Covid masks:As an emergency physician, there are many things that I will not miss when the Covid-19 pandemic is finally brought under control. I will not miss having to wear full personal protective equipment (two masks, face shield, gown, two sets of gloves) for every hospital shift.
I will not miss having to tell a patient’s family that they are unable to visit their loved one in the emergency department. I will not miss wondering whether I am bringing the virus home to my family. Most of all, I will not miss treating the rooms full of people, gasping for breath from this virus, hoping the few effective treatments available will save their lives.
I do hope, though, that a few things stick with us after SARS-CoV-2 becomes less of a threat. Respect for masks is at the top of that list.
Now, let’s be honest. We’re all anxious to see each others’ faces again. Once the majority of us have been vaccinated against Covid-19, masks will become less necessary. Mandates for public masking will be lifted, and universal masking will become less common. That’s OK.
But the pandemic has unequivocally proven the public health value of masks. And they should stick around in certain situations.
Masks have never been controversial in health care. My mask-wearing clearly protects my patients; that’s why we wear masks in the operating room, or when doing sterile procedures. But masks also protect me, whether from a co-worker with the flu or a patient with tuberculosis. That’s why I was one of the earliest advocates for high-quality personal protective equipment for health care workers in March 2020.
Our understanding of the value of masks for the public, on the other hand, has been fraught with controversy, and has dramatically evolved since the beginning of this pandemic.
A mea culpa: I and other public health experts were very wrong about the value of public masking at the start of the pandemic. Our statements were based on well-founded fears of hoarding (we all remember how toilet paper and flour were unable to be found!), but our guesses about the value of public masking turned out to be profoundly incorrect. We quickly learned that many of our assumptions that drove the early recommendations about public masking were, frankly, wrong.
But by April 2020, we had realized how important public masking could be. Because SARS-CoV-2 is spread by asymptomatic as well as symptomatic people, simply “staying home if you’re sick” doesn’t stop the virus’ spread; we need to protect each other from asymptomatic spreaders, too.
Because the virus spreads by aerosols, simply maintaining a 6-foot distance from other people is insufficient; only with good masks can you stop breathing in the viral particles expelled by someone across the room. And although N95s and the equivalent are the most reliable, we have learned that even cloth masks can do a terrific job at filtering out the virus when good-fitting, well-made and appropriately used.
In other words, when people mask up, whether with cloth or surgical-grade masks, we dramatically decrease the rates of transmission of SARS-CoV2.And they will continue to have value in certain circumstances going forward.
For example, even once the pandemic is mostly contained, there will likely be sporadic outbreaks of Covid-19 for years to come, particularly in areas with low vaccination rates or when novel variants appear. In those cases, we should be willing to once again temporarily mask up, to keep our community safe until the outbreak can be tamped down.
There will also always be groups of people who are not fully protected from Covid-19, even after being vaccinated. We already have studies showing that people who are immunocompromised (like transplant patients) do not develop full immunity. Those folks should be encouraged and supported in masking in public. By maintaining masking in crowded places for the rest of us — on public transportation, in malls, or in other indoor locations — we destigmatize protecting the vulnerable.
Finally, I have been struck by the impact of universal masking on other respiratory diseases.I can count on one finger (really!) the number of cases of influenza I saw in my emergency department this winter. Based on national data, the same is true across the country. Although SARS-CoV2 is far worse than the flu, the flu is not benign; in a normal year, it is estimated to kill 12,000-60,000 people (depending on how bad that year’s variant is). The total lack of flu this year is a tremendous gift.
And pediatricians across the world will tell you how few of the normal “winter viruses” they’ve seen this year. This is, at least partly, due to masking. This, too, is an extraordinary feat, and worth repeating.
Here’s the final thing: When we are all willing to wear masks, even just in certain situations, the mask both loses its stigma and gains power to protect all of us from both big threats like Covid-19, and smaller threats like the flu. It no longer signals that a person is sick, or that a person is strange, nor that they have a particular cultural or ethnic background. It is no longer scary or felt to be an imposition on our rights. Mask-wearing can simply signal that we care about others’ health, and about our own.
This will require a sea change in our public attitudes, but other countries have done it: after the original SARS outbreak, many Asian countries normalized mask-wearing. And this sea change in attitudes is already starting to happen in the United States. Masks don’t have to signify something scary or unfamiliar.
Check out Taylor Swift’s flowery mask at the Grammys, or Jennifer Aniston’s “famous face mask.” As the parent of an-almost-teenager, I can tell you that her mask has become her favorite new accessory. It has become a form of self-expression or a marker of being part of the in-group. It is also a growing domestic business opportunity.
One small takeaway from SARS-CoV-2 for Americans should be that masks can make a difference for us, too.