers stressing the importance of wearing a mask.
Michael Campos from the Miami Veterans Administration Medical Center and his team analyzed the breathing patterns of 15 healthy physicians without lung conditions and 15 veterans living with chronic obstructive pulmonary disease (COPD). They compared these before and after wearing a mask through a six-minute walking test.
During the walk, individuals with severe COPD experienced decreased oxygenation, as expected by the researchers. However, at 5 and 30 minutes after the walk, researchers found no major changes in oxygen saturation or carbon dioxide levels between the groups.
“We show that the effects are minimal at most even in people with very severe lung impairment,” Campos said in a statement. Asked about the discomfort felt by some people when wearing a mask, he added: “The feeling of shortness of breath, felt with masks by some is not synonymous with alterations in gas exchange.”
If you’re walking briskly up an incline, for example, you may experience feelings of breathlessness. An overly tight mask may also increase these. The solution is simply to slow down or remove the mask if you are at a safe distance from other people, Campos argued.
The use of face masks has become a highly politicized issue throughout the pandemic, with some individuals falsely claiming that wearing a mask can negatively impact a person’s breathing and put their health at risk. Scientists have attempted to combat these theories, reassuring that face masks can safely prevent COVID-19.
Despite these efforts, some people are still not persuaded. Anti-mask groups have been holding rallies in cities in several countries in objection to pandemic-related restrictions. Demonstrators have continuously questioned the effectiveness of mask-wearing and social distancing practices.
The impetus behind Campos’ research came after reports of a public hearing in Florida where individuals made provocative comments, namely that wearing masks were putting lives at risk and finding out that no data on the effects of surgical masks on gas exchange was available. That has now changed with this new study.
“We acknowledge that our observations may be limited by sample size, however, our population offers a clear signal on the nil effect of surgical masks on relevant physiological changes in gas exchange under routine circumstances (prolonged rest, brief walking),” wrote the authors. “It is important to inform the public that the discomfort associated with mask use should not lead to unsubstantiated safety concerns.”
An unproven but exciting new theory suggests that even if face masks don’t fully protect the user, they work to reduce the viral load — and this, in turn, is likely to trigger immunity following an asymptomatic infection, somewhat similar to vaccine inoculation.
From the early stages of the pandemic, infectious experts have supported the use of face masks as a way to reduce COVID-19 transmission. This was especially prevalent in Asian countries, where face masks were much more commonplace to begin with, but eventually caught on elsewhere in the world. The evidence shows a strong link between wearing face masks and reducing community transmission, and face masks have become a pillar of our fight against COVID-19.
But they might also be doing something else. They might be giving some people immunity without a visible symptom.
The theory is unproven but plausible. It was addressed in a commentary published in the New England Journal of Medicine, one of the most prestigious medical journals in the world.
“Universal masking seems to reduce the rate of new infections; we hypothesize that by reducing the viral inoculum, it would also increase the proportion of infected people who remain asymptomatic,” write Monica Gandhi and George Rutherford, two infectious experts.
The idea is that masks make it so that even if you get infected, the initial viral load that infects you is quite small, which reduces the intensity of the symptoms or even eliminates them completely.
This has been speculated before, though it’s still unclear to what extent this initial viral load affects the severy of the disease. However, Gandhi and Rutherford call on several observational studies that back their hypothesis up.
For instance, the typical rate of asymptomatic infection is estimated to be around 40% by the CDC. However, in places with universal or near-universal face masking, the asymptomatic infection rates are much higher, even reaching 80%. Countries that have adopted widespread face masks tend to have much better survival rates, which also suggests a shift to more asymptomatic cases.
More localized studies also seem to back this idea up. For instance, in an outbreak on a closed Argentinian cruise ship where passengers were provided with surgical masks (and staff had N95 masks), the asymptomatic rate was 81% (compared to 20% for other ship outbreaks without universal masking). In US food processing plants where workers wore masks every day, the proportion of asymptomatic cases was even higher, reaching 95%.
The idea is also supported by a study on animal models, where Syrian hamsters administered higher doses of virus exhibited more severe manifestations of the disease.
While this theory is still somewhat speculative, it would fit very well with the observed data. If it is indeed true, it would suggest that in addition to helping limit prevention, face masks would also work as a vaccine of sorts, improving immunity after an asymptomatic course (or at the very least reducing the intensity of the symptoms). Ultimately, to keep the disease in check, we need to reduce both the transmission rate and the severity of the disease — and masks seem to help on both ends.
While experts are still not sure how COVID-19 immunity works and how long it lasts, reinfection rates seem to be rare and in general, the infection seems to grant immunity, at least for a few months. Promising data indicate that even mild or asymptomatic COVID-19 cases grant immunity.
As we wait for a vaccine with winter lurking in the northern hemisphere, we need every bit of help we can get. If there is an added benefit to face masks, that would offer even more support for their widespread usage. Researchers call for more studies to analyze this theory.
“To test our hypothesis that population-wide masking is one of those strategies, we need further studies comparing the rate of asymptomatic infection in areas with and areas without universal masking,” the researchers conclude.
