As with any bacteria, fungus or virus, the path of least resistance is the most common route of infection. In this disease that could be several routes, oral or nasal inhalation. Even the eyes could be a route of infection since tears drain into the nasal passages, though that has not been considered a likely one except in maybe one particular case.

Masks can decrease the exhalation of the virus from an infected person or a carrier. It also can conceivably decrease the passage of the virus from the air inhaled.

Is it possible to have a civil and unemotional discussion of the issue of masking? I’d like to think so and want to give it a try. By way of background, I’ve been called a “Constitutional Conservative” by friends; I consider myself an independent, espousing a liberal or conservative view depending on the issue. In other words, my thinking and judgment is issue-based and, hopefully, always independent of political bias.

I have firm beliefs concerning the masking issue but I fully recognize that there are other, to me perhaps incomprehensible, points of view. I would like to understand these better. Please help me do that with thoughtful, civil and unemotional responses to my positions.

#1 – Covid-19 is a very large and nasty threat to our personal and national health and welfare: Yes, it is a bigger threat to older folks and those with preexisting health issues but it attacks all ages. It is much worse than the common flu. It makes no sense to downplay the magnitude of the problem. So the first step to an effective national response is for all of us to agree that this is a very serious problem. Some people get hung up on what they consider false statistics, how deaths are categorized, how testing results are published, etc. Can we stop this sideshow, folks, and agree that we’ve got a helluva problem and that we all need to contribute to the solution?

#2 – Mask effectiveness: Some argue that masks are ineffective in filtering out viruses and are therefore useless. Generally true that they can’t trap single, individual virus particles. But the virus isn’t dispersed that way. The biggest threat is viruses attached to droplets of fluids expelled in an infected person’s breath, sneeze or cough. True, recent findings suggest the viruses may also travel in aerosol “clouds” that could be airborne for some time (an aerosol can be loosely defined as a cloud of small particles or droplets whose travel is influenced more by air movement than by gravity). But threat aerosol droplets/particles are still bigger than individual viruses. And speaking of individual viruses, the “viral load” (or viral "dose") is a factor in that it determines the severity of the illness. So, do masks offer perfect protection? No. Do they reduce the risk? Absolutely....

#3 – Masks reduce the probability of an infected person infecting others: This one would seem to be tough to argue against. We know that face coverings can stop droplets expelled with breath air, sneezing and coughing. Many infected people have no symptoms and don’t know they are carriers. Doesn’t it make sense to sacrifice a little of your personal freedom and put up with a little discomfort in order to further the safety of others, including your families and friends? What would be your reasons for not doing it?

#4 – Self-protection - masks reduce the probability of you getting infected: Much has been made of the value of face coverings in reducing the dispersion of coronavirus by infected persons. Not much has been said of the protection against coronavirus provided to the individuals wearing the mask. I’ve seen this denied or downplayed. I don’t understand why. The filtration material works the same way, whether the air stream is going one way or the other. Granted, the dynamics of the filter challenge are different. In preventing the spread of coronavirus by an infected person we are trying to stop the droplets at the source. When considering the self-protection aspect of wearing a mask we may be faced with a somewhat different filter challenge in that our physical position relative to the airborne threat, as well as the size of the droplets, may be different. Mask construction and fit are also issues. But masks will reduce the risk of infection to the wearer. How much? There are too many variables to allow accurate assessment. But for me, even a slight risk reduction (and I believe it is significantly more than “slight”) is worth putting up with the downsides. Isn’t it for you?

#5 – Positive effect of mask-wearing on businesses: We all lament the terrible effect coronavirus has had on small businesses and the economy in general. Nobody wants to see local stores and businesses shut down. I believe that businesses would be helped if everyone wore a mask and acted prudently when in public. Mask-wearing would reduce the overall spread of the virus thus moving faster towards relaxation of closures. But it also could have another positive effect. Many people are reluctant to go anywhere because of fear of infection. With everyone wearing masks there would be less fear and more willingness to support business establishments. Isn't this a positive effect of wearing masks in public?

#6 – “It’s an infringement on my rights”: Some say that universal mask requirements are an encroachment on their rights and freedoms. I don’t understand that. I’m not free to shout “Fire!” in a movie theater, talk about bombs when sitting in an airplane, run around the streets naked or urinate in public. I believe in individualism but gladly give up these rights for the common good. But there is another way to look at this. Why not just wear a mask voluntarily based on the benefits discussed above?

#7 – Denial of service to those not wearing a mask: We’ve seen examples of people getting very upset and aggressive when told they can’t come into a store without a mask. This is another one I don’t understand. Why can’t a store insist on mask-wearing? Do you also object to their restrictions against shoeless and shirtless customers? I understand that some people can’t wear masks (difficulty breathing, etc.). But these are special cases and there should be ways to handle them.

#8 – Mask design and availability: In my opinion we are in a war. The government, under the Defense Production Act, should take steps to ensure availability of quality masks not just for health care providers but for all. There should also be a review of mask designs and some guidelines provided for what constitutes an acceptable mask for the public. Should everyone have an N95 mask? Maybe. The masks should be easily decontaminable for reuse. Necessary research and development should be identified and acted on. Some might say it’s too late for that. But what about the next time?

Folks, it’s not an “all or nothing” situation. The name of the game is risk reduction and we should all do our share….wearing a mask is a big part of that.

As I said, I’m interested in understanding why all the negativism regarding mask-wearing. I would appreciate hearing your reasons if you disagree with any of what I’ve said above . But, please, no politics!

Thank you if you got this far!

I am a podiatrist. I do surgery. I treat infected wounds.

We don't wear a mask in surgery to protect our self. We wear it to protect the patient. That would be a regular surgical tie over the head mask quite similar to the over the ear mask most people have ( the blue or pink ones).

The mask protects us a "bit" but it is significant. It protect the patient from us, the staff and docs, a whole lot.

During infected processes if potentially air borne ( not my specialty) we wear the N95 mask. Often with a regular surgical mask on top of that. A real N95 is fit tested. That mask, the N95, is actually a respirator. It is tight. It hurts. It leaves marks and later bruises and is potentially dangerous for someone with say, severe COPD. In public, a paper over the ear or a fabric mask ( constructed well and properly) is protecting you the wearer a tad, but better than nothing, and the person next to you, significantly. So, if we all wore one we could get the R0 - reproduction rate of SARS-CoV-2 down below one. Meaning each infected person then infects less than one and the curse starts to go down.

Often in the hospital those in the Covid ICU will wear a PAPR , a positive pressure airway helmet. Air is filtered by a unit on your waiste or back and flows under positive pressure around your face and out the bottom of the hood.

Moral of the story? Wear a mask. No violation of your rights. No Civil right violation. In my office if you decline after being asked, you are politely pointed to the door. For a paper or cloth mask, there are exemptions, but medically they are very, very few in number. Inconvenient yep. Nasty hot breath - yep. Safe- yep. End of story about masks.

Oh as a PS. They don't breed bacteria, they don't cause infections (keep them clean and rotate them), they don't stop O2 from getting in, they don't cause a build up of CO2, OSHA did never suggest other wise and all the other excuses I hear. I even read one woman felt she was exempt because her gynecological exam was abnormal ( last I took anatomy that "thang" does not breath - don't think that has changed much) and her chiropractor told her they were dangerous. They aren't dangerous and the chiropractor is catering to her and probably charging her. As a podiatrist I have been asked to write exemptions. Feet don't breath either so no. I don't.