On March 2, 2021, over a year into the pandemic, Texas Governor Greg Abbott joined 15 other states in the USA and lifted the mask mandate, stating that with vaccines being rolled out and case numbers falling it was time. It was met with grave concern from Federal health officials who feel it is too early to lift restrictions, with case numbers still worryingly high and new, potentially more contagious, variants emerging.
This time last year, the thought of wearing a mask to leave the house was unthinkable but now it has become routine. Early in the pandemic, guidance on mask wearing was unclear. The WHO and CDC guidance stated that they did not recommend people who are well wear a face mask and many countries felt that masks should also be reserved for health-care personnel, especially as personal protective equipment was in short supply. China, and other Asian countries such as South Korea and Japan however, were early adopters of universal masking and slowly other countries followed suit as evidence emerged on the airborne transmission of SARS-CoV-2 and the prevalence of asymptomatic cases. During the second waves of the pandemic most US states mandated the use of face masks in public settings and the UK Government made it law to wear a face covering in most indoor venues and on public transport.
These public health measures were a reaction to the mounting evidence from observational and laboratory studies showing face masks are effective at reducing the spread of COVID-19 and might also reduce the severity of disease due to lower viral loads. Masks are effective not only at protecting the wearer from becoming infected but also from spreading infected droplets from someone who might be asymptomatic and unaware they are contagious. They are most effective though when the majority of people wear them and when they are combined with other public health measures, such as physical distancing and handwashing.
There has been a lot of debate surrounding children and masking and with many schools beginning to start in-person learning again, the guidance for schools and parents has been confusing and inconsistent. In the USA, the CDC has recommended children older than 2 years should wear masks when in public, and many states have mandated masks for children and teachers returning to school, even in the younger age groups, but the guidance is not consistent across all states; with half of states not requiring masks for all students. The English Government suggest only children older than 11 years should wear masks and they are only recommended for secondary school students when physical distancing cannot be achieved. The lack of definitive guidelines seems partly due to the uncertainty of evidence surrounding spread of COVID-19 in schools and a concern that masks might impede learning and socialising, especially in younger children.
Another area of uncertainty regarding masks is which masks should you wear? The N95 masks provided to medical professionals fit tightly and can filter up to 95% of small particles, but the fabric face masks most commonly worn by the public have varying effectiveness of filtration and no regulatory oversight. The CDC has provided basic guidance about having two or more layers of washable, breathable fabric, and having a nose wire to stop leaks. The American Society for Testing and Materials (ASTM) has created guidelines and standards that were published on Feb 16, 2021. Companies will be able to have their masks tested and add a label to say they meet ASTM requirements, so consumers will know the level of protection of the mask they are buying. The CDC also released a report on Feb 19, 2021, suggesting ways to improve the fit and efficacy of face masks, including fitting a cloth mask over a medical procedure mask, so-called double masking, which increased the protection from small particles from around 40% to 83%.
Although wearing masks has become almost normal, many people are keen to know how long we will need to continue wearing them. But now is not the time to stop vital basic and effective elements of public health protection for COVID-19. We are just beginning to gain ground in the fight against COVID-19 and only 9% of the US population are fully vaccinated, with global cases still numbering nearly 300 000 a day. Wearing a mask is more than protecting yourself from getting COVID-19. It is about protecting someone else, working together as a society, and a sign of unity. But we need clearer guidelines to motivate and engage people to continue to wear masks for the foreseeable future.
© 2021 Edwin Remsberg, VW Pics/Science Photo Library