A group of researchers from City University of Hong Kong successfully produced laser-induced graphene face masks with an anti-bacterial efficiency of 80%, which can be improved to almost 100% within 10 minutes under sunlight. It has already been tested on two strains of coronavirus with positive results.
Amid the pandemic, face masks have become an important tool to prevent the spread of the COVID-19. Nevertheless, the commonly used masks aren’t anti-bacterial, which can increase the risk of secondary transmission if the masks are discarded improperly or if people touch the contaminated surfaces of the used masks.
Dr. Ye Ruquan from City University of Hong Kong recently developed an easy way to produce graphene, a material known for its anti-bacterial properties. That’s why right after the outbreak of the novel coronavirus he decided to explore the possibility of applying his technique to produce graphene masks at the university.
Alongside his research team, Ye tested the graphene with the E. coli bacteria, achieving an anti-bacterial efficiency of more than 80%. The activated carbon fiber and melt-blown fabrics, two materials that are commonly used in face masks, only have a 2% and 9% efficiency, respectively, showing the large potential of graphene.
Over 90% of the E. coli deposited on carbon fiber and melt-blown fabrics stayed alive after eight hours, while most of the bacteria deposited on the graphene were dead after eight hours. The graphene also showed a larger anti-bacterial capacity for aerosolized bacteria, according to the results of the experiment.
While more research is needed to understand the mechanism behind the bacteria-killing property of the graphene, the researchers believe that it could be related to the graphene’s sharp edge that damages the membranes of the bacterial cells. The bacteria could also be killed by dehydration caused by the water-repelling property of the graphene.
The team also performed experiments to test whether graphene’s capacity to produce heat after absorbing light would enhance its anti-bacterial effect. The results showed that the anti-bacterial efficiency of the graphene could reach almost 100% after 10 minutes of exposure to the sunlight.
Following the initial results, the researchers are now working with a laboratory in China to test the graphene against two species of coronaviruses. The initial tests showed that the material inactivated 90% of the virus in five minutes and 100% in 10 minutes of sunlight.
“Laser-induced graphene masks are reusable. If biomaterials are used for producing graphene, it can help to resolve the problem of sourcing raw material for masks. And it can lessen the environmental impact caused by the non-biodegradable disposable masks,” said Ye in a statement.
Despite a very slow reaction and contradictory initial recommendations from national healthcare systems and even the World Health Organization, the consensus now is that face masks are effective at curbing the spread of COVID-19 infections. However, not all face coverings provide adequate protection. According to a new study, face shields and face masks fitted with exhalation valves allow expelled droplets to come in contact with the wearer much easier than regular cloth or surgical masks, greatly enhancing the risk of infection.
Manhar Dhanak and Siddhartha Verna, both professors of mechanical engineering at Florida Atlantic University in the U.S., visualized jets of droplets expelled towards a hollow mannequin head fitted with either a face shield or valved face mask. Both options have become quite popular lately because people feel they’re more comfortable. However, the results of the analysis show that that comfort is traded for safety.
“Face shields and masks with exhalation valves are not effective for restricting the spread of aerosol-sized droplets. But we have seen widespread adoption of these two alternatives to regular masks. Our main motivation was to raise awareness among the general public about what exactly happens to the smallest respiratory droplets when these options are used,” Dhanak and Verna told ZME Science in an email.
The researchers employed a manual pump to simulate a cough or sneeze expelling droplets that may contain virus particles towards the mannequin head. Laser sheets measured even the smallest particles during the spatial and temporal development of the ejected flow.
“The spreading of droplets depends to a large extent on the ambient airflow. It is difficult to convey how easily very slight changes can alter the droplet dispersal patterns,” the researchers said.
The visualization showed that although face shields block the initial forward motion of the expelled jet, droplets can still move around the visor easily and come in contact with a person’s mouth, nose, and eyes. By themselves, face shields are thus ineffective compared with mouth and nose coverings.
“The main purpose of face shields, when used by healthcare workers (in conjunction with masks), is to protect them from incoming sprays and splatters. But the shields by themselves are not effective in stopping the incoming aerosol-sized droplets (approximately 5 to 10 micron and smaller),” the researchers said.
And although exhalation ports fitted on some masks improve breathing, they also allow a large number of droplets to pass through the valve unfiltered, the flow visualization showed.
Instead, people should stick to high-quality cloth or surgical masks in order to minimize the risk of infection for themselves and others in the community.
These findings may be particularly important in the context of schools re-opening, where students and staff will be exposed to the same ambient droplets and aerosols in an indoor setting. Some might feel face shields and masks fitted with exhale valves are more comfortable, but the tradeoff is not worth it, judging from these results.
Next, the researchers plan to investigate the effectiveness of plexiglass and cloth screens around cubicles at curbing the spread of COVID-19.
Despite having by far the most confirmed coronavirus cases in the world, the US response to the pandemic has been surprisingly lax at times. Democrat Joe Biden, who is challenging incumbent President Donald Trump, wants a much stronger approach.
What Biden is saying
Biden called on all US governors to issue a 3-month mask-wearing mandate, arguing that it will allow them to open businesses and schools sooner.
“Every single American should be wearing a mask, when they’re outside for the next three months, at a minimum. Every governor should mandate mandatory mask-wearing,” Biden said after a coronavirus briefing he received with his running mate, Kamala Harris.
