Universal Masking: Simple. Effective. Necessary.

posted by DeeAnn Vaage on Thursday, July 23, 2020

I am asked frequently if face coverings are effective and if universal masking can make a difference in slowing the spread of COVID-19. The short answer. Yes and yes! Now to explain…

SARS-CoV-2, which is the virus that causes COVID-19, is one of seven types of coronavirus. Four of the coronaviruses cause the common cold that affects many of us each year. The other three are novel viruses, ones that are completely new in which no one has any prior immunity. These include the sudden acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and now SARS-CoV-2. They are spread through respiratory droplets produced when someone who is infected coughs, sneezes, or talks. The virus is spread when these droplets land in the mouths or noses of people in close contact with one another (within about 6 feet). Through recent contact tracing, we know that COVID-19 can spread very easily from person-to-person via respiratory droplets.

Since SARS-CoV-2 is what we call a ‘novel’ virus, there is no known effective treatment, and there is no vaccine (although progress is being made). Our only defense to prevent the spread of this respiratory disease is to modify our behavior. Thus, social distancing, hand hygiene, surface disinfection, and masking are critical to slowing the spread. When you think about it, these are all things your mother advised you to do long ago, right? They are inexpensive, low-tech strategies to combat this worldwide epidemic. Simple. Effective. Necessary.

“But do masks really work,” you may ask? To be honest, I was skeptical back in March when COVID-19 entered our vocabularies and began to monopolize my professional and private life. As an Infection Preventionist for over 22 years, I had dealt with numerous infectious disease outbreaks (measles, influenza, Ebola, scabies, etc.), attended seminars, participated in disaster drills, and planned for a novel respiratory pandemic. Even though I had read the book, “The Great Pandemic,” a historical account of the pandemic influenza of 1918, and had a pandemic plan ready to go in my files, I was overwhelmed by how quickly and efficiently a novel virus like COVID-19, could infect and affect our entire world.

Healthcare was quickly making adjustments and the virus was spreading faster than my fingers could type updates to necessary policies and protocols. “Should we be wearing cloth masks?” someone asked me. I was unsure what to say at the time. “Would it come to that?” I asked myself. Thankfully, despite my early doubts, thoughtful and dedicated seamstresses began to donate thousands of cloth masks to healthcare facilities to be used in case of a crisis. I too dusted off my sewing machine and made masks for my family in case we needed them.

Unfortunately, the crisis is now and we have come to this juncture. We are all too well aware of lives taken by complications from COVID-19. The families who have suffered losses plead with their healthcare providers, “Please tell people to wear masks so this does not happen to someone else’s family.” To protect our most vulnerable among us and to avert further community spread, the time is now to consistently wear face coverings.

Today I am a firm believer in the effectiveness of universal masking and the use of cloth face coverings in public settings. Outbreak data verifies that SARS-CoV-2 can be transmitted from persons without any symptoms and masks are effective in what we call, “source control.” They can and do decrease the spread of respiratory droplets from being dispersed when people exhale. (This is why the healthcare team wears masks during surgery to reduce the risk of a surgical site infection caused by respiratory droplets falling onto the surgical field.) Spencer Hospital, like many other healthcare facilities, has implemented universal masking, and as a result, we have realized zero employee exposures in the workplace. Moreover, recent research on cloth masks has shown that even fabric (common household textiles) can contain respiratory droplets that spread infectious particles quite efficiently. Cloth masks are widely available while the supply of surgical and N95 respiratory masks are not, so our goal is to preserve those masks for the highest-risk exposures in healthcare and emergency settings.

The key to universal masking, like herd immunity with vaccines, is the more people who wear masks in public places, the more the entire community is protected. When asked to wear a mask, many people think it is for their protection when in fact, it is to prevent the spread of the virus unknowingly to someone else. We now know that the spread of COVID-19 can occur by persons who are pre-symptomatic (before their symptoms start) or asymptomatic (have no symptoms at all). Especially now, wearing a cloth face covering is critical to stop the virus’s momentum. I wear a mask for you and you wear a mask for me! Wearing masks collectively is like creating a big community-wide quilt to cover and protect us all. Simple. Effective. Necessary.

A report published last week in the Morbidity and Mortality Weekly Report provided new data on the effectiveness of face masks in preventing the spread of COVID-19 and re-emphasizes the need for universal masking. Investigators determined that compliance with a city-wide masking ordinance helped prevent the spread of SARS-CoV-2 from two hair stylists in Springfield, Missouri. Before they were diagnosed with COVID-19, the stylists serviced 139 clients, even after they were symptomatic (one for 9 days and the other for 4 days). Following a 2-week investigation and follow-up, it was found that the hair stylists wore cloth face masks while working and of the 104 interviewed clients, 98% reported wearing face coverings. Among those who wore face coverings, 47% wore cloth face coverings. As a result, none of the exposed clients became ill or tested positive for COVID-19. These findings support the role of source control in preventing the transmission of COVID-19.

Lastly, an analysis recently published by Goldman Sachs Research suggests that by expanding community masking by 15%, “we could prevent the need to bring back stay-at-home orders that would otherwise cost an estimated 5% of gross domestic product, or a projected cost of $1 trillion.” That is a pretty big return in your investment when compared to the price of a face mask.

To conclude, I will restate the original question, “Are cloth face coverings effective and can universal masking make a difference in slowing the spread of COVID-19?” The answer remains the same, yes and yes! Face coverings can be an important tool for minimizing the spread of SARS-CoV-2 in our community. Simple. Effective. Necessary.