John_F Loc: Minneapolis, MN

There has been plenty of debate about wearing masks to help prevent the spread of coronavirus. And with good reason. At the start of this pandemic, we didn’t really have much scientific evidence. And what little evidence we had involved other diseases, like the flu, which can’t be applied to the COVID-19 virus, SARS-CoV-2 or Coronavirus.

When this all got really bad, I was in Peru, desperately trying to get home the day before that country shut its airports. I was traveling with a handful of other doctors, and none of us wore masks. We were sure that anything other than an N95 was pointless.

But I was wrong. We were wrong. The WHO is STILL thinking wrong. Because we were thinking backward. We were thinking of how to avoid getting it. But we should have been thinking about how to avoid spreading it.

Because yes, if an infected person coughs in your face, you are likely to get infected unless wearing an N95 and face shield. But a simple cloth face mask turns out to be remarkably effective at keeping someone’s germs to themselves, especially during the presymptomatic phase of the disease.

I’m not here to force you to wear a mask, or to call you stupid for not wearing one. I’m just here to show you the evidence that changed my mind. I hope you come to the same conclusion as I did: We don’t have to choose between killing the economy or killing people. With simple face masks in addition to hand washing we can eliminate the virus, reopen the economy, and save thousands of lives all at the same time.

THE TRUTH ABOUT MASKS

The truth is that coronavirus is largely spread by respiratory droplets. And homemade masks can block the majority of those droplets. “Healthy” people infect just as many people as sick ones. And places like Austria saw a 90% drop in COVID infection within two weeks of mandating masks. So all of us should be wearing masks. But please don’t take my word for it. I’ve been wrong before, I’ll be wrong again. Instead, look at all the evidence below.

CLOTH MASKS BLOCK THE PRIMARY MODE OF CORONAVIRUS TRANSMISSION

First of all, we needed to realize exactly how coronavirus spreads. This is primarily through respiratory droplets which are about 5-10 microns in diameter. Studies tracing the outbreaks in China show that the transmission mode was primarily through these larger droplets. https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations

Still we can’t rule out transmission through aerosols (droplets smaller than 5 microns). But, fortunately cloth masks can block both droplets and aerosols.

A study from Wake Forest (in publication) shows that home-made masks can block almost all droplets, including aerosols. The better the material, the more droplets they block. The best masks are made with two layers of batik quilting fabric, or else cotton backed with flannel. These block even more droplets than a standard surgical mask, like the one I’m wearing in the photo on this post. https://newsroom.wakehealth.edu/News-Releases/2020/04/Testing-Shows-Type-of-Cloth-Used-in-Homemade-Masks-Makes-a-Difference

Other studies have shown that unfitted surgical masks can drastically reduce the spread of the seasonal human coronavirus, a much less virulent cousin that causes mild colds. This study shows that even if aerosols and droplets emerge through the mask, they seem to have been filtered of all coronavirus RNA. https://www.nature.com/articles/s41591-020-0843-2#Tab1

The following video demonstrates the effect on a scale we can see. These droplets are bigger than the ones we’ve talked about so far. I use it only to help visualize what the other studies show on the microscopic scale.
https://m.youtube.com/watch?v=UNHgQq0BGLI&time_continue=19&feature=emb_title

And its important to remember, that you have to inhale a certain number of live viruses to actually catch the disease. That exact number isn’t known for COVID. But 1000 is the best guess of virologists. You may think “who cares if the mask blocks most virus? All it takes is one and I get sick.” But that’s not correct.
https://www.sciencemediacentre.org/expert-reaction-to-questions-about-covid-19-and-viral-load/

Blocking most of the virus droplets means the people around you are unlikely to inhale enough to get infected. This is also why being outside is safer than in an enclosed area; the wind spreads your droplets around and people nearby are less likely to get hit with enough live virus to cause an infection https://www.vox.com/future-perfect/2020/4/24/21233226/coronavirus-runners-cyclists-airborne-infectious-dose

WHY HEALTHY PEOPLE SHOULD WEAR A MASK

This is a frequent topic of debate. Why should healthy people be made to wear a mask? Well there is one major problem: up to half of those infected with COVID don’t know it, but can still spread it. So you can’t really know whether you are truly healthy. It’s an assumption of health, and it’s often incorrect.

