COVID-19 Resource Center

COVID-19 Resource Center

April 03, 2020
5 min read
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Universal masking policy stands to protect community, ease anxiety about COVID-19

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Peter Chin-Hong

Universal masking policies have been a common topic of debate during the COVID-19 pandemic, which has now affected citizens in most countries and territories throughout the world. Some hospitals have begun implementing their own policies regarding masks. Officials are also calling on policymakers to act while experts weigh the benefits of having the general public wear masks during essential outings.

Currently, the CDC does not recommend that the general U.S. population wear masks while out in public to reduce the risk of spreading or contracting COVID-19. Now, however, it is being called upon to re-evaluate its recommendations.

Changing views on masks for the general public

U.S. Surgeon General Vice Adm. Jerome M. Adams, MD, MPH, who had initially advised against the general public wearing face masks, suggesting they were not effective in preventing the contraction of COVID-19, has also changed his stance on the matter, according to a report from CNBC.

The report explained that growing evidence shows a significant amount of asymptomatic spread of COVID-19, leading Adams to call on the CDC to investigate masking policies. Another report by the news website Stat said the White House is expected to recommend all Americans wear masks when out in public, based on updated CDC guidance that has not been officially announced. According to another report, this one in the Washington Post, the updated CDC guidance could encourage everyone to take measures to cover their faces while out in public.

Universal masking policies have been a common topic of debate during the COVID-19 pandemic.
Source: Adobe Stock

So far, most reports reiterate that masks worn by the general public should be homemade, including the use of a simple cloth covering, and that N95 masks that should be reserved for health care workers. According to the Washington Post report, CDC officials told the news outlet that the new guidance would specify this and suggest the do-it-yourself cloth masks or bandanas that people could make on their own.

Infectious Disease News Editorial Board Member Peter Chin-Hong, MD, professor of medicine and director of the transplant infectious disease program at the University of California, San Francisco (UCSF) and advocate for universal masking policies, told Healio that such masks promote creativity while also providing protection.

“I was looking around on the drive to work and thought it was cool. People are putting smiley faces and Hello Kitty on masks, getting creative. You can be creative and it does give you protection,” he said. “You can wear a homemade mask or wear a bandana; you can wear a scarf. In this particular context, you don't have to have a high-grade mask.”

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Chin-Hong, whose own facility has implemented a well-received universal masking policy, emphasized the importance of “context-dependent.”

For example, in a hospital setting, it is difficult to maintain social distance because doctors cannot stay 6 feet away from all patients, according to Chin-Hong. In addition, even if doctors could keep their distance from infected patients, it is not always clear who is infected due in part to lack of testing but also because asymptomatic transmission has resulted in an opportunity for unprotected encounters.

“In a hospital setting, to me, [wearing a mask is] kind of a no-brainer,” he said. “It has a lot of biological plausibility.”

Outside the hospital, it’s a matter of social distancing accountability, he says, adding that what surpasses comorbidities as a risk factor for COVID-19 is whether or not you can control your environment.

“If you're in a farm in Montana, you don't really need to wear a mask because you know who you're going to come into contact with and you probably can't get it from your horse,” Chin-Hong explained. “But think about taking a random elevator, even a quick one down to the parking lot all of a sudden, there are a lot of people in the elevator. When you're out in the community, you can’t always maintain safe social distance.”

He explained that the same is true for a grocery store or train station. Because of this, other guidance issued should be maintained.

Social distancing and the toll of COVID-19

In the Washington Post report, Adams emphasized that even with masks, people should avoid touching their face and should continue following social distancing guidelines.

Chin-Hong echoed this, saying other recommendations and guidelines should not fall to the wayside.

“Wearing a mask isn't the only thing you should do. Don't be complacent. Don't get false security. [Wearing a mask is] just one part of many things you can do. You can’t just wear masks and wash your hands; you can still transmit the virus if you’re scratching your nose behind the mask.”

In a press briefing hosted by the Infectious Diseases Society of America, Rochelle Walensky, MD, MPH, FIDSA, vice chair of IDSA's HIV Medicine Association and chief of the infectious diseases division at Massachusetts General Hospital, explained that wearing a mask is not a way to avoid social distancing.

“Everyone must practice social distancing,” she said. “The mask would be an addition if you were going to do an essential activity like picking up a prescription.”

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She added that wearing a mask will not protect you from getting sick; it protects those around you from what you could transmit.

With no evidence to date about the benefit of universal masking, some believe that universal masking may just ease the anxieties of those out in public, Michael Klompas, MD, MPH, of the department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute, and Brigham and Women’s Hospital, and colleagues explained in an editorial in the New England Journal of Medicine. In addition, wearing a face mask outside of a hospital setting offers little, if any, protection not because they don’t work, but because the chances of contracting COVID-19 from a passing interaction out in public is minimal.

“Expanded masking protocols’ greatest contribution may be to reduce the transmission of anxiety, over and above whatever role they may play in reducing transmission of COVID-19,” the authors wrote. “The potential value of universal masking in giving health care workers the confidence to absorb and implement the more foundational infection-prevention practices described above may be its greatest contribution.”

The masks work as a metaphor, according to Chin-Hong.

“You see people walking around wearing a mask and it reminds you that we are in the middle of a crisis right now in the United States,” he said, adding that everyone has to take personal responsibility not only themselves, but for the community as well. “Everything that you do to keep yourself safe also affects the community. Seeing a lot of people walking around wearing masks is a powerful reminder.”

He added: “We're in for a marathon and not a sprint; we need a national approach, not a piecemeal approach. This is not the time to bring up American values of independence and self-destiny. The virus doesn't care about your independence and your rights. All the virus wants is to transmit itself from one person to the next.” – by Caitlyn Stulpin

Disclosure: Chin-Hong reports no relevant financial disclosures.