The position is markedly different from that of Trump, whose support for face masks has come half-heartedly, after months of denying the usefulness of masks. Biden has been consistently wearing a mask and encouraging others to do the same.
However, this is the first time that he’s addressed a national mandate for wearing face masks.
“We absolutely need a clear message from the very top of our federal government that everyone needs to wear a mask in public, period,” he said.
“It’s not about your rights; it’s about your responsibilities,” Biden said. He tried to present the issue as a matter of patriotism to protect fellow Americans.
Why this matters
We don’t know who will be US president in 2021, but whether it’s Trump or Biden, it will almost certainly have a big impact in how the country deals with the pandemic.
The positions of the two candidates on face masks are very different, with Trump firmly rejecting a national mask mandate because he wants a “certain freedom” for Americans, adding that “I don’t agree with the statement that if everybody wears a mask everything disappears.”
In the US, face masks have been heavily politicized. Although most Americans say they wear a face mask in public, there are clear divides down the political line, with Democrats being much more likely to support wearing face masks than Republicans.
Election day is November 3. Whoever the next president may be, his task will be to unite rather than divide American people and deploy a coordinated, energetic response to the pandemic. The virus has no political color, and it’s bound to cause more problems come autumn and wintertime.
While cases have somewhat stabilized in the US, the disease burden caused by the coronavirus will be compounded by the flu season and other infectious diseases.
“When you ask me what Thanksgiving’s going to be like, I think it’s just dependent on how the American people choose to respond,” Dr. Redfield said. If people follow the CDC’s social distancing and hygiene recommendations and get their flu shots, “it will bring this [COVID-19] outbreak down,” he said.
After an initial fumbling, the world has largely understood that face masks are a key ally in our fight against the novel coronavirus. But as the reality of wearing a mask day in and day out sinks in, practical problems also start to emerge. Buying single-use masks can be costly and cumbersome, but are cloth masks as efficient? Speaking of, which types of masks are more efficient?
While there’s still a lot to be understood, scientists are closing in on the answers.
Testing face masks
Masks have two main purposes: the most common application is to protect the wearer from pathogens, but in the case of surgical masks, the main goal is to protect from the wearer. In the case of the novel coronavirus, there’s a little bit of both. While masks offer some protection to the wearer, they are most useful in filtering droplets coming from the wearer. But given the recent explosion in the types of face masks being used, there’s also a lot of confusion.
So a group of researchers from Duke university devised a simple method to assess which masks are most and least effective in terms of droplet filtering.
They used a straightforward setup that involves a black box, a laser, and a cell phone. An operator wears a face mask and speaks inside the dark box, into the direction of the laser beam. Droplets that propagate through laser scatter light, which is recorded with a cell phone camera. A simple algorithm is then used to count the droplets in the video — a setup that can be recreated for less than $200 by non experts.
With this simple but effective setup, researchers analyzed 14 commonly available face masks, ranging from the professional N95 respirator masks to surgical, cotton, and different types of cloth masks.
The camera was used to record a video of approximately 40 s length to record droplets emitted while speaking. The researchers first measured how many droplets are produced by speaking before and after wearing each mask. Each test was repeated 10 times.
N95, surgical, and multi-layer cotton masks perform well
The best-performing mask was the fitted N95, which filtered 99.9% of the emerging droplets. Three-layer surgical masks were the runner-up.
Then, researchers note, a number of masks made from cotton and other reusable materials performed very well, filtering over 80% of the resulting droplets. As previous research also suggested, the high-thread multi-layer cotton masks (3-5 layers) many people have been using can indeed serve as effective filtering barriers against droplets. However, not all materials performed well.
Wearing a gaiter mask actually produced more droplets
Researchers were very surprised to see that fleece actually produced more droplets than wearing no mask at all, as the material dispersed the largest droplets into a multitude of smaller droplets. Bandanas also offered a modicum of protection that varied greatly between different measurements (the longer the bars above are, the more variation there was between individual measurements).
Considering that smaller particles are airborne longer than large droplets (larger droplets sink faster), the use of such a mask might be counterproductive, the researchers note.
Another interesting takeaway is the performance of the valved N95 mask — which features an exhalation valve. This valve doesn’t affect the protection of the wearer, but because the valve produces a strong outwards airflow, it can decrease the protection of people around the wearer.
Replicating the setup for other masks
The researchers note that their primary objective was to create a demonstration of how to easily measure face mask droplet filtering efficiency.
The setup can be reproduced by companies or even individuals producing and selling face masks to test their efficacy, especially as it features easily available materials and technology. The researchers hope that their study will also raise awareness about how useful masks can be.
The fact that many cotton face masks behaved so well is encouraging, showing that even such a mask can offer substantial protection, both for the wearer and for those around the wearer. However, the study also highlights that not all materials perform well, and the flimsiest of materials may actually end up doing more harm than good. This could be an important consideration for policymakers mandating the use of face masks
Limitations of the study
However, there are significant limitations to the study. For starters, we don’t know exactly how the coronavirus is spread through droplets, and the number of droplets is just one part of the equation — it’s not fully understood how the size of the droplets also affects transmission.