In fact numerous studies have found that roughly half of COVID infections are transmitted between people before they know they are sick. (These are in process but so is the pandemic.) https://www.nature.com/articles/s41591-020-0869-5

https://www.medrxiv.org/content/10.1101/2020.03.05.20031815v1

This asymptomatic transmission is what accounts for people developing infections after lockdowns and quarantines are instituted.
https://www.medrxiv.org/content/10.1101/2020.04.17.20053157v1

MASKS WILL STOP THE SPREAD OF THE VIRUS

Using all of these numbers, new models predict a vast drop in COVID cases with the universal use of face masks. (I know models have been wildly inaccurate, but stick with me just a bit more.) Some actually show it to be far more effective than the economic shutdown we have been going through. In fact they give us hope that with only 70% of the population wearing masks we could extinguish this disease before a vaccine is ever developed. That’s something we can all be happy about.
https://arxiv.org/abs/2003.07353

https://news.cgtn.com/news/2020-05-09/AI-modeling-shows-mask-effective-in-COVID-19-prevention-QmaVnIJYaI/index.html

https://www.medrxiv.org/content/medrxiv/early/2020/05/15/2020.05.09.20096644.full.pdf

BUT DOES IT WORK IN REAL LIFE?

Like I said, the last few months have been full of models and predictions whipsawing from one extreme to another. And there are valid concerns that average people don’t know how to use masks or that masks might give us too much confidence, leading to unsafe behavior. But we can look to real-life examples to provide evidence of the effectiveness of masks. And that shows us that masks can be incredibly effective.

Let’s talk about Japan (we’ve had 10 times their number of cases despite only being 2.5 times as large.) They’ve had no lockdown and closed no stores, but everyone wears masks. And they’ve had days with no new cases reported. But there could certainly be other reasons for their low case levels, such as total testing and differences in reporting. Besides, you could argue that their culture is used to wearing masks and would use them more effectively.

So instead let's look at Austria, a country with no previous culture of face mask wearing. They made masks mandatory in public starting April 6. Two weeks later, infections had dropped by 90%.https://www.sciencetimes.com/articles/25410/20200421/austria-90-drop-coronavirus-cases-requiring-people-wear-face-masks.htm

Let’s look at the Czech Republic. They required facemasks in mid March. Within three days, the people produced enough masks at home for every man, woman and child, all 10 million. Coupled with their social distancing, this has kept the total cases in Czech Republic to one of the lowest in Europe, with only 50 deaths. https://www.usatoday.com/story/opinion/2020/04/04/czech-government-implemented-face-mask-requirement-help-combat-coronavirus-column/2940393001/

Similarly, Slovakia, the second country in Europe to implement facemask use has had some of the lowest cases and deaths in Europe. https://www.euractiv.com/section/coronavirus/opinion/facemasks-against-covid-19-why-slovakia-became-the-trailblazer/

And finally let's look to America. What happens when a hot zone institutes face mask policies? Well Brigham and Women’s Hospital in Boston instituted universal masking of patients and staff, the rate of staff COVID infections dropped by 50%. https://www.wbur.org/commonhealth/2020/04/23/brigham-and-womens-masks-infections

Other than that, it’s hard to say. Our testing rates are low, case reporting and compiling vary significantly from state to state, and most states only require employees to wear masks when in contact with customers. We really don’t have reliable data from which to draw conclusions.

WHY NOT JUST MASK THOSE AT HIGH RISK?

While this seems like a reasonable and simpler solution at first, it is logistically impossible. Most elderly people here live in multigenerational homes and can't afford to live on their own. Even if they stay home, their families will bring COVID home to roost.

And if we were to round them all up and put them in some sort of protective housing, well that too would be an enormous violation of civil rights. Plus putting many high risk individuals together just means that when a care worker at this facility eventually infects somebody, we will have just set up a slaughterhouse and made the disease that much more likely to kill them all.

Plus you have the final piece in this puzzle. Unfortunately it's another one that puts egg on the face of the medical community and our assumptions. It turns out that wearing an N95 mask is maybe not the best way to keep yourself from getting sick. Having the infected person wear the mask is. In a study published (and largely overlooked) in 2013 in the Journal of Aerosol Medicine and Pulmonary Drug Delivery, it was shown that even a simple surgical mask on a source of aerosol was better at preventing exposure than an N95 on the “healthy subject.” https://www.liebertpub.com/doi/10.1089/jamp.2012.0998

This is why the motto in Czech Republic is “My mask protects you, your mask protects me.”

WHY WE SHOULD ALL BE WEARING MASKS

Putting it all together, we should definitely all be wearing masks as much as possible in public. Especially situations with high risk of transmission (office buildings, restaurants, parties, bars, nightclubs, public transit, gyms, and religious services). For more info on that, please read this incredibly informative article by Dr. Erin Bromage at Dartmouth https://www.erinbromage.com/post/the-risks-know-them-avoid-them

I’ll be the first to admit that the medical profession is playing catch up here. And the inconsistent, conflicting messages have been very confusing. Hell, I’m contradicting the WHO! But I think the evidence is solid. And so do others:

Face Masks Against COVID-19: An Evidence Based Review https://www.preprints.org/manuscript/202004.0203/v1

CAN’T WE JUST GET IT OVER WITH?

