Buzz
Last week, the World Health Organization unveiled new guidance on masks, prompting yet another round of complaints about how “they” keep changing their stance. Initially, the WHO did not advise healthy individuals to wear masks; now, they recommend that people over 60 and those with underlying health conditions should wear masks when distancing is not feasible. They also suggest that local authorities may wish to recommend masks for everyone, but ultimately leave this decision up to local officials.
Throughout the pandemic, mask-related messaging—including who should wear them and what types—has appeared contradictory. However, many of the key points have remained consistent.
What has changed, however, is our understanding of which facts are most significant, and how the potential harms and risks weigh against the benefits. For example, on February 7, we published a post urging people to stop buying coronavirus masks you don’t need. This was another recommendation from the World Health Organization, echoed by various public health organizations. While the message remains valid, the focus on what’s most important has shifted.
Back then, there were just 12 confirmed cases of the coronavirus in the entire United States. Unless you were one of those cases (or had close contact with someone who was), the general belief was that it was very unlikely you had already been infected. At the same time, medical masks were in short supply across the globe. Do you remember the chaos with toilet paper? The priority was to prevent panic buying. Given the low number of cases in only a few cities, it was true that the majority of people didn’t need masks.
What has changed since then? Primarily, these things:
Community spread
Initially, testing was not sufficient to track the virus's true spread. In early 2020, to get a test, you had to be a contact of someone infected or highly suspected to be infected, meaning that community spread could not be detected. That was a mistake. And when we realized this, the lack of testing became another significant failure. By the time we understood the extent of community spread, it was too late to trace every case and their contacts.
With community spread going unchecked, it became impossible to assure people that they were unlikely to come across the virus in everyday situations. We just didn’t know.
It took some time to understand that people could transmit the virus without showing any symptoms. While experts still debate how common asymptomatic (or presymptomatic) transmission is, we now know that it can occur. A key reason for wearing masks is that they prevent you from unknowingly spreading the virus you may be carrying.
Availability of masks
There has been, and continues to be, a shortage of personal protective equipment for healthcare workers. If anyone needs masks during a pandemic, it's them. Healthcare workers interact with individuals who have (or might have) COVID-19, and they can transmit it to others. For their own safety, and the well-being of patients and the community, it makes sense to prioritize healthcare workers.
That’s why, during a March 8 interview, Dr. Anthony Fauci stated, 'Right now, in the United States, people should not be walking around with masks.' In the clip, he adds that wearing a mask isn’t harmful, but 'it’s not providing the perfect protection people think it is,' and that widespread mask use could contribute to the ongoing shortage.
That statement was accurate then, and it remains true today. Mask skeptics have circulated this clip ever since, either to suggest that masks aren’t currently recommended (by hiding the fact that the clip is outdated) or to paint Fauci and the CDC as hypocrites. However, the fundamental facts haven’t changed.
Fabric masks shifted the balance
If medical masks aren’t available, are fabric masks good enough? That’s the question that policy makers and public health organizations debated for weeks.
There’s still not a clear answer. Fabric masks are not as good as medical masks, but they probably still provide some protection. Is a society better off, overall, when mask wearing is common? That’s also still unclear. Probably fewer people are breathing out droplets of virus. Probably people aren’t making the situation too much worse by touching their masks and by getting too close to others under the mistaken belief that masks protect them.
As much as we’d like all our decisions to be based in science, this one is still a judgment call. One fortunate change is that we turned out to be capable of making and distributing a huge number of fabric masks. People who sew made masks for themselves and friends; clothing companies started churning them out. Pretty soon it wasn’t too hard to get a mask, and not too onerous to expect people to be able to obtain them.
Here’s what hasn’t changed
Throughout this entire timeline, a few things have remained consistent and still hold true:
Both fabric and surgical masks serve best as a form of source control (on the infected person), rather than offering protection from others.
Fabric masks are less effective than surgical masks.
There continues to be a shortage of surgical masks and respirators (N95s), so unless you're a healthcare worker, it's probably better to use fabric masks.
Masks aren't a flawless defense, and should be considered as part of a larger strategy that includes distancing and other protective measures.
So even with the shifting guidelines, the key principles remain unchanged. Stay home if you're sick, and maintain distance from others as much as possible. Given the current situation, wearing a fabric mask when you can't keep distance from others is a sensible choice. And if the guidelines change once more, don’t be too shocked. We should anticipate changes as we gather more information and as the situation evolves.