Secondly, the cell phone camera might not detect the very smallest of the droplets, which again may or may not affect the risk of transmission. Also, the physiology of different speakers is different and may affect the overall filtration rate.
There are other methods to test face masks as well, and the authors note that their examples serve mainly as a demonstration. The researchers are hoping companies, museums, and community outreach centers can set up the test to show people which masks are the most effective.
“We should point out that our experiments differ in several ways from the traditional methods for mask validation, such as filtration efficiency of latex particles. As is apparent from the neck fleece study, liquid filtration (and subsequent particle size reduction) are more relevant than solid filtration. In addition, our method could inform attempts to improve training on proper mask use and help validate approaches to make existing masks reusable,” the study reads.
Which face masks are the best against the coronavirus
So where does this leave us regarding the coronavirus pandemic? As we’ve known for a while, N95 and other equivalent respirator masks are the best option when it comes to filtration, but they’re not always available to the general public and can be quite expensive.
Surgical masks are a second-best option, but only if they are proper three-layer masks. Perhaps the most important takeaway from recent studies is that when designed and worn properly, masks made of cotton can be comparable in efficiency to surgical masks.
This gives the general public a cheap, reusable, and accessible option for face masks. Study after study has shown that masks can be a simple and very effective protective tool against the coronavirus. We’d be wise to use it.
Some opponents of face masks have argued that they will make people ignore other protection measures (like washing hands or distancing). A new analysis of multiple studies lays that idea to rest.
Unfounded concerns like this one can threaten public health by delaying the introduction of protective measures such as wearing of face coverings, the researchers conclude.
Burying an old theory
When face masks were first brought into the COVID-19 discussion, there were a few arguments against them. The first one is that the protection masks offer is imperfect — and while technically true, there is already convincing evidence that masks do help in preventing the disease. Another concern was that masks would make people act recklessly, giving them a sense of false security and causing a negative net effect.
This idea is sometimes called ‘risk compensation’ or ‘risk budget’, and it’s been debated for some time. Researchers have been looking at it for years, especially when it comes to introducing some kind of mandatory protection measure.
The common-cited example is the mandated wearing of bike helmets, which purportedly leads to an increase in the number of bike injuries and fatalities. Another common example is the introduction of HIV pre-exposure prophylaxis (PrEP) and HPV vaccination which allegedly leads to an increase in unprotected sex. However, none of those things are true, according to a new study.
Two quoted systematic reviews concluded:
“In sum, this systematic review found little to no support for the hypothesis bicycle helmet use is associated with engaging in risky behaviour.”
“The consistent, replicated evidence found across the 20 studies examined in this systematic review provides a strong body of evidence refuting that there is an association between HPV [human papillomavirus] vaccination and risky sexual behaviour”
This is why large-scale analyses are so important: individual studies can sometimes miss the big picture, and there are indeed studies suggesting that bike helmets increase the risk of accidents, but that’s not really true when you zoom out.
A team led by Professor Dame Theresa Marteau at the Behaviour and Health Research Unit from the University of Cambridge has examined the existing evidence for risk compensation. They looked at 22 systematic reviews and three observational studies, finding that both the bike and the HPV example are plain wrong. In fact, for the HPV vaccination, the opposite was found: those who were vaccinated were less likely to engage in unprotected sexual behavior.
The same thing was found in the case of face masks.
Risk compensation theory “is a dead horse that no longer needs to be beaten”
Studies on over 2,000 households suggest that wearing masks does not reduce the frequency of handwashing or hand sanitizing — another crucial hygiene measure. In fact, in two studies, self-reported rates of handwashing were higher in the groups allocated to wearing masks.
It’s an interesting and important takeaway, and a new one too because none of these initial studies were tailored to look at risk management — it’s this new analysis that pulls it all into place. According to the study’s authors, this is the final blow to the old theory of risk compensation.
“The concept of risk compensation, rather than risk compensation itself, seems the greater threat to public health through delaying potentially effective interventions that can help prevent the spread of disease,” said Professor Marteau.
“Many public health bodies are coming to the conclusion that wearing a face covering might help reduce the spread of SARS-CoV-2, and the limited evidence available suggests their use doesn’t have a negative effect on hand hygiene,” added co-author Dr. James Rubin from the Department of Psychological Medicine, King’s College London.
However, the study does have significant limitations. None of the coronavirus face mask studies had been peer-reviewed, so the findings should be taken with a grain of salt. But Martineau and colleagues say this is sufficient evidence to put risk compensation theory to rest. The theory, they say, is “a dead horse that now needs burying to try to prevent the continued threat it poses to public health, from by slowing the adoption of more effective interventions”.
The last reasonable arguments against face masks are being blown away. We’ll either follow the scientific advice, or pay the price.
Journal Reference: Mantzari, E et al. Is risk compensation threatening public health in the covid-19 pandemic? BMJ Analysis; 27 July 2020: DOI: 10.1136/bmj.m2913
A study published in the prestigious peer-reviewed journal Cell confirms what was already obvious: SARS-CoV-2 can propagate through the nose, and if you want the mask to be effective, you should wear it on your nose.
