How do people catch the coronavirus? You would think that after six months there would be scientific consensus for this most fundamental question. And yet people are still arguing about aerosols vs. droplets. And there is still a huge fight over face masks. How well do they work to protect people from COVID-19? There is a surprising paucity of data. But a study published in JAMA (July 14, 2020) suggests that face masks can make a difference.
The Fight over Face Masks Gets Ugly:
Have you seen a fight over face masks on the news or on YouTube? This week there was a stabbing and a resulting shooting in Michigan. A man died as a result. Here is the UPI story:
“July 14 (UPI) — An argument over wearing face masks at a convenience store in Michigan led to a 77-year-old man being stabbed and his suspected attacker being shot to death by police Tuesday, state police said.
“The altercation happened around 6:45 a.m., when 43-year-old Sean Ernest Ruis entered the Quality Dairy store in Windsor Township without wearing a mask. The 77-year-old man, whose identity wasn’t revealed, confronted the man about wearing a mask, which was required by an order signed by Gov. Gretchen Whitmer.
“The argument continued outside the store, where Ruis allegedly stabbed the 77-year-old man before fleeing. The older man was hospitalized in stable condition.
“An Eaton County sheriff’s deputy tracked Ruis down in a neighboring town around 7:15 a.m. and pulled over his vehicle. Surveillance footage, which is graphic in nature, appears to show Ruis exiting his vehicle before lunging toward the deputy, who opened fire. Ruis falls to the ground after several gunshots.”
This is not the first time someone has died because of a fight over face masks. There was another killing in Michigan and one in Gardena, California. We won’t get into the reasons so many people are fighting. That has to do with factors outside our area of expertise. We will comment on the scientific research, though.
Confusion Over Face Masks:
Public health officials were slow to recommend face coverings for the general public. Here is an article we wrote about the Surgeon General’s flip-flop on face masks:
Should You Wear A Face Mask Every Time You Go Out?
Have you been out lately? If so, you have probably noticed that some people are being careful. But many others do not wear a face mask. How risky is that?
Despite the slow start, public health officials from the CDC and WHO are encouraging the folks to wear face masks whenever people are out in public. A lot of people are still resistant. The fight over masks is pitting governors against mayors and county commissioners. This week the Governor of Georgia banned municipalities and counties from requiring face masks. In our opinion, this kind of political wrangling is sure to confuse the public even more.
What About the Science?
A research letter published in JAMA (July 14, 2020) tracked the rate of positive tests for SARS-CoV-2 among health care workers in MGB (Mass General Brigham), a big hospital system in Boston. The trend was rising steeply starting at the beginning of March.
Then the hospital system required all health care workers to wear surgical masks at work, starting March 25. It wasn’t until patients were also required to wear surgical masks, starting April 6, that the rate of positive coronavirus tests clearly began dropping.
The researchers conclude:
“Universal masking at MGB was associated with a significantly lower rate of SARS-CoV-2 positivity among HCWs [health care workers]…these results support universal masking as part of a multipronged infection reduction strategy in health care settings.”
The authors admit that this is not the final word on face masks. They also point out that:
“Randomized trials of universal masking of HCWs during a pandemic are likely not feasible.”
We would add that it is virtually impossible to prove beyond a shadow of a doubt that wearing a mask will prevent all COVID-19 transmissions. We suspect, though, that if you had to have surgery you would want the surgeon and nurses in the operating room to wear face masks.
Is there a randomized, double-blind, placebo-controlled trial to prove that surgical masks prevent patients from getting infections? Perhaps such studies have been done, but I’ll bet you would prefer not to volunteer to be in the placebo-arm of such a study.
Outside of health care settings, organizations ranging from Walmart to the French Republic are now requiring face masks for everyone, particularly in stores. Starbucks, Best Buy, CVS, Costco and Publix also require shoppers to cover their faces. Experts hope that this will help slow the progress of the pandemic.
Will face masks work to slow the spread of COVID-19? Only time will tell. People in China, Taiwan, Thailand, Singapore, Japan and South Korea do not fight over face masks. In fact, if you go outside in those countries without a face mask you are likely to get a frown and potentially an unpleasant comment. BBC News (May 12, 2020) reports:
“Yet in some parts of Asia everyone wears a mask by default – it is seen as safer and more considerate.
“People who do not wear masks in these places have also been stigmatised, to the point that they are shunned and blocked from shops and buildings.”
Of course, the culture is quite different in the United States and parts of Europe. We find it odd that Americans were willing to wear face masks during the 1918 pandemic but many refuse to do so in 2020. Here are some photos from 1918.
During that pandemic the Red Cross put out a public service announcement that stated:
“the man or woman or child who will not wear a mask now is a dangerous slacker.”
The masks of 1918 might have been pretty ineffective. But most western cities like Denver, San Francisco and Seattle mandated them. People who were “mask slackers” were fined, shamed by having their names printed in newspapers and even sent to prison.
The 1918-1919 flu pandemic killed tens of millions of people around the world. It is estimated that about 675,000 Americans died. Let’s hope that we do not approach that number this time around. Will face masks solve our problem? Not likely, but when they are part of a comprehensive public health program, we expect face masks can make a difference.
Share your own thoughts about the fight over face masks in the comment section below.