At the height of the HIV crisis, authorities did not tell people to put away condoms. As fatalities from car crashes mounted, no one recommended avoiding seat belts. Yet in a global respiratory pandemic, people who should know better are discouraging Americans from using respiratory protection.
Facing shortages of the N95 masks needed by health-care workers, the U.S. surgeon general announced on Feb. 29 that masks “are NOT effective in preventing general public from catching #Coronavirus,” despite significant scientific evidence to the contrary. This is not just a problem in the United States: Even the World Health Organization says, “you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.”
There are good reasons to believe DIY masks would help a lot. Look at Hong Kong, Mongolia, South Korea and Taiwan, all of which have covid-19 largely under control. They are all near the original epicenter of the pandemic in mainland China, and they have economic ties to China. Yet none has resorted to a lockdown, such as in China’s Wuhan province. In all of these countries, all of which were hit hard by the SARS respiratory virus outbreak in 2002 and 2003, everyone is wearing masks in public. George Gao, director general of the Chinese Center for Disease Control and Prevention, stated, “Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”
Studies have documented definitively that in controlled environments like airplanes, people with masks rarely infect others and rarely become infected themselves, while those without masks more easily infect others or become infected themselves.
Masks don’t have to be complex to be effective. A 2013 paper tested a variety of household materials and found that something as simple as two layers of a cotton T-shirt is highly effective at blocking virus particles of a wide range of sizes. Oxford University found evidence this month for the effectiveness of simple fabric mouth and nose covers to be so compelling they now are officially acceptable for use in a hospital in many situations. Hospitals running short of N95-rated masks are turning to homemade cloth masks themselves; if it’s good enough to use in a hospital, it’s good enough for a walk to the store.
The reasons the WHO cites for its anti-mask advice are based not on science but on three spurious policy arguments. First, there are not enough masks for hospital workers. Second, masks may themselves become contaminated and pass on an infection to the people wearing them. Third, masks could encourage people to engage in more risky behavior.
None of these is a good reason to avoid wearing a mask in public.
Yes, there is a shortage of manufactured masks, and these should go to hospital workers. But anyone can make a mask at home by cutting up a cotton T-shirt, tying it back together and then washing it at the end of the day. Another approach, recommended by the Hong Kong Consumer Council, involves rigging a simple mask with a paper towel and rubber bands that can be thrown in the trash at the end of each day.
It’s true that masks can become contaminated. But better a mask gets contaminated than the person who is wearing it. It is not hard to wash or dispose of a mask at the end of the day and then wash hands thoroughly to prevent a contaminated mask from spreading infection.
Finally, the idea that masks encourage risky behavior is nonsensical. We give cars anti-lock brakes and seat belts despite the possibility that people might drive more riskily knowing the safety equipment is there. Construction workers wear hard hats even though the hats presumably could encourage less attention to safety. If any risky behavior does occur, societies have the power to make laws against it.
Many authorities still advise only people with symptoms to wear masks. But this doesn’t help with a disease like covid-19, since a person who does not yet show symptoms can still be contagious. A study in Iceland, where there has been unprecedented levels of testing, found that “about half of those who tested positive [for covid-19] are nonsymptomatic,” according to Iceland’s chief epidemiologist, Thorolfur Gudnason. In fact, in early February, National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci warned there was strong evidence that covid-19 spreads even among people without symptoms. If we all wear masks, people unknowingly infected with the coronavirus would be less likely to spread it.
I also have heard suggestions that widespread usage of masks in the West will be culturally impossible. The story of the Czech Republic debunks this notion. Social media influencers campaigning to encourage DIY mask creation catalyzed an extraordinary mobilization by nearly the whole population. Within three days, there were enough masks for everyone in the country, and most people were wearing them. This was an entirely grass-roots community effort.
When social distancing requirements forced a small bar in Prague to close, its owner, Štefan Olejár, converted Bar Behind the Curtain into a mask manufacturing facility. He procured sewing machines from the community and makes about 400 cotton masks per day. The bar employs 10 people, including a driver who distributes the masks directly to people who are not able to leave their homes.
There are “mask trees” on street corners around the country, where people hang up masks they have made so others can take them.
The most important message shared in the Czech Republic has been this: “My mask protects you; your mask protects me.” Wearing a mask there is now considered a prosocial behavior. Going outside without one is frowned on as an antisocial action that puts your community at risk. In fact, the community reaction has been so strong that the government has responded by making it illegal to go out in public without a mask.
When I first started wearing a mask in public, I felt a bit odd. But I reminded myself I’m helping my community, and I’m sure in the coming weeks people who don’t wear masks will be the ones who feel out of place. Now I’m trying to encourage everyone to join me — and to get their friends to wear masks, too — with a social media campaign around #masks4all.
Community use of masks alone is not enough to stop the spread. Restrictions on movement and commerce need to stay in place until hospital systems clearly are able to handle the patient load. Then, we need a rigorous system of contact tracing, testing and quarantine of those potentially infected.
Given the weight of evidence, it seems likely that universal mask wearing should be a part of the solution. Every single one of us can make it happen — starting today.