Your nose is a superspreader
It’s a sight we’ve all grown accustomed to: people wearing their mask “half-heartedly” — covering their mouth but not their nose. The reasoning behind this is, presumably, that it’s easier to breathe this way, and (again, presumably) this still counts as wearing a mask. But, as several studies have already shown, the nose is just as capable as the mouth at transmitting the novel coronavirus.
In a new study, researchers show that nose cells are significantly more likely to become infected and shed virus compared to the throat or lungs. Sure, the mouth may spread aerosols farther away, but the nose is more “contagious”. So every time someone exhales through their nose, they are likely to generate a higher concentration of infectious particles than if they were breathing from their mouth.
Simply put, your nose is a superspreader.
This study was not aimed particularly at masks. Researchers were most interested in assessing the infectivity of different parts of the respiratory tract and studying how the virus can move down to the lungs.
However, a takeaway from this study is that blocking the nose offers greatly increased protection, limiting the spread of virus-carrying aerosols.
“Although speculative, if the nasal cavity is the initial site mediating seeding of the lung via aspiration, these studies argue for the widespread use of masks to prevent aerosol, large droplet, and/or mechanical exposure to the nasal passages.”
Face masks are not perfect — we know that already, and that was the main reason why widespread usage was recommended so late in the pandemic. But even so, they offer a great deal of protection, and study after study has shown that they are instrumental in our defense against the pandemic. Wearing a mask (and wearing it properly) can literally make or break the pandemic response.
Unfortunately, many people still refuse to wear face masks for political reasons or due to already debunked conspiracy theories. Scientific studies such as this one underline the importance of this protective measure, but whether or not people follow it, that’s a completely different story.
Besides social distancing, wearing a mask is one of the best ways to avoid the spread of the novel coronavirus. But whether or not people are willing to use one has less to with the pandemic than with their political affiliation, at least in the United States, according to the results of a survey.
The Axios-Ipsos survey on coronavirus showed that there is a growing political divide between Republicans and Democrats on the use of face masks. The percentage of Democrats who said they wear masks all the time when going out went from 49% between April 10 and May 4 to 65% between May 8 and June 22.
On the other hand, not that many Republicans seem to be using a mask when leaving their homes. During the same timeframe, the percentage went from 29% to 35%, according to the survey. This shows a clear political divide among American citizens.
President Donald Trump hasn’t been seen wearing a mask yet and last week told the attendants to a rally in Tulsa to “do what they want” regarding masks, which weren’t mandatory to attend the gathering. Republican governors have also refused to wear masks in public, while Democrats are urging residents to do so amid a surge of cases.
The political gap can actually be traced back to confusing public health messaging on the use of masks when the pandemic was starting. Americans were first told by the government not to purchase masks due to concerns that they could run out, leaving healthcare workers without them.
But such fears were real, according to government virus expert Anthony Fauci. He gave a congressional testimony this week and he said he “didn’t regret” telling people not to buy masks, as the government “didn’t want to take away the masks from health care workers” and wanted to people to stay in their homes as much as possible.
Conservatives who prize individual autonomy over social responsibility experience “a massive pushback of psychological resistance” when presented with mask mandates, Steven Taylor, the author of “The Psychology of Pandemics”told Axios. That reaction is reinforced “if leaders like Trump downplay the significance of COVID-19 or if they won’t wear masks,” he added.
The results of the Axios-Ipsos survey illustrate this perfectly. While Republicans in blue states use masks less than Democrats, they wear them at higher rates than Republicans in red states. At the same time, Democrats in red states use masks at lower rates than Democrats in blue states.
If there’s something that can break the political divide, that’s the outbreak itself. Cases are going up in red states such as Arizona and Texas, who had to backtrack the decision to lift the lockdown, closing down bars and restaurants. Meanwhile, in those same states, Google searches for masks are going up.
According to a new study based on statistical models, face masks can play a key role in reopening our society without risking a sweeping second wave of infections.
“Our analyses support the immediate and universal adoption of face masks by the public,” said Richard Stutt, who co-led the study at Cambridge.
“All models are wrong,” a common aphorism in statistics goes, “but some are useful”.
We’ve seen over the course of the pandemic that some statistical models turn out to wildly wrong, but here’s the thing: models aren’t necessarily meant to be right — oftentimes they’re meant to give us an idea of what could happen under different scenarios.
In the new model, researchers wanted to see how different lockdown and face mask behaviors would affect disease transmission. The research showed that lockdowns do help, but they’re not a sufficient measure to prevent a second wave. The model also showed that if sufficient people wear face masks in public, transmission can be substantially reduced and a second wave can be averted.
“If widespread facemask use by the public is combined with physical distancing and some lockdown, it may offer an acceptable way of managing the pandemic and re-opening economic activity long before there is a working vaccine.”
Keeping R < 1
If we want to keep the disease in control, we have to ensure that the number of cases isn’t growing. The infamous ‘reproduction number’ or R0 (which indicates how many new infections are caused by an existing infection) must be kept under 1 to keep the outbreak under control. If the number is over 1, then the number of infections is rising, and we’re at risk of new outbreaks.
The study’s modeling included all stages of infection and transmission from the air as well as contaminated surfaces. Unlike other previous models, researchers also considered the negative aspects of mask use, such as increased face touching.
