(Some excellent reasons to wear non-medical masks, and a few reasons not to)
By Kitty
UPDATE (Nov 2020): A lot of changes and new knowledge have come to light since this blog was written. Some of this content is still accurate, but some of it may have become obsolete. Please read the more recent mask-related blogs for up-to-date information regarding the COVID-19 pandemic and mask-related issues.
Disclaimer: Nothing in the following article should be construed as medical advice. If you need some of that, consult your GP, not the lady who makes your corsets. It’s just my considered opinion, folks.
“You know those don’t work, right?”
That’s what one man walked right up to me to say when I was out grocery shopping yesterday (in my self-made face mask).
Now, to be clear, we’re not yet under lockdown in the small BC town where we live, but we ARE under strict instructions to stay at least six feet apart from other humans. So of course this piqued my immediate interest. What about me wearing a mask was so important that he’d violate social distancing requirements to accost a strange woman going about her business? Did he believe I was endangering others with my cute doggy-print mask? I mean, one doesn’t usually feel the need to critique random people’s lifestyle choices unless they’re doing something harmful, right?
After all, I did NOT feel the need to tell this man that his smoking habit (he reeked of cigarette smoke) “doesn’t work” if he’s trying reduce his risk factors should he contract COVID-19. Or that his apparently all-candy-bar diet (judging by the content of his shopping basket, as he was in front of me in line at the store) isn’t going to help his immune system respond optimally to infection. Even though both of those things are true, our social conventions say I shouldn’t tell him he’s making a mistake, unless he’s doing something that impacts me or others negatively.
And yet, this is not the first time I’ve heard of people reacting to face masks with skepticism or even outright hostility. There are multiple stories of employees being actually forbidden from wearing masks, even when it is an essential part of their job to interact with people, for fear of “instilling fear”. Grocery clerks at my local store tell me that the head office won’t let them wear face masks because the customers won’t like it. And people who don’t like it say it’s because “masks don’t work.”
But in Austria, a place traditionally very opposed to face and head coverings, people are now being told they should wear masks when they go into public buildings. In parts of Asia, face masks are very nearly mandatory any time anyone leaves home, socially if not legally, and pretty much any GP there will probably tell you they are a very good idea. Nobody has offered a fact-based reason (which is not the same as an opinion; see below) why the wearing of no-medical fabric face masks might be bad for anyone.
So what’s a thinking person to believe? This blog is my one-Kitty attempt to break down the complexities surrounding the wearing of non-medical face masks: their politics, cultural context, effectiveness, and potential dangers. And most relevantly, whether or not we should all be Masked Pandemic Superheroes right now. Things are about to get very nerdy, wordy, and a bit pedantic, because Kitty (ironically for someone who designs fancy clothes for a living) is by training and inclination a hardcore scientist. You have been warned.
NOTE: Everything I say is either stated as my opinion, or correct to my best knowledge at the time of writing. But you know it’s a fast-changing situation, so take that into account if you’re reading in the future.
Do non-medical face masks “work”?
When Cigarette and Candy Man accosted me, two things leapt into my mind: a question and an observation.
The question: if I’d happened to sneeze at the very moment when he was face-to-face with me telling me how masks “don’t work,”, would he be glad that I was masked, or not? I mean, we do have an current dust advisory due to no rainfall, and I have been sneezy in consequence.
The observation: he seemed to have a nasty smoker’s cough, and for my part, I sure was happy I was wearing a mask at that moment, whether it officially “works” or not.
Do masks “work”? This is a question without an answer, just follow-up questions. The real question is, “work for what purpose?” Also, “what kind of masks?” (Because non-medical masks are not all made alike). Also-also, “Work according to whom?” And it gets really, really complicated from there. Let’s talk about it.
Okay, so can masks keep us from catching Coronavirus?
This is what we’re all secretly wondering. Very broadly speaking, we don’t know if fabric face masks work to protect you against infection, and to what extent, because not enough properly controlled studies have been done — even though loads of people in other countries have always worn them during cold and flu season, long before anyone had ever heard of COVID-19. We have little idea what common materials might be more or less effective at blocking pathogens, what difference good or bad fit might make, or what even how conditions (wind, proximity, temperature, etc) might affect effectiveness in general.
