Since the beginning of the COVID-19 outbreak, public health authorities have advised us that masks are not necessary and should not be used by the general public for protection against the rapidly spreading virus.
While it is true that N95s and surgical masks — which have become scarce due to hoarding — should be prioritized for use by medical professionals at greatest risk for infection, the rest of us could and should wear other protective face coverings. There are compelling scientific reasons for this:
Masks work. There is widespread evidence from the field of occupational health, the SARS epidemic, and other outbreaks that wearing masks protects us from germs and interrupts the transmission of disease from sick to healthy people.
Masks are the best way to enforce the “do not touch your face” mantra we are hearing about for COVID-19. The coronavirus, like all respiratory viruses, needs to enter mucous membranes in the nose, throat, and eyes to cause infection. If you can successfully block access to these critical entry points, you will avoid infection by the coronavirus, flu, and any of several hundred other respiratory viruses. Unfortunately, we humans are relatively unique among mammals in that we continuously touch our eyes, noses, and mouths for seemingly no reason every 2.5 minutes. This behavior is hard-wired and starts in utero. Let’s get real — we’re not going to be able to instantly stop doing something we’ve been doing our whole lives.
So what’s the answer? Cover your face with a mask. This will deny you access to your own face and make you conscious of how often you are tempted to touch your nose and mouth. A nonmedical mask will not protect you from a direct cough or sneeze from an infected person, but if you’re practicing good social distancing, any type of face covering is great protection from your biggest threat: your own hands.
Wearing masks is a powerful signal to others that these are not normal times, and that we all need to change our behaviors to stop a potentially devastating epidemic. Wearing a mask for the first time can be deeply uncomfortable, especially when others are not doing the same. We felt strange at first, but after a few days, we’ve become proud rather than embarrassed to wear a mask outside. If more people donned masks, it would become a social norm as well as a public health good. If we can stop handshaking to fight COVID-19, we can also end mask stigma.
Asian countries that have been successful in containing the virus without locking down society, such as Hong Kong, Singapore, and Taiwan, routinely use masks. As of March 17, the three countries together had fewer than 1,000 cases of the coronavirus — despite having close connections to China’s Hubei province, where the epidemic originated and exploded late last year. There are many explanations for this success, including the rapid recognition of the threat, swift application of lessons learned during the 2002 SARS outbreak, and widespread testing and strict isolation of confirmed cases. But masks are also used routinely for protection against infectious diseases in these countries, and universal mask use is part of their coronavirus guidance. In Taiwan, masks are such an important first line of defense that artificial intelligence is used to create live maps of local supplies of face masks so that citizens know where to get them.
So what needs to be done here in the United States? Cover your face. Nonmedical masks should be worn by everyone going outside. Inexpensive cloth masks are available for purchase online. Alternatively, scarves, bandana-style neck gaiters, and other similar face coverings can work effectively. Masks should be placed over the mouth and nose and removed carefully, without touching the outside surface, and cloth masks should be washed frequently.
We must also encourage others to cover their faces too. We need to change our perception that masks are only for sick people and that it’s weird or shameful to wear one. Instead, donning a mask needs to be seen as a responsible action to protect the wearer’s health and the health of those in close proximity to her. If our political leaders and cultural influencers put on masks, we could change our social attitudes and norms rapidly.
This will not be easy. Adding further instructions on top of everything we are being asked to do to stop COVID-19 could lead to overload and fatigue. However, handwashing, social distancing, and doing your best not to touch your face are not enough to stop the coronavirus. For the health of your neighbor and yourself, wear a mask.
Shan Soe-Lin is managing director of the Boston-based Pharos Global Health Advisors and a lecturer in global health at the Jackson Institute for Global Affairs at Yale University. Robert Hecht is the president of Pharos Global Health Advisors and a clinical professor of epidemiology at the Yale School of Public Health.
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