person wearing facemask

Every year public health officials encourage people to do two things to reduce the risk of catching the flu. 1) Get a flu shot. 2) Wash your hands! We rarely, if ever, see or hear messages about wearing a face mask to prevent the flu. It’s not something American health professionals promote. When people see someone wearing a surgical mask they shy away. It makes them a bit uncomfortable. Yet in Japan or China wearing a face mask is considered culturally acceptable, even desirable during an influenza epidemic.

Why Do People in Asia Feel Comfortable Wearing a Face Mask?

According to an article on Nippon.Com (Feb. 11, 2016), the custom of wearing a face mask got started during the worldwide Spanish flu pandemic of 1918. Over 20 million Japanese people were affected and nearly 400,000 died (Emerging Infectious Disease from the CDC, April, 2007). Although the custom of wearing a face mask got started during that time, it wasn’t until the last couple of decades that it really caught on.

In Japan it is considered polite to wear a surgical mask if you come down with the sniffles whether from a cold, the flu or spring pollen allergies. People do not shy away from someone wearing such a mask. They are grateful. It is estimated that nearly one third of the population wears a mask during the height of flu season.

Our Readers Want to Know: Does Wearing a Face Mask Work?

Here is a question from a visitor to this website:

Q. I read that just breathing can spread influenza virus. Does a facemask help prevent transmission? If so, what should I look for?

A. New research suggests that an infected person can spread viral particles simply by breathing (PNAS, Jan. 2018).  When hand washing is combined with facemask use, the protection from influenza is enhanced (Epidemiology and Infection, May 2014).

Here is what the investigators had to say:

“The combination of hand hygiene with facemasks was found to have statistically significant efficacy against laboratory-confirmed influenza while hand hygiene alone did not.”

Hand Washing Was Not Shown to be Effective:

Did you understand what these authors were saying? Need some clarification? Here is a more complete description of what they found:

“We examined the efficacy of hand hygiene interventions in preventing influenza virus transmission in the community. The subgroup analysis from developed countries suggested that a combined intervention consisting of hand hygiene with facemasks is an effective strategy to prevent influenza, but we did not confirm the efficacy of hand hygiene alone for reducing influenza illness. This is consistent with evidence on the important role of aerosol transmission of influenza, such that interventions against contact transmission alone like hand hygiene may not be sufficient to control influenza transmission in the community.”

Still not convinced? Read on:

“The findings of this review have implications for the recommendations and guidelines of hand hygiene and facemask use in the future. Given the lack of substantial efficacy of hand hygiene identified in our review, and the increasing evidence supporting a role of aerosol as a mode of influenza virus transmission, further public health initiatives may need to re-examine the control measures for aerosol transmission. In particular, measures such as hand hygiene that focus on reducing one mode of transmission (i.e. contact) may not be sufficient to control transmission…”

People’s Pharmacy Perspective:

We apologize for belaboring this message, but it is one that seems to have eluded public health officials. Hand washing by itself is not a great (or even a very good) way to avoid catching the flu. But hand washing combined with wearing a face mask can be helpful. That’s because breathing in air is how a lot of people catch influenza.

University of Maryland researchers report that people with influenza can spread flu viruses into the air without coughing of sneezing. Just breathing is enough to “generate infectious aerosols.” If you happen to walk by and breathe those suspended tiny droplets you could catch their flu.

Which Face Mask to Buy?

Face masks are not perfect. But they are better than nothing. How do you find a good product? A surgical mask rated level three offers the best protection. In one study, nurses wearing a face mask were just as protected against the flu as nurses using an N95 respirator (JAMA, Nov. 4, 2009).

Level three surgical masks can be purchased online for a reasonable price.

Share your own experience with wearing a face mask in the comment section below. Is this something you would consider? If not, why not? Do you think we will ever embrace the Japanese style of waring a face mask as a polite thing to do?

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  1. Pat

    I think everyone should wear a mask in a doctor’s office. You never know if someone is sick or not. When I wear mine in the box store or grocery store I get a wide space and strange looks. News pictures from China and Japan
    show pictures of people wearing masks all the time. People in the U.S. are slow in changing their ways, I think. It would help if the schools taught this.

  2. Dana Roth

    I don’t know about arthritis, but I changed my routine to eat prunes ~4 each night after dinner and find I don’t have to get up during the night to urinate. I can , until I have been asleep for 5 hours.

    P.S. Why isn’t anyone talking about taking Vitamin C to avoid the flu? Perhaps because is isn’t a prescription drug and the patents have expired?

  3. Sara
    Washington State

    I take immune suppressant drugs for Multiple Sclorosis. I felt a little awkward the first time I wore a mask on an airplane. What I soon realized was that it was my “super power”. People seem to avoid you which is just fine by me. I also bring Wet Ones (bring enough to offer to your seat mates, I’ve never been turned down) and wipe down the tray table, arm rests and anything else around my seat that I will probably end up touching. I also use the hand sanitizer, especially after touching the door latch when exiting the restroom.

