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Should we all be wearing masks? The discussion is underway

A man wearing a protective mask seated in a subway car in Moscow on Tuesday.
A man wearing a protective mask seated in a subway car in Moscow on Tuesday.KIRILL KUDRYAVTSEV/AFP via Getty Images

Are we all going to be wearing masks soon?

Up to now, the advice has been not to wear a mask unless you’re sick or taking care of someone who is sick.

But there’s growing discussion, as the coronavirus epidemic grows, about whether everyone should wear masks in public — and there are reports that federal officials could soon recommend that everyone cover up with homemade ones.

The Washington Post reported Monday night that officials at the US Centers for Disease Control and Prevention are considering the recommendation.

William Hanage, a professor of epidemiology at the Harvard University T.H. Chan School of Public Health, said Tuesday in a telephone news conference his views are in “something of a state of flux.”

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He said experts have usually taken the view that masks are not effective and potentially risky and, in the current circumstances, they should be conserved for health care personnel.

But if there were enough masks to go around, they could “serve an important role,” he said. That role, he emphasized, would be not to prevent the mask wearer from inhaling infected air, but to prevent an infected mask wearer from spreading the virus into the community.

“Masks are not effective necessarily at preventing acquisition of disease … but they may help protect people who are infectious from transmitting,” he said.

He said masks could play an “outsize role” if it turns out there has been a lot of disease spread by people who are asymptomatic (who have no symptoms) and don’t even know they’re infected.

One caveat, he said: Research shows that people who use masks may touch their faces more, which is a potential route of transmission of the virus. He said it would have to be determined if the benefits of wearing a mask outweighed the price of people touching their faces more.

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Dr. Daniel R. Kuritzkes, chief of the Division of Infectious Diseases at Brigham and Women’s Hospital, said in an e-mail, “Masks are good for preventing people from spreading infection to others, probably less effective at protecting people from acquiring infection.”

But the bottom line, he said, is, “We really have no data on how effective this would be as a public health measure.” And he emphasized it was certainly not a substitute for social distancing, hand-washing, and other practices that have already been recommended.

The Post reported that one federal official, who spoke on the condition of anonymity because it is an ongoing matter of internal discussion and nothing has been finalized, said the new CDC guidance would make clear that the general public should not use the medical masks — including surgical and N95 masks — that are in desperately short supply and needed by health care workers.

Instead, the recommendation under consideration calls for using do-it-yourself cloth coverings, according to a second official who shared that thinking on a personal Facebook account. It would be a way to help “flatten the curve,” the official noted.

One proponent of the general public wearing masks is Scott Gottlieb, the former commissioner of the US Food and Drug Administration who is now among the group advising Massachusetts Governor Charlie Baker.

In a roadmap for how to emerge from the pandemic crisis, Gottlieb said that right now as the pandemic rages, “Everyone, including people without symptoms, should be encouraged to wear nonmedical fabric face masks while in public.”

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The discussion over the new recommendations comes at a time that research from MIT is raising troubling questions about how far the virus can be transmitted by people sneezing, coughing, or just talking.

The World Health Organization on Monday stood by the current guidelines, citing concerns about whether mask-wearing actually works and the shortage of masks for health care workers, CNN reported.

But calls for more mask-wearing have been percolating.

In a Boston Globe op-ed on March 19, two academics from Yale who are also officials at Boston-based Pharos Global Health Advisors, wrote, 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.”

“Masks right now are the most underused intervention we have,” Shan Soe-Lin, one of the authors, said in a telephone interview. If they’re used in addition to social distancing and hand washing, “We can make a big difference in flattening the curve."

Robert Hecht, the other author, said, "We desperately need to prevent new infections. Otherwise, the hospitals are going to be totally overrun. The biggest missing piece is the use of masks by the general public.”

He said he would love to see government leaders get on board — and would welcome the sight of Charlie Baker wearing one at a news conference.

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“We should all wear masks — store-bought or homemade — whenever we’re out in public,” Jeremy Howard, a distinguished research scientist at the University of San Francisco, said in a Post op-ed on Saturday.

“Given that even homemade masks may work better than no masks, wearing them might be something to direct people to do while they stay at home more, as we all should,” Zeynep Tufekci, a professor of information science at the University of North Carolina, said in a New York Times op-ed on March 17.

Thomas Inglesby, director of the Johns Hopkins Center for Health Security, told the Post the CDC should urge people to use nonmedical masks or face coverings.

“I think it would be a prudent step we can all take to reduce transmission” by people who are infected but have no symptoms, he said.

Jeffrey Duchin, a top health official in Seattle and King County, Wash., which endured the first widespread outbreak of coronavirus in the United States, told the Post, “Homemade masks theoretically could offer some protection if the materials and fit were optimized, but this is uncertain.”

“It’s also possible that mask-wearing might increase the risk for infection if other recommendations (like hand washing and distancing) are less likely to be followed or if the mask is contaminated and touched," he noted.

But he also said, “Well-designed homemade or commercially manufactured masks for the public that did not draw on the supply needed by healthcare workers could potentially provide some protection.”

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Material from Globe wire services was used in this report.






Martin finucane can be reached at martin.finucane@globe.com