If, you like me, are a science nerd, you may now be thinking of a particular study. Alas, even the very few studies that have been conducted aren’t directly applicable to real life. If someone did study how much infectious substance goes through various materials by firing droplets at them point-blank, how relevant is it, really? No one is going to walk right up to you, look you in the eye, and sneeze directly through your face mask. The big gaps you see at the sides of a poorly-fitting mask are probably more of a threat to you than droplets flying in through the mask front and centre, in the context of a more realistic scenario, such as someone squeezing by beside you in a narrow aisle when they’re struck by a coughing fit. As far as I know, no one has studied this yet, so this is only speculation (but an interesting one, all the same).
They tell us you’re most likely to be exposed by touching a contaminated surface then touching a mucous membrane (most likely on your face), or less likely, by actually receiving a droplet expelled from an infected person. So it stands to reason that anything that reduces droplets that reach your face or keeps you from touching your nose, eyes, or mouth must help, or at least not hurt. Very few things in medicine are 100% successful, not even actual vaccines, and a things doesn’t have to be 100% effective to count as useful.
But the expert Dr./Mr./Ms. So-and-so said masks don’t work!
Here’s a difficult truth we all must learn as we become grown-ups: everybody confuses facts and opinions at one time or another. And sometimes, even experts can be motivated by something other than glowing honesty, such as the desire to relieve a desperate product shortage at the expense of truth, or the fear of publicly admitting that they were wrong before.
In 1865 (not so long ago, in the grand scheme), a physician was killed, essentially for being too outspoken about a super-unpopular idea, which was that his fellow doctors should – GASP! – wash their hands between dissecting cadavers and delivering babies. No one in his medical community wanted to admit they may have caused infections that killed loads of women in childbirth, so he was basically bullied into a nervous breakdown and committed to an insane asylum, where he is believed to have died from an infected wound resulting from guard abuse. This is a true story; look up Dr. Semmelweis. There’s a lesson in this somewhere.
Remember this scientific fact: no matter how important, famous, or experienced someone is, everything they say is only their opinion, until such time as there’s evidence to back them up. Meaning that until some properly designed studies have been done and replicated, anything anyone says on the subject of non-medical masks is ALSO only opinion, because we do not actually have enough relevant evidence yet.
In short, people who say home-made masks are totally ineffective are just expressing an opinion. People who say masks keep you safe are also just expressing an opinion. So is everyone who says something in between. This is unsatisfying, but true.
This is not to say that we should not listen to and respect the opinions of experts in their own field, because we absolutely should! It does mean that we need to think critically, and decide for ourselves, when some expert opinions profoundly conflict with others. Which segues nicely into the next point….
Why do people in different countries say different things about face masks?
This would make a great topic for an anthropological study, wouldn’t it? Generalizing broadly, the official stance in countries such as Canada and the US (and large swathes of Western Europe) has been that non-medical cloth face masks are not very useful at best, and harmful at worst. But you’ve most likely noticed that this is absolutely NOT the prevailing attitude in other places, notably many East Asian countries.
No one can conclusively say why this divide exists (no evidence, remember?). But I can attest that the wearing of face masks, medical-grade or not, has been a normal part of life in at least some parts of East Asia for as long as I can remember. If you had a cold and you didn’t want to miss school, you wore a mask. If you went to a crowded community meeting during cold and flu season, you wore a mask, and so did everybody else. If you needed to interact with lots of elderly, very young, or immune-compromised people, such as when taking your grandmother to her check-up, you wore a mask. If your kid had a cough, you wore a mask every time you went outside, in case you were catching too. If you were a conscientious sort of person, anyway.
Do you notice a common trend in all of the above examples? You were supposed to wear a mask mainly to PROTECT OTHERS, not so much for yourself. In cultures where everyone is supposed to think first of the communal good before the individual (whether or not they actually do is another matter), the attitude toward masks seems fundamentally different.