  4. mike
    Chatsworth, GA

    I wear a face mask in heavily congested public places like the box stores, grocery stores and the “mart stores.” I went into a crowded costco with my mask on and people seeing me with a mask would venture in the opposite direction, especially if I faked a sick cough. They would part the wave for me. One can assume in crowded places there is going to be a percentage of shoppers there who have had the flu or have been exposed. Why take the chance? Also, take 1 tsp of elderberry concentrate three times a day. I did not get the flu shot as advised by my doctor because it is only effective for certain types of strains of the flu.

  5. Echosyn
    Dallas, Texas

    MCS, Multiple Chemical Sensitivity, ravaged my immune system in 1981 so I changed my habits and diet to all natural foods, fabrics and substances. Now I am recovered and have on hand a complete home apothecary system which has made my body resist chemical contact and all attacks from microbes. A simple broad spectrum antibiotic lotion is always at hand and totally effective. When I go in public during epidemics I coat my hands and exposed skin with the lotion. It contains: witch hazel, oil of oregano, povidone iodine, neem oil, eucalyptus, alcohol, vitamin E and lanolin.

  6. Ellen

    We were on a cruise ship during flu season. I wore face mask to protect from breathing in the germs, but all the other passengers thought I was sick and avoid me like I had plague!
    Last week, I was at the doctor’s office wearing my face mask. A very sick man was in the waiting area and he was pacing up and down, all the while coughing and sneezing passed me several times! Thanks to my face mask, I wasn’t sick but my husband who is shy wering the face mask was sick for 2 whole weeks!!!
    It’s about time the CDC adds wearing face masks in their advices to fight the spreading of germs!!!
    Thank you People’s Pharmacy for posting this important subject.

  7. Sadie

    My brother is a volunteer at our local hospital. He also had Guillian Barre and cannot take the flu shot. Each year he has to sign something from the hospital that says while volunteering he will wear a mask.

    This year during Flu season he put on his mask and his gloves (he handles food). Apparently, it frightened the public and someone complained and his supervisor made him take it off.

    So he no longer wears one. Fortunately, he must have a strong immune system, because he has never had the Flu. But it just shows how Americans are afraid of those mask.

  8. ray

    a well thought of article and good inputs

  9. mog

    I think it helps, not simply to smile while wearing the mask, but to make friendly comments when I meet others who are also wearing face masks. A frequent comment I use to total strangers is, “Who IS that masked man (or woman)?!” People do smile back, even if they obviously aren’t feeling all that great. I especially encourage the smiling remark when we meet at the health clinic.

  10. Sandra

    I wear a face mask all cold and flu season anywhere I go in public due to chronic Lyme Disease and autoimmune illness weakening my immune system. It’s a lot like not having an immune system at all. Most people assume I am sick when I wear a mask. This article seems to also focus on the effects of the sick wearing masks. But I don’t go out if I’m sick, I wear the mask to try to avoid getting ill. I have almost been kicked out of a facility for wearing a mask because the assumption was that I had the flu. Elsewhere, I have been thanked for wearing the mask to keep from making others sick. My response is that I’m not sick, y’all are! I wish it were more common for the healthy to wear masks so that there would not be the assumption that only the sick wear them.

    In my rural mountain community, adults have not mastered the art of sneezing or coughing into one’s elbow, and seem to feel compelled to foodshop anytime they are sick, so the grocery store is the best place to pick up germs. I have found a mask is not enough in the grocery store, and for fear of getting the H2N3 flu strain that is so deadly this year I have had to resort to wearing disposable gloves as well. I always worry I will be kicked out of the store for looking like someone who is avoiding being recognized and doesn’t wish to leave fingerprints!

  11. Dorothy

    Wearing a mask is also helpful when working outdoors during pollen season. But, it is difficult to breathe in a mask

  12. Virginia
    LuLa, GA

    As a retired OR nurse we need some education on the use of face masks. Never wear one longer than 3 hours without changing: dispose a used one immediately, and never reuse. If the mask becomes damp from your own breath, change it. Do not touch your face without washing your hands first. Also it is a good idea to wash your face when you get home after a day of mask use. Sneezing into your elbow–be sure to wash that garment before you wear it again. The comment about sick healthcare workers not being home- hospitals are the worst about letting you stay home when you are ill!!

  13. Wade L. A.

    I’m 75 years old and this flu season I said that heck with it and I wore a mask everywhere I went shopping even in in the hospital emergency room and so far no flu which could be deadly to someone my age.

    I feel we need to start a campaign in this country to get people to start wearing masks when they have the flu or to keep themselves from getting the flu we need to get people to feel that it’s socially correct and television news programs could spread that information very easily and get the word out. I wash my hands a lot too I keep a small bottle or sanitizer in my pocket when I go shopping.

