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The messaging on masks and coronavirus has been mixed, and has shifted throughout the pandemic. We now have better data, and it is clear that wearing a masks can help prevent the spread. We should be wearing masks when we go out in public, and that shouldn't be a political statement.

Related HCT episodes:
Coronavirus Q&A 7-16-2020 https://youtu.be/4xzJuTqaG-0

Visualizing Speech-Generated Oral Fluid Droplets from NEMJ https://www.nejm.org/doi/full/10.1056/NEJMc2007800

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The messaging on masks has been all over the place. We've had more than one request to talk about it, again, so that's the topic of this week's Healthcare Triage.

[Healthcare Triage intro]

When all of this began, we and others firmly stated that wearing a surgical mask was not the best way to protect the general public from contracting the virus. We stressed other measures, including social distancing and hand-washing to keep people safe. At the time, there were fewer cases than today, and we were getting close to locking down. I did more than one interview where I wondered why people were going out anyway, masked or not. They're supposed to be be sheltering in place.

Still, the overall messaging could have been clearer as we moved along. This has resulted in some misunderstanding and frustration. Public health officials urged people to stop buying masks so that we could preserve them for healthcare workers, which prompted people to ask why healthcare workers needed them if they did not protect the wearer from infection. And of course, they were often talking about N95 masks, not cloth masks, which are recommended today, and we could have done a better job of differentiating between them.

In one of our first Q&A episodes, I pointed out that masks protect others from you, not vice versa. This remains true. As Ed Yong wrote in April, "even if they can't stop viruses from getting in: they can stop viruses from getting out." Indeed, a research article in the New England Journal of Medicine provides a video showing droplets generated by speech with and without a mask, and the difference is striking. We'll link to that in the description.

This is especially important for viruses that may infect people days before they cause symptoms, or that have a fairly high rate of asymptomatic infections. The current coronavirus appears to have both of these unfortunate traits. People who feel just fine may be unknowingly spreading virus particles as they go about their daily activities. Even wearing homemade masks can help. Some evidence suggests that items like tea towels and cotton t-shirts can block between 50 and 72% of virus particles emitted via coughs, compared with 89% blocked by a surgical mask.

While we could use a lot more evidence on face masks and other coverings, experts tend to agree in a few things. Masks can act as symbols, signaling that we as a society are in this together and taking it seriously. They can also offer reassurance to vulnerable people or people who cannot remain at home due to work or other responsibilities because, again, the evidence we do have tells us that we are more protected when people around us are wearing masks.

Some people don't know this, and are not wearing a mask because they don't think it's effective. Others seem to know, admitting they don't wear one because it only protects other people. I have to admit that I struggle with this logic. Shouldn't we want to protect other people if there's a chance we could be infected? And if self-benefit is one's top priority, all of us participating in protecting others does end up protecting ourselves because other people wearing masks are doing it to protect us. If we all set the example to protect each other, we will all end up with more protection.

It's true that masks are not a solution in and of themselves. They are nowhere near as effective as social distancing. There is some concern that they provide a false sense of security to the wearer, potentially resulting in riskier behavior. There is also some concern that wearing masks, which are uncomfortable, results in more face touching, which is a problem. Wearing one doesn't give you license to throw social distancing out the window, but it does offer value in terms of risk reduction in situations where a six-foot distance cannot be maintained. Combined with other prevention measures, consistent and widespread mask wearing may help us to prevent spread and keep things open.

Some of the changing guidance on masks is simply result of this being a novel and rapidly evolving situation. Different factors like availability of surgical masks and data on the utility of homemade masks have affected the recommendations as we move through the pandemic. Health officials are often doing the best they can with a lot of unknowns in a constantly shifting landscape.

It's a tragedy that masks have become a partisan issue. I said on Twitter than I can understand people being annoyed about masks; I cannot understand when people become outraged when asked to wear a mask.

So yes, the messaging on masks could have been better the past few months, but we have more evidence now: If you must be out and about, please wear a mask. Still, don't let the mask make you forget what else is important: stay home if you're sick, maintain social distance whenever possible, don't touch your face, wash your hands, all that stuff. Masks are part of the solution. They're not a strategy in and of themselves.

Hey, did you enjoy this episode? You might enjoy last week's episode, where we did a Q&A on new COVID stuff. We also really appreciate it when you like and subscribe down below, and if you go on over to patreon.com/healthcaretriage, you can help keep the show going, even during a pandemic. We'd especially like to thank our Research Associates: James Glasgow, Joe Sevits, Josh Gister, and Michael Chinn, and of course, our Surgeon Admiral, Sam.