I know I sometimes think “I’d rather just catch this virus, get it over with and get back to normal life.” I’m sure many of you do too. Some think that risking infection is their duty to return the country to normal. But that’s letting the virus win.

Patriots make sacrifices, sure. But not senseless ones. And risking infection is an unnecessary sacrifice because wearing a mask, washing your hands, and keeping 6 feet away is the only sacrifice you have to make. (Well, that and getting your brain tickled by the COVID nasal swab if you have symptoms.)

I hope you come to the same conclusion I did. I hope we can all agree to make these accommodations. For so long, it has seemed like we would have to choose between our people and our economy. But with this new information, for the first time in a long time, I’m hopeful we can save both.

Stay safe my friends

davesit Loc: Media, PA

Well said.

Nicholas DeSciose

Thank you so much for this information. It means a great deal. I’ve always wondered why UHH hasn’t been more proactive concerning the virus?

Mama Bear984 Loc: Langley, BC Canada

John I live just outside Vancouver, BC, Canada. When this started to get our attention here was in December. The Asian people were running from store to store buying up every mask & bottle of sanitizer. I worked the health area of a major grocery chain up here. We thought they were nuts.then They we’re getting them for themselves & send the rest back to China. They already knew all hell was breaking there. In January we were hearing reports but ignored the, until February here when we knew things were getting bad. Then mid March when the WHO called it world wide pandemic. We started wearing masks back in late February it started slow but we now know it was effective in our province. We have had 2800 people infected, 2200 recovered & 167 deaths. Only 4 in ICU this week, & 20 in hospital the rest are at home in quarantine. We have a fabulous BC Health Province team with daily reports os things we need to know.
We have right from the beginning in late March we’re already social distancing in my store as employees then our company stated to all customers this is how it’s done. We learned the other day that our country had been doing genome tracking of the tested cases of where the virus came from. I could have bet money all ours came from China, nope, as we are a gateway to them with flights.
We has a few cases in early February, we got a bunch from Iran late February & that go into our seniors homes. The rest came from eastern Canada/Europe virus. That’s what caused most of our problems mid-March. 96% of our deaths here are from senior homes. We locked them down & they still are. We wear masks almost everywhere. And we also learned that because of the Asians masking up I. The very beginning we were saved from the worst of it. They were right wear them, they always have. So anyone who says you are wrong should look at our numbers. We has one death this week just one for the whole Province.
Ontario & Quebec are still battling it, they got a bad infections from people returning from Florida spring break & incoming vacationing from Europe. But they are on the down swing.
We are all very concerned by the wave after wave that is going through your country of deaths & numbers running so high. We have closed our boarders to you it’s a month by month. We see the ignorance that people have regarding this bug. This is not a god given right to do what they want, an economic, right or a constitutional right, it’s a fight for your life right.
We will likely keep our boarders closed until end of summer we don’t need vacationers coming up here & not following our directions. We have a 14 day quarantine here, a few Americans have crossed in Alberta saying they are driving to Alaska. They lied & we’re vacationing in Banff, no masks, no social distancing. The police were called & they sit on a camp site away from everyone else for 14 days, their pissed. Well you lied to us, you came here to vacation. We don’t know if you are infected or not so there you sit, or we escort you to the boarder & go home. They drove all the way from Texas.
Stay safe.

TriX Loc: Raleigh, NC

👍👍👍👍👍👍👍 Spot on. I cannot for the life of me understand why it’s such an inconvenience. The primary resistance seems to be “it’s my ??? Amendment right to do as I please, and no one has the right to tell me what to do”. Here in N.C., which has one of the highest percentage of new hospitalizations for Covid-19 of any state and every other metric is going straight up, one of our local 1/2 mile dirt tracks defied the executive order, packed 4,000 fans, shoulder to shoulder in the crowds, in lines and in the stands. To make it worse, they actually had a sign stating “no masks allowed”, and styled the whole (money making) exercise as a protest against government overreach. The state health department finally closed them down, but not until this had occurred several times. I know all these people are invulnerable, but don’t any of them have parents or grandparents?

And now it’s being called playing politics (because we have a Democratic governor) when the the state rightfully told the RNC that if they wanted to hold the Republican convention in Charlotte (whose cases are currently skyrocketing), they’d need to wear masks and submit a plan for some reasonable distancing if they wanted to use the Charlotte coliseum. Their plan was to pack 19,000 people, shoulder to shoulder, in the coliseum without masks, and when this was rejected by the state health officials, the convention was moved to Jacksonville FL rather than devise a plan to prevent a widespread outbreak (with those and the other expected 20,000 attendees taking the virus back to their states and their communities). Yes, it cost the state and businesses who needed it badly many tens of millions of $, but what would have been the cost to the state if many thousands of new cases had occurred, and the state had to revert to stage 1 where most business would be forced to close again. Why is any of this so hard to understand?

