Advice re masks for COVID-19 muddled, misleading

Medical Doctor Virus Coronavirus Mask
cdd20 / Pixabay

Let’s face it. The U.S. government isn’t exactly batting 1.000 when it comes to addressing the COVID-19 pandemic. Trump Administration and CDC missteps led to costly delays in coronavirus testing that cost us a month in efforts to track down and contain the spread of COVID-19. The US has tested over about as many people for the virus over the last two months as South Korea is testing every single day. Another step the government has taken which could be harmful is the confusing and misleading advice regarding the use of masks for COVID-19.

Masks for COVID-19 not recommended?

The CDC website as of 3/15/20 says: “CDC does NOT currently recommend the general public use facemasks. Instead, CDC recommends following everyday preventive actions, such as washing your hands, covering your cough, and staying home when you are sick.” The World Health Organization recommends against using masks for COVID-19 except in situations that they specifically mention, such as healthcare facilities. And Surgeon General Dr. Jerome Adams elevated the rhetoric to all caps when he tweeted, “Seriously people,” he begins, “STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

When you think about it, the Surgeon General’s words don’t seem to stand up to logic. How is it that masks will not protect the general public but WILL protect healthcare workers?

It should also be pointed out that the Surgeon General has taken policy positions and said things that raise questions as to whether he truly has his finger on the pulse of citizens under his care. He said on March 8 that he didn’t know of any public health doctor who has asked for a test being unable to get a test, despite widespread evidence that Americans wanting to be tested for the virus—including those at high risk– are unable to do so. While Adams served as Indiana State Health Commissioner under Governor Mike Pence—now Vice President—he and Pence delayed providing a clean needle exchange program to drug users in an opioid epidemic even though HIV cases were mounting. Adams has said that while he shared Pence’s concerns about needle exchange programs, he came around and persuaded the governor to change his mind about that.

But actually, there’s a little bit of a kernel of truth to what the Surgeon General says. Part of it is that the earloop surgical masks often seen at hospitals do very little to protect the wearer from germs but will help keep the wearer’s germs from spreading. The reason is that these masks don’t seal well, but do a good job of block water droplets in which viruses travel. Also, N95 masks often require training and fitting procedures, because if they are used incorrectly, they will not be effective.

Nevertheless, there are still problems with his statement. A vlogger going by the name Canadian Prepper made the valid point that suppliers of masks to the healthcare industry already prioritize medical facilities over individuals. I did witness this practice firsthand during the 2009 H1N1 pandemic when I tried to order a case of N95 masks for members of my co-op house from such a supplier. I eventually received them—nine months after the fact and long after the worries about H1N1 had mostly subsided.

Yes there’s been a run on masks. Many of them have been bought by people trying to make money by buying them up and selling them at higher prices. Amazon, eBay, and other online sellers have cracked down on this. And while the vlogger Canadian Prepper has said that the N95 masks available in hardware stores are not used in hospital setting, it is true that they have affected construction workers and others who need masks to protect their health.

And the video below is testimony from an American who has taken to wearing masks despite the CDC’s advice, and she explains why.

The British medical journal The Lancet, criticized WHO’s position limiting the use of masks for COVID-19. They cited instances where most of the public wearing masks were helpful in stemming spread of the disease, and said, “If everyone puts on a mask in public places, it would help to remove stigmatisation that has hitherto discouraged masking of symptomatic patients in many places. Masking, as a public health intervention, would probably intercept the transmission link and prevent these apparently healthy infectious sources.”

They added, “Cloth masks were used by surgeons successfully during operations before disposable masks were available. In real life, most people in all seriously affected areas are reusing their disposable masks. All governments must prepare to handle the probable mass panic and explore other sustainable alternatives to the disposable masks for effective source control in community settings.”

No advice for high-risk people who still must work

Canadian Prepper also points out something that I, as a taxicab driver has also observed: The CDC has NO advice for people who are at higher risk for complications from the virus, yet do not have paid sick days. I am one of them. We are given the stark choice of either taking days off we cannot afford or putting at ourselves at risk of catching the virus.

While I’ve pointed out that there’s a kernel of truth about masks for COVID-19 not being effective, there are peer-reviewed studies that contradict the Surgeon General’s statement most significantly by Aiello at the University of Michigan in 2010 and 2012. Professor Raina MacIntyre, who heads the Biosecurity Program at the University of New South Wales in Australia, has noted that regulations regarding whether someone should wear a mask or a respirator have been remarkably inconsistent within the World Health Organization. This resulted in what she described as a game of “Russian roulette” with healthcare workers treating Ebola. MacIntyre has more recently said that viruses can travel well beyond the six feet social distancing recommended by health authorities.

So what is someone to do if they have a high risk for complications from COVID-19 but doesn’t have sick days or can’t afford to take unpaid sick days?

So what’s the correct advice?

The government’s motivation with its mask advice—as closely as I can discern—is based on the fact that 1) there is a shortage of masks, and 2) mentioning masks as an option—even with the caveat that they are not 100% effective—might motivate people to take chances they shouldn’t take. Certainly just staying at home is a more effective option, especially if they live by themselves.

But a lot of us can’t afford to take unpaid sick days (and a number of employers won’t let people do so anyway). In such cases, is it really appropriate to shut the door on something that will increase the chances of avoiding the virus? What hurts people more? Not mentioning the option of wearing a mask in the hope that people will stay home instead? Or mentioning the mask option so that people have yet another–if imperfect–tool to avoid the virus?

Honestly, I think the mask/no mask question is parallel to the question as to whether sex education that mentions contraception or abstinence-only sex education works better. (And it’s not just because both masks and birth control are both considered prophylactics.) Studies show that teen pregnancy rates are higher with abstinence only education.

Just as there will always be teenagers engaging in sexual behavior, there will always be people wearing masks during a pandemic. Government officials might do whatever they can to get people to abstain from leaving the house, but people will do so anyway and many will have no choice.

I should also note that the mask shortage is in large part due to the fact that so many companies have moved their production work overseas—particularly to China. According to Prestige Ameritech—one of the few mask remaining mask manufacturers with factories in the US—nine out of ten masks used by health care workers are made outside the US. Around 2005, a number of mask manufacturers—including Kimberly-Clark—moved their mask manufacturing plants overseas. Mike Bowen, executive vice-president of Prestige Ameritech, said, “The surgical mask supply went from being 90% U.S.-made to being 95% foreign-made in literally one year.” He had seen what the risk to the country might be if an epidemic or pandemic broke out, and tried to alert Presidents Obama and Trump about it.

There may be value in The Lancet’s strong recommendation (worded, really, as a directive), that alternatives to disposable masks be found. Many of the mask manufacturers listed on this website make masks that offer at least some protection against viruses, though many manufacturers, for liability reasons, include a disclaimer saying that their product doesn’t specifically protect against the coronavirus. But then again, that’s really true of all masks.

I will point to my own disclaimer saying that this blog doesn’t give medical advice and recommends consulting with a doctor before incorporating a mask into a health routine. Masks should not be used as a substitute for social distancing or isolation. But that doesn’t mean they won’t help, and the government needs to clarify that.