If a drug proven to reduce coronavirus transmission by 50% to 85% existed, would you take it? Masks offer that kind of protection for public health, and yet people still go out in public without them. Why is that?
In early April, the Centers for Disease control and prevention updated its COVID-19 recommendations to include the wearing of cloth masks to protect public health. Nancy Kass, the deputy director for public health at the Johns Hopkins Berman Institute of Bioethics, explains the ethical argument for wearing a mask to protect others. And Dr. Scott Segal of Wake Forest Baptist Health shares his testing on the efficacy of different types of cloth masks.
Wearing a mask is more than a good health measure. Since the Stone Age, people have used face coverings in ritual, theater and more casual self-expression. Like any other garment, masks are a fashion statement that can communicate personality or ideology to others. Yet, obscuring identifying markers and a locus of emotion allows the mask to transform the wearer, disguising humanity in favor of a deity or creature — or making them wholly anonymous.
Drawing on global traditions of mask-making, Shukuru Bilal transitioned her modest fashion company to protective gear. Bilal designs elaborate and effective masks that may just turn the tide on social media toward masked photoshoots. Host Anita Rao talks with Kass and Dr. Segal about the ethics of mask-wearing during the pandemic. She also asks the founder and lead designer of Shukuru Couture to tell the stories behind the sell-out fashion pieces.
The Science and Ethics of Masks
How does public health messaging evolve during this pandemic?
Kass: It would be great in public health if we knew all the answers at the beginning. But the problem is that we don't. And one of the communication basics in public health is to, as often as possible, start communication by saying: Here's what we know. And here's what we don't know. And based on that, here's what we're advising ... Also as studies come out in regions of the country where there is a lot more mask wearing and the incidence of new disease is going down, the more the public health experts can come back and say: remember, we told you it was just a precaution and now we can really tell you that it's making a difference. Wear this kind of mask where it whenever you go out in a public place, it will make a difference.
How do public health officials tailor their communication strategies to get across the importance of masks?
Kass: We know from other public health communication that the same messages don't resonate with all people. There might be some people for whom mask-wearing is compelling if they saw a message that said something like: I'm doing my part to help my sister-in-law with leukemia or my sister-in-law with diabetes. There might be other people influenced by a message that says something like: I'm helping my city stay open. And the more we understand what are the messages that appeal to different audiences — as well as even things as basic as the marketing of different styles of masks with different messages and different logos and different prints on the material — the more we start to understand what is going to make somebody say: Yeah, I'm gonna wear the mask.
How can someone check fabric for its efficacy as a mask without a lab?
Segal: The sewing people told me about a trick that they use to try to tell the difference between high-quality cloth and lower-quality cloth and it really couldn't be more simple. You simply hold it up to a bright light or even to the sun if you're careful. And you observe whether the light passes through the cloth and sort of outlines to the individual fibers. If it does, that means the light is shining between the spaces in the width of the fabric and that's probably a less effective filter than one that seems to not show the light passing through that much.
What kind of fabric is best for a homemade cloth mask?
Segal: Higher grade cotton cloth — what sewing people will tell you is called quilters cotton — performed better than simple printed cotton fabrics that you might find in a big box discount fabric store. These fabrics tend to have thicker yarns with tighter weaves, often a higher thread count. Under an electron microscope, you can see that the spaces between the fibers are much, much smaller than they are in the lower grade cottons. And we found that two layers of that material was the most effective. There were also some other designs including an outer layer of a lower grade cotton with an inner flannel layer that were also very effective.
How should the mask fit?
Segal: You want the mask to be closely worn, totally covering your nose and your mouth. And you don't want large gaps at the sides or at the top or the bottom or you'll simply be exhaling and inhaling through those gaps.
Can wearing a mask cause respiratory issues like limited oxygen intake or carbon dioxide poisoning?
Segal: Masks really can't lower your oxygen level or increase your carbon dioxide level. I would say in perhaps in the most ill patients with pulmonary disease, there could be a small group risk of worsening your ability to breathe. But no, a mask is not going to cause respiratory problems.
Is it necessary to wear a mask while outdoors?
Segal: I've certainly been out and about outdoors, not necessarily exercising, where there are lots of other people around and I think you should wear a mask in that setting. If you're going to be jogging around your neighborhood or riding a bicycle, and maybe only transcendently pass another individual, I think there may be less of a mandate to wear a mask in a situation like that.
What is the safest way to take off a mask?
Segal: When you take a mask off, and this is true even for medical grade masks, you don't want to handle the front of the mask — the part that you've been breathing in and out of. You want to handle the straps or the ear loops, and then you should wash your hands when you're done. What we do if we're going to be reusing a mask is we put it in a paper bag — paper rather than plastic — so it will dry out because we know that moisture makes them less effective ... And then you should wash it periodically if it's a cloth mask, and we believe that just ordinary machine washing is the way to go on that.