  14. Helen

    When I was in Japan a few years ago, I was told because of the density of the population it is primarily people who have a respiratory virus of some sort or allergic episode who wear the masks to help prevent spreading germs and infecting others. Because it is so prevalent, I’m sure there are also some who wear them as a preventative measure.

  15. Luba

    I ask myself the same thing…. what is this resistance to wearing a facemask? It’s something I often do. Maybe it will catch on and its “weirdness” will disappear. In Mexico, 2009, at the time of the worldwide flu pandemic, the city I lived in shut everything down for three days. Everything! (except hospitals, fire and police stations). So stores, offices, schools, restaurants, banks, etc. were closed. And that did it…. no more flu in that city. It literally could be doing something as simple as that…

  16. Frances
    Palm Desert, Ca

    This is something I never ever see. What do people do when they first arrive at a Clinic or Doctor’s office. After checking in, the first thing they do is look for a magazine to read. Now, this particular magazine you pick up, has probably been fingered over and over again, by sick people. People are only there because they don’t feel well, they could have all kinds of diseases and they have been thumbing through maybe many magazines. Please bring your own little book and read it, or read from your phone, at least that only has your own germs on it. Just my 2cents.

  17. Pam

    I would not mind wearing a mask. Am flying to the Middle East next week and I wonder if
    a mask will make a difference?

  18. sandy
    Salem, VA

    I have been wearing a face mask during flu season for the past 4 years. I can’t take the flu shot and have Hashimoto’s disease so I have to be very careful, having a weakened immune system. Having to use public transportation makes it extra hard on me. People make comments but I’ve gotten used to them—children aren’t afraid like I thought, they just talk to me–they look at my smiling eyes, unlike some adults. I would recommend for everyone to wear a mask. I believe a lot less people would get sick.

  19. Larry M
    Raleigh, NC

    I used to fly frequently. In the cold/flu season wore a face mask and told my seatmates, the flight attendants, and anyone else who looked at me queerly that “I’m not sick. I just don’t want to get sick.”

  20. Jacqueline

    I wear face masks. I have had pneumonia several times, and I am very careful and try to avoid public gatherings this time of year. However, I must keep my doctor appointments, and the offices are always full of coughing, sniffing people. I have decided that I had rather stay well than worry about what a stranger might think of me. I have also noticed that people will leave all the chairs next to me empty, so that is perfect with me! I have stayed well this year, and I am very thankful. I LOVE face masks! I wish everyone wore them!!

  21. T

    I haven’t worn a mask in public, either to avoid flu or because I was infected, but I have some and I would. (I am fortunate to be able to stay home when I am sick.) However, I learned that holding my breath when someone sneezed, and walking away from him or her before breathing again could reduce the possibility of inhaling the germs. Someone told me that years ago when I was pregnant and wanted to avoid sickness working in an office. I don’t know if it helps but I still do it to this day, just in case, because it makes some sense. I have not had the flu, ever.

  22. Sandy
    Washington State

    In January of this year, I had one of the viruses going around: high fever and malaise for 5 days. I wore a face mask while at the walk-in clinic and at the pharmacy while I picked up medication and the juices and soup needed to sustain me. I hated the masks as they are hot and scratchy, but felt it was a moral duty not to spread my germs while in public. I wish more folks in our country would adopt wearing masks when they are ill and do not stay at home.

  23. Virginia

    Good morning! I am a cancer survivor and take Rituxan every two months. This drug keeps lymphoma at bay but lowered my IgG and IgA and IgM. The drug also prevents an adequate response to the flu shot. I have flown out West 2 times in the last 4 months. I wore a mask on the plane and In the airport and used hand sanitizer often. I am not sick with any respiratory illness at this time and I have been home from my most recent trip for 6 days.

  24. Jane
    North Carolina

    I always wear a surgical mask when I fly. The overhead stream of air helps but a plane with so many people breathing and sneezing can be a breeding ground for colds and flu

  25. Joy

    I believe it is wise to wear a face mask, especially since I have read that flu is caught by breathing air containing the virus. I have also read that a person may be contagious 2 days before they get symptoms so no one knows if they may be spreading the virus.
    I teach piano so I have very close contact with students so I am protecting them also. Since the virus can stay on surfaces for 2 days it is important to wash our hands as well as things that are touched often.

  26. NorthwoodsCynic

    Have you ever WARN a face mask? The correct word here is WORN. Darn those pesky homonyms!

  27. Jenny

    This article is very compelling, as I lay in bed with the flu. I think this will become essential as our population increases.

    • ray

      More people will die of stress and heart failure than the flu. My doctor’s office furnishes a mask to the patients or anyone coming into the office. I just wish more people would cover their mouth and nose when they cough or sneeze.

  28. jim

    I am especially concerned when caregivers have the flu or a cold. I wonder if there have been any studies as to whether it is more effective if the patient or the caregiver wears the mask when the caregiver is the ill person. There seems to be a casual indifference re: caregivers working when ill, and I am sure that has led to many a negative outcome for the person requiring caregiving.

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