Here in Canada, for example, we tend to focus first on whether we can use face masks to keep ourselves from getting sick, making the our motivation seem essentially selfish. With the current shortage of medical masks for health care professionals, the mere idea of wearing a mask has become tainted with the notion of stealing something from those who really need it. Experts who stated that masks aren’t effective (sometimes in an obvious attempt to counter mask shortages) have caused a certain breach of public trust, leaving people more confused than ever — especially now that some North American health authorities have done a one-eighty into saying we should wear masks.
In contrast, say in South Korea, it feels like there’s actual social pressure to wear masks in public, because you’re meant to think about the protection of society as a whole and not your own preferences. Because of this background belief that masks are a service for preventing community spread, I think it would be very hard for any medical expert to speak against mask wearing without presenting some hard evidence in support.
Even health experts surely aren’t immune to cultural biases, and there’s no denying that face masks are a huge culture shock in North America in a way that they just aren’t in some places. And sadly, xenophobia and a pinch of racism do factor into some people’s reactions, especially at street level.
But didn’t they say it’s dangerous to wear masks if you don’t do it right?
Yes, there’s the one practical argument that keeps getting put forward against masks, which is that if people don’t know the safe and correct way to use them, they might actually be dangerous (which, presumably, is more of an issue in places where masks are unfamiliar).
Of course, if you put on or take off your mask with dirty hands, or pull it down to talk to your neighbours, or keep touching your face to adjust an uncomfortable mask, it may do more harm than good. In which case, would it not make sense to teach people proper mask usage, the way people are now being taught proper hand-washing all over again, instead of blaming the masks? Imagine telling people they shouldn’t wash their hands because some people might do it wrong and endanger themselves.
So are there any good reasons to wear face masks?
It’s only my opinion, but I think yes, with a goodly number of caveats.
First, it’s because I think of face masks primarily as a tool which is about protecting others. If I cough or sneeze, my mask will prevent droplets from travelling as far or wide as if I wasn’t wearing a mask. While I have no idea how much of my sneeze a mask will stop, I feel reasonably confident that it will stop at least some of it from spreading or travelling as far, which is worlds better than nothing. If, for example, you happen to be one of the small but significant minority that carry Coronavirus without major (or any) symptoms, this could make a real difference to the vulnerable.
Next, face masks increase awareness, both in myself and in others. If I’m spacing out while browsing the bananas, seeing someone in a mask jolts me into remembering that I need to keep six feet away. I lost count of the number of times in just one shopping trip when someone in a busier aisle (who was brushing unthinkingly right beside others) saw my mask, jumped a bit, and scooted right into social distancing mode. We’re being asked to do something which is very foreign to us, so it’s to be expected that sometimes we forget, a visual reminder can help.
Third, I find that a mask keeps me from habitually touching by face. I had no idea I did so much of it until I started regularly wearing masks. Every time I jerk my hand away from scratching my nose because the mask reminds me, I’m glad I’m wearing one. Now, if you find you’re touching your face more because you feel the need to constantly adjust your mask, you seriously need to find yourself a better mask, or alter it for a more secure and comfortable fit.
From a perspective of enlightened self-interest, masks will also protect me and mine if everybody can agree that they’re for reducing community spread more than for up-front self-protection, because in the long run, less spread equals a safer world and a less congested medical system. Fewer of your coughed-out droplets will be landing on my avocados at the grocery. And I, for one, would feel safer donating blood if the technician was wearing a mask while bending over me.
Finally, also from a self-centred point of view: if I accidentally walk into someone’s sneeze, I’d rather be wearing a mask than not, just because I’d prefer to have droplets land on my mask than directly on my nose and mouth. It’s my opinion and I’m sticking to it, until evidence tells me to change my mind.
If we collectively understand that the wearing of face masks is a truly altruistic act, maybe we can remove the cultural stigma against them — perhaps even educate everybody on safe use for maximum effectiveness.
So what are those caveats, then (or, when shouldn’t you wear a mask)?
If you’re one of those people who think a face mask makes you invulnerable to infection, or gives you license to flout official recommendations about social distancing or isolation, then you are 1) stupid, and 2) shouldn’t wear a mask.
If you don’t know (or don’t follow) the correct, safe way to use a mask — including but not limited to the right way to put it on/take it off and when or how to sanitize it — you should definitely learn before you try one.
