With the understanding that your article was written more than two months and 170,000 COVID-19 deaths ago, I am tempted to believe that you may have shifted your position. That is certainly what both the Centers for Disease Control and Prevention and the World Health Organization have done in the interim. Both are now firmly recommending that cloth masks be worn in public as there is greater recognition of the high transmissibility of COVID-19, of the fact that the virus is airborne, and a consensus that masks do, indeed, act as an effective deterrent against its spread.
Scientific advice is not stagnant: it changes with the addition of new information, and in the case of the novel coronavirus, new facts and issues arise every day to change our understanding, as well as our needs. A Penn State study published in the journal Science on June 10th now estimates the infection rates from COVID-19 may be 80 times higher than that of influenza. While the original CDC guidance against mask-wearing was partially based upon an incorrect understanding of how the virus spreads, it was also a reflection of the national shortage of PPE: health officials were concerned about the hoarding of N-95 masks that left first responders ill-equipped and unprotected. That dynamic has changed.
The researchers who are actively studying every aspect of the disease are working round-the-clock to give us the most current, most accurate information possible, and with every new study, our ability to protect ourselves and others grow. Just last week a Massachusetts study was published in JAMA confirming that universal masking at Mass General Brigham, the largest healthcare system in Massachusetts, was associated with “a significantly lower rate of SARS-CoV-2 positivity among health care workers.” Though the study was not as tightly controlled as the RCTs that you reference, the fact that the decrease in MGB’s positivity rate preceded the decrease in the general public suggests that universal masking should be part of a multi-pronged infection reduction strategy.
The debate and protests over wearing masks are nothing new. One needs only to look backward to the 1918 pandemic. Initially, mask-wearing was viewed as patriotic and responsible, and the first phase of the pandemic’s spread was minimized. But by January of 1919 people were mask weary, and thousands gathered unmasked in San Francisco to raise objections that are all-too-familiar to us today: Masks don’t work, wearing them is an irritant, and they are a violation of our constitutional rights. The protests were successful enough to force San Francisco to lift its newly re-imposed mask order just four days later, just as the second wave was tapering in the city. With those early masks being made of gauze it is difficult to determine whether they afforded any protection against the spread. There is no question about the effectiveness of the protests.
I must assume you will continue debating masks, in part because of confusing messages from both scientific organizations and from politicians. The very real fear of the disease and the effect of lockdowns on our collective psyche and the economy have people searching for certainty about a disease that we know little about.
Though you may decry anecdotal evidence when compared to the previously-conducted RCTs, it is important to note that those studies were not dealing with this disease. We are in the fog of war, and it makes sense to rely upon what is most currently known. The CDC recently released a report on two hairstylists in Springfield, Missouri who were symptomatic and tested positive for COVID-19 after having worked with other stylists and 139 clients. Both the stylists and all of the clients had adhered to a universal face-covering policy, and no symptomatic secondary cases were reported among the clients tested despite close proximity and poor ventilation. The CDC concluded that “adherence to the community’s and company’s face-covering policy likely mitigated the spread of SARS-CoV-2.”
In the face of this type of evidence, the question to be raised is whether it is better to ignore the growing body of evidence that demonstrates mask effectiveness or to join forces with those who have issued regretful deathbed statements. The discomfort of wearing a mask is minimal and may protect you and the vulnerable around you.
You may not want to wear a mask because you fear that behavior would not be accepted within your social group. It may run counter to the beliefs of those with whom you share political ideologies. You may even fear being targeted or ridiculed for wearing a mask. These are legitimate concerns that can be eliminated by policies mandating the wearing of masks in public and strengthened by making masks accessible for free to every individual, as was the case in 1918. Celebrities and online influencers can be recruited to assist in eliminating mask hesitation.
Perhaps the greatest tool used in the 1918 pandemic was the assertion that wearing masks was a patriotic duty and a way of showing responsibility to our fellow citizens. This particular phrase was recently asserted by President Trump. Perhaps if his followers can be convinced of this, the surge in coronavirus cases throughout the United States can be slowed and the battle against the disease won.