“We show that, when facemasks are used by the public all the time (not just from when symptoms first appear), the effective reproduction number, can be decreased below 1, leading to the mitigation of epidemic spread. Under certain conditions, when lock-down periods are implemented in combination with 100% facemask use, there is vastly less disease spread, secondary and tertiary waves are flattened and the epidemic is brought under control.”
Want fewer lockdowns? Wear a mask
Of course, it’s a virtual impossibility for 100% of people to wear face masks (and all models are wrong, remember), but this is a good indication of how useful masks can be. For instance, if everyone would wear masks, and the masks were only 75% effective, it would still be enough to bring a very high R number of 4 (which was the case in the UK or New York before the lockdown) to under 1 — even without any lockdowns.
Even masks that only offer a droplet capture of 50% still offer significant and widespread benefits. In all scenarios in the study, face mask use by 50% or more of the population reduced R below 1, flattening future disease waves and allowing for less stringent lockdowns.
Wearing masks is a selfless act
In fact, another notable takeaway from the study is that even if people wear masks improperly (for instance, by repeatedly touching the outside of the mask, which actually raises the wearer’s risk), masks can still have a positive impact. Even if people wear masks so improperly (which can end up quadrupling the wearer’s risk of infection), the net effect is still positive as long as enough people wear them.
Of course, the idea is to wear masks properly and use them to protect yourself as well, but this is a testament to how useful masks can be. In fact, researchers say, the primary role of a face mask is not to protect you from others, but rather to protect others from you.
Sure, face masks can also offer some protection to the user, but wearing face masks is primarily a selfless act. You wear masks to protect others, and others wear a mas to protect you.
“There is a common perception that wearing a facemask means you consider others a danger,” said Professor John Colvin, coauthor from the University of Greenwich. “In fact, by wearing a mask you are primarily protecting others from yourself.”
“Cultural and even political issues may stop people wearing facemasks, so the message needs to be clear: my mask protects you, your mask protects me.”
The researchers have also criticized the UK’s approach to face masks. Just 1 in 5 Brits support the wearing of face masks, compared to approximately 70% of Americans, for instance. Furthermore, the UK government has only recently decided wearing face masks to be mandatory on public transportation — whereas other European countries have generally imposed the wearing of masks in far more situations.
“In the UK, the approach to facemasks should go further than just public transport. The most effective way to restart daily life is to encourage everyone to wear some kind of mask whenever they are in public,” Colvin said.
Ultimately, an important takeaway is that improvised face masks (such as the ones you would make yourself from textiles, or buy) can be of tremendous help. They may very well make the difference between a flattened or a devastating second wave.
How is it that a crowded mega-city like Tokyo, without a stay at home order and with a menacing outbreak, managed to avoid a catastrophe? The key might lie in its people’s awareness of public hygiene — and masks in particular.
Mask-wearing has become an anathema to many parts of the US (and some parts of Europe) — but it may be a good part of why Japan and several other Asian countries are faring so well comparatively.
When you look at the coronavirus mortality rate, it is substantially lower in several Asian countries than the US or many countries in Europe. Japan is a particularly striking example. Prime Minister Shinzo Abe ended the national state of emergency last week as Japan has by far the lowest coronavirus figures in the group of seven major economies. Even as Japan wobbled as it took a hit from a second wave of infections, it is still standing.
Japan has no legal way to enforce a lockdown, so it relied on its population to respect the quarantine — and while the crisis is far from over, it managed to stave off the infections to a relatively low number. There are currently under 20,000 confirmed cases in Japan, which for a country of over 126 million, is stunning. The fact that Japan managed to keep its infections so low despite its sprawling urban agglomerations is even more impressive.
In a recent press conference, Japan’s national expert panel addressed some questions about why the country seems to be faring so well — and they cite face masks as an important factor.
“There’s strong awareness of public hygiene, starting with the habit of washing our hands. And, due to historical experiences, there is widespread knowledge about preventing infections,” the panel explained.
“Another social factor is that Japanese people feel comfortable wearing masks on a daily basis. Many people are allergic to pollen, so they do this during the cedar pollen season from the beginning of the year until spring, as well as to protect against influenza.”
Face masks have been a major point of contention over the course of the pandemic. A part of that is owed to the initial guidance provided by organizations such as the WHO and CDC. In part due to fears of shortage, in part due to a hesitancy to issue guidance on incomplete evidence, early guidance on face masks was confusing and contradictory — this did not happen in Japan and several other Asian countries. Face masks were recommended from the start, and they were already widely accepted in these societies.
But even so, the panel explains, Japan only barely managed to escape a health disaster.
“Japan’s health care system was on the brink of collapse, and we just barely managed to avoid that, thanks to an all-Japan effort. Even though we didn’t go as far as a lockdown like those seen in the U.S. and Europe, there has been great social and economic sacrifice. It’s difficult to find a balance between preventing the spread of the disease and social and economic activity.”
In the end, it was the common-sense measures that made all the difference: physical distancing, wearing masks, and hand hygiene.
“Cluster surveillance has enabled us to ascertain what situations and places present a high risk. We have found out that wearing masks, hand hygiene, physical distancing and avoiding talking loudly are effective in preventing transmission.”
Something else that Japan did with great success was cluster tracing. The cluster-based approach to disease control was designed based on the recommendations of the WHO. Each infection cluster is traced to the original source and everyone in the cluster is isolated and treated as necessary. This way, you don’t test randomly and massively (which can also work), but you spend a lot more time tracing clusters. The approach is not perfect, but it works.
However, Japan is not out of the woods yet. In order to keep the situation under control, Japan plans to step up its cluster tracing, in addition to other measures such as antibody testing and physical distancing.
“A second wave is very possible, so we need to detect clusters faster than before. We also need to use the antigen testing we have developed, alongside PCR testing, to find cases before symptoms become serious,” the panel concludes.
After weeks or even months of lockdown, countries are starting to slowly reopen some parts of society. To avoid a new surge of cases, several distancing and protection measures have been recommended, including the widespread use of face masks out i public — though this is not the case everywhere.
In Austria, people have to wear face masks when shopping. Spain has made face masks compulsory when using public transportation. In Germany face masks or coverings must be worn while in shops, grocery stores, and shopping malls, as well as on local public transportation. In the UK, the government has been lax about recommending face masks, but it is now starting to come around. In many Asian countries, face masks were already common before the coronavirus pandemic, and they’ve only become more widespread in the past couple of months.
Meanwhile, US states have different approaches when it comes to face masks and the federal administration has sent mixed messages. As a result, face masks have become extremely controversial across the country, even though the scientific evidence strongly supports their use.
The science is still not complete, but recent studies are strongly indicating that widespread usage of face masks slows down the virus. If we want to relax the lockdown and not cause a public health disaster, face masks are really paramount.
It’s time to wear masks, researchers say
In an essay published in the British Medical Journal, Professor Trisha Greenhalgh at the University of Oxford and colleagues argue that despite limited evidence, masks “could have a substantial impact on transmission with a relatively small impact on social and economic life.”
When they looked at the literature, Greenhalgh and colleagues found unclear evidence, but here’s the thing: even if masks offer limited protection, this limited protection multiplied with a substantial part of the population wearing masks can make a big difference.
We know that people are infectious before symptoms of COVID-19 start to appear, and many never show any symptoms at all. So the argument is that masks could prevent presymptomatic or asymptomatic carriers from spreading the virus when they are coughing, sneezing, or talking.
Furthermore, masks are cheap and have essentially no risk.
“Masks are simple, cheap, and potentially effective,” they write. “We believe that, worn both in the home (particularly by the person showing symptoms) and also outside the home in situations where meeting others is likely (for example, shopping, public transport), they could have a substantial impact on transmission with a relatively small impact on social and economic life,” they write.
The message was murky in the beginning. Health organizations wanted to protect and prioritize health workers, and feared that if the public would start buying face masks, this would lead to shortages, causing more harm than good. But it’s already been a few months and production has readjusted and shortages have been alleviated for the most part. Also, cloth masks are likely better than wearing no mask at all, Javid and colleagues argue, and a series of recent pre-print articles back this conclusion up.
Multi-layered cotton, in particular, has emerged as a promising alternative to surgical masks, with some studies showing that 4-layer cotton masks can be as effective at filtration as surgical masks.
But even basic masks, made out of an old t-shirt, can offer some protection. A recent study concluded:
“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.”
While the protection is far from absolute, it is significant, especially when worn by a significant part of society.
Why some people don’t want to wear masks
The objections against face masks are, almost always, not scientific — but rather political and religious. Some people see masks as an infringement on their religious freedom, with Republican legislator Nino Vitale writing:
“This is the greatest nation on earth founded on Judeo-Christian principles. One of those principles is that we are all created in the image and likeness of God. That image is seen the most by our face. I will not wear a mask.”
However, one can’t help but wonder if the image of God also includes a suit and tie, or clothes in general.
Other opponents see face masks as an infringement of freedom, in general, with one extreme case taking place in a supermarket in San Diego: a shopper came in with a face mask covered by a Nazi swastika, allegedly likening the lockdown measures and face mask regulations with Nazi Germany.
Psychologists have also identified another trait associated with refusal to wear a mask: toxic masculinity. Basically, many might fear that wearing a mask would make them seem weak and don’t want to wear one out of bravado. If you find this unlikely, just look at authoritarian leaders who want to propagate a “strong man” image.
Donald Trump openly said he doesn’t want to wear a mask, Mike Pence refused to wear a mask even when it was mandatory (although he did admit this a mistake later on), and Brazilian President Jair Bolsonaro outright refuses any precaution against the disease, saying that his health is enough to beat the virus. According to David Abrams, a clinical psychologist and professor of social and behavioral science at New York University’s School of Global Public Health, some men see the mask as a sign of vulnerability.
Wearing masks, even as a temporary measure meant to prevent viral transmission and save lives, seems to be a surprisingly polarizing topic that many outright reject.
We won’t have definitive answers for a while — and we need to take decisions now
There are legitimate, scientific questions about the effectiveness against face masks — essentially, we don’t know just how effective they are, just that they are somewhat effective.
The problem is that testing the efficacy of face masks for a new virus is no easy task. The best way to test their effectiveness is through randomized control trials (where one group has the intervention being tested and another group receives a placebo or no intervention at all). But randomized control trials are essentially impossible to set up in this type of scenario, with such a dangerous disease.
