The Whole Truth About Masks and COVID-19

(Posted April 3, 2020; revised April 8, 2020)

OK, it’s time to take the gloves off. 

The tension between public health imperatives and personal health concerns is palpable in the various news accounts of the new CDC Guidelines on wearing masks in public 

[Source: one among many: "A Debate Over Masks Uncovers DeepShite House Divisions," New York Times, 3/4/2020]

In this post (and several to follow) we promise to tell the whole truth about COVID-19 transmission --- to the extent that infectious disease experts have been able to determine it to date --- and its implications for the personal health of ourselves, our loved ones, and our fellow Vermonters. 

We can no longer hold back and tow the line of the CDC and other public health officials when they, perhaps understandably, provide guidance that while intended to head off the collapse of our health systems may not be good (or accurate) advice for individuals concerned about their personal health and that of their loved ones, especially if they are in higher-risk categories and this could be a matter of life or death.

We will continue to eschew any political analysis or judgements about how and why our country has come to this state of affairs; we will leave that to others. Instead, we will seek to explain the apparent contradictions in the guidance we have been given over the past month by public health officials and organizations on various matters, including: masks, testing, and matters related to social and physical distancing like surface and airborne transmission. 

This first such post will address the issue of masks and the question: Why have the CDC and other public health agencies been so adamant that healthy people don’t need to wear masks when out in public, if at the same time they are emphasizing how critical masks are for healthcare and other service workers?

Let us begin this explanation of the apparent contradictions in the guidance about mask-wearing that we have been given over the past month by public health officials and agencies like the CDC and the Vermont Department of Health, which up until noon April 3rd, still had the following statement on its website:  

The Department of Health does not recommend people wear a face mask in public….If you are not sick: You do not need to wear a mask. Face masks are more effective at “keeping germs in,” but they are not as effective at “keeping germs out.”

This statement is a perfect example of the sometimes conflicting objectives of public health and personal health. 

The public health objective regarding masks is the imperative that health care workers have adequate amounts of effective masks and so don’t become infected with COVID-19 by carrier patients and so that possibly asymptomatic healthcare workers don’t unknowingly spread COVID-19 to patients who are in the hospital for a non-COVID-related serious medical condition. 

It is this public health imperative that led CDC and other public health officials to attempt to head off panic-based buying, hoarding, and price-gouging of mask sales to people who were considered by the authorities to be “less in need” of these masks than health care and other front-line workers. Unfortunately, these officials did so by mis-stating the case against masks for protecting people from COVID-19 infection

One powerful example of this mixed-messaging came in late February, quite early in the spread of COVID-19 in the U.S., when the Surgeon General tweeted:

“Seriously people — STOP BUYING MASKS!...They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can’t get them to care for sick patients, it puts them and our communities at risk!” 

And the media fell into line with such public health messaging, as for example, this piece from CNBC (3/2/2002): “Do face masks work? Medical experts explain how to protect yourself from coronavirus)

However, by mid-March Chinese medical researchers were making it clear to public health officials the world over that masks had proven to be effective in preventing the spread of COVID-19 both from and to others. And, around this time, there began to be clear signals from infectious disease professionals and information specialists in the U.S. that the CDC’s position on mask-wearing was not entirely accurate and was almost certainly confusing the public and damaging the CDC’s credibility.

And, more than a week ago, respected U.S. journals like Sciencemagazine.com, published by the American Academy for the Advancement of Science (AAAS) were reporting that  public health officials in Hong Kong, Singapore, and South Korea credit mask-wearing as part of their overall public health effort that appears to have been relatively successful in “flattening the curve,” notably more so than U.S. public health efforts to date.

Even as of the morning of April 4th, even with dozens of articles and opinion pieces in the NY Times and other reputable media outlets describing and criticizing the official public health position on masks, the CDC still seemed to be struggling with how to inform the public that their previous guidance to individuals on mask wearing was not completely accurate and that indeed everyone should be wearing masks of some sort when venturing out into public.


Meanwhile, in the afternoon of April 3rd, the Vermont Department of Health got out ahead of the CDC and other federal authorities and began advising people to use cloth masks when they go out in public. 
Here is the new statement on the Vermont Department of Health web site:
SHOULD I WEAR A FACE MASK WHEN I GO OUT IN PUBLIC?
Yes, please wear a mask when you are out of your home. Since COVID-19 may be transmitted by someone who does not have symptoms, by wearing a mask you help to protect others. This does not change the guidance to go out only when essential.
So now, the race to find suitable masks has begun for individuals who have been following the previous claims from the CDC, the Vermont Department of Health, and the media that wearing masks in public was neither necessary nor effective. 
The challenge to us all in doing so is to remember that the public health intentions of that message were and still are valid:

  • Do not think that just because you may be wearing a mask you can walk around outside with your friends or hang out with your neighbors. Social and physical distancing remain by far the most effective means of slowing down the spread of COVID-19 and keeping us all much safer. 
  • It is crucial that health workers have sufficient numbers of appropriate masks to keep them and their non-infected patients safe and, in doing so, to prevent our health systems from imploding. 

As a result probably the best action for people to take with respect to wearing a mask when away from home is to obtain homemade cloth masks or make one themselves. 

To understand why cloth masks are preferable for most people, see our post "What kind of masks should we be using during the COVID-19 crisis?"

There has been widespread Front Porch Forum posting by people making these cloth masks, mostly to donate to hospitals, but it is beginning to look as though some of these homemade masks do not meet hospital standards and so might be available for purchase or for free from local mask-makers. 
Readers are encouraged to go to Front Porch Forum and search the archive by typing in “Masks” and or “COVID;” you will find the contact information for many local mask-makers. 

Or read articles on how to do it yourself, including: “How to Sew a Face Mask,” New York Times, 3/31/2020 and this YouTube video: Making a face mask without a sewing machine. 

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