Mama Bear984 Loc: Langley, BC Canada

Well I guess when the bug burns through all the stupid people killing them off, you will be ok.
I’m sorry that everything down there always boils down to a political debate.
We watch in horror seeing what happening. I don’t know you or your views on politics but you have no leadership. I’m sorry.

IDguy Loc: Idaho

The only thing about that I’d like to know is why it took the Republicans so long to move on. Perhaps they saw value in influencing State election results.

I’m sure your characterizations of the Republicans demands are false and they plan to take many steps to ensure the safety of convention attendees. Why make up or repeat such lies?

“The RNC said it has plans to implement temperature checks, testing before and during the convention, making masks available and providing enhanced sanitation of public areas.”

TriX Loc: Raleigh, NC

Since you don’t live in N.C., you don’t know what the hell you are talking about. Would you like me to post the actual newspaper articles, or will you just label those as “media lies”? My comment had nothing to do with politics except to name the party of those involved. It’s your kind of decisive partisanship that is a big part of the problem, not the solution. Now go reread the RNC posts as to how the plan was for 19,000 UNMASKED participants in the coliseum, and then come back and tell me the information is a lie.

IDguy Loc: Idaho

“The RNC said it has plans to implement temperature checks, testing before and during the convention, making masks available and providing enhanced sanitation of public areas.”

You are correct that I will not be impressed by fake media reporting.

TriX Loc: Raleigh, NC

I guess you are conveniently ignoring that President Trump specifically wanted a full convention WITHOUT face coverings. Do you deny that?

I understand your traditionally contrarian view to anything posted, but are you seriously contending that 19000 people, shoulder to shoulder in a coliseum, even with optional face coverings (against the president’s stated wishes for no face coverings) is safe in the current climate? If you genuinely believe that, instead of just taking a position which focuses on politics and divisiveness instead of medicine, then you should be booking a plane ticket to Jacksonville. So are you willing to walk what you talk?

IDguy Loc: Idaho

Here is the full quote from the RNC letter:

“ We are asking for your approval on the following safety protocols:
Pre-travel health surveys through our partnership with local health care providers
Daily health care questionnaires delivered via an app
Thermal scans of all mandatory attendees prior to boarding sanitized, pre-arranged transportation
Anti-bacterial gel wilf be widely available
Aggressive sanitizing protocol for all public areas
Our planned transportation buses will be dropped off at the Charlotte
Convention Center which will act as a mandatory hub for a final health care screening by health care officials
All attendees would have to pass a clean health check prior to entering the dedicated chute to the Spectrum Arena — where all attendees would then be processed through normal United States Secret Service screening with normal event queue
Media suites and hospitality areas will be subject to food service guidelines similar to any other restaurant
With your approval on those proposed safety protocols, and in addition to Secret Service requirements, we will then work with all the stakeholders and principals to execute a detailed plan to secure our shared goal of a safe and secure convention.”

I feel sorry for those who let themselves be brainwashed by the fake media.

TriX Loc: Raleigh, NC

Let’s take a look at this. Since it’s pretty well established that asymptomatic people can pass the virus, do you think that getting temperatures taken and filling out a survey (when the attendee has no idea whether they are infected or not) is adequate “screening’ to protect against 19,000 untested people in an enclosed space? Come on, give us your qualified medical opinion....

The state of NC currently has rules in place preventing gatherings of more than 25 people, whether you agree or not. Nothing political about this - medical necessity considering cases are spiking here. So do you think 19,000 is larger than 25 or not? Come on - quit trying to make this pandemic a political issue - it’s a medical problem! How hard is that to understand? There’s no “fake media” here, just medical facts, and I feel sorry for anyone who can’t understand that. You are part of the problem...

phlash46 Loc: Westchester County, New York

I don't see anything about masks, mandatory or not; nor is it possible to have any significant distance among 19,000 people in that arena (I've been there). You are spreading bullwhompy; shame on you.

JohnSwanda Loc: San Francisco

Very well researched. Can you debunk the notion from the anti-maskers that wearing a mask is unhealthy or can cause disease?

IDguy Loc: Idaho

Sorry, but it is entirely political. The Governor wanted the ability to trash the convention. Covid gave him excuse.

The only thing I don’t get is why the Republicans took so long to get out of Dodge once they saw what he was up to.