So far, our evidence tends to come from laboratories or influenza studies, both of which are approximations. But here’s the thing: the same thing can be said for washing your hands for 20 seconds or maintaining a distance of 2 meters for social distancing. There aren’t any randomized control trials supporting these issues, but there is still some evidence to support them, so we just do it.
If we turn to empiric correlation, this also seems to support the use of face masks. The city of Jena was the only German city to have imposed mandatory face masks by March 31 and it recorded no new infections in the following eight days while surrounding cities continued to report a surge in cases. The Czech Republic, the first country in Europe to mandate face masks in public, reported slower growth of cases compared to its neighboring countries — very similar places, with very similar strategies, seem to report fewer cases when face masks are introduced into the equation.
So no matter how you go about it, the scientific, medical, and empiric evidence seems to support the widespread use of face masks. They may be unpleasant, they may be a drag — but they can help stop the spread of the disease.
Using face masks has become necessary and even mandatory in many parts of the world to reduce the spread of the novel coronavirus. Virus transmission is believed to take place via respiratory droplets resulting from sneezing and coughing, which can be at least partially prevented by the use of masks.
This has caused a global spike in the demand for face masks and the decision to limit the sale of some models, especially the N95 mostly used by health workers. Still, shortages have been reported, leading to many using the same mask repeatedly, with many risks implied.
In this context, researchers have come up with a potential solution. They developed a membrane that can be attached to a standard N95 mask and be replaced when needed. What’s more, the filter has a smaller pore size than the actual masks, blocking more virus particles.
An N95 mask offers more protection than a surgical mask does because it can filter out both large and small particles suspended in the air. As the name indicates, the mask is designed to block 95% of very small particles. Some masks have valves that make them easier to breathe through.
Detachable filters for the most advanced face masks
Muhammad Mustafa Hussain from the University of California, Berkeley, California, and colleagues developed a silicon-based, porous template using lithography and chemical imprint. They placed it over a polyimide film and used a process called reactive ion etching to make pores in the membrane. Then, they peeled off the membrane, which can be attached to the mask.
To make sure that the membrane was breathable, the researchers measured the airflow rate through the pores. They found that for pores tinier than 60 nanometers (in other words, smaller than SARS-CoV-2), the pores needed to be placed a maximum of 330 nm from each other to achieve good breathability.
“The porous membrane is based on a naturally hydrophobic polymer such that the droplets that come into contact with the mask will roll and slide over the mask due to the large inclination angle of the membrane when worn on the face mask,” the researchers wrote.
The finding follows other recent studies that have been trying to provide answers to the mask’s scarcity. For instance, a team of CalTech researchers proposed a new way to clean masks, safely, efficiently, and in an inexpensive way — using ethanol instead of isopropyl alcohol.
In the US, the Centers for Disease Control and Prevention (CDC) recommended early this month that citizens should wear “non-medical, cloth masks” to help prevent the spread of the coronavirus. Previously, the CDC had recommended that only those with COVID-19 symptoms wear masks.
Despite initial guidance which said that they weren’t necessary, face masks are now highly recommended alongside social distancing measures, with many local or national governments encouraging their use or even making it mandatory.
It wouldn’t be an exaggeration to say every one of us should be wearing a mask, either commercially-available or homemade, according to a soon to be released study which explains that the need for universal masking is “urgent.”
Researchers found out that if 80% of a closed population wore a mask, COVID-19 infection rates would drop to approximately one-twelfth of the number of infections seen in a population in which no one wore masks.
“I felt like this was pretty urgent,” De Kai, chief architect of the study, told Vanity Fair. De Kai was born in the United States to Chinese immigrants. “I saw the country where I grew up, where my family lives, about to face this pandemic without knowing much about something as simple as wearing a mask to protect themselves and others.”
Unlike in the U.S., masks are worn in everyday life in East Asia to fend off pollution. Using complex models used by epidemiologists to track previous outbreaks (like Ebola and SARS), as well as artificial intelligence, De Kai and his team were able to model how the virus would move around communities in the US should they use masks on a massive scale.
They created different scenarios modeling societies like those in Japan, which generally wear masks, and others that generally don’t, and compared how their use influenced infection rates over time. They also added some original programming to the simulation’s algorithms that take into account mask-specific criteria, such as how effective certain types of masks are.
With no mask, the researchers saw a high rate of infections in their model. When all the simulated Americans wore masks, infection rates dropped down to nothing. The goal, these simulations showed, is for 80% to 90% of people to wear masks at any one time — otherwise, they won’t be effective. “If you get down to 30 or 40%, you get almost no effect at all,” De Kai said.
The evolution of guidance on wearing face masks has been one of the most bizarre series of events in the current outbreak. Initially, all guidance except for some countries in Asia such as South Korea or China argued against using face masks, explaining that the evidence was too inconclusive to warrant their use. The US Surgeon General even specifically asked people to stop buying face masks in order to prevent possible shortages for medical workers.
Not long after that, however, official guidelines took a 180 turn, and even the Surgeon General himself appeared in a video showing people how to make an improvised face mask using only an old T-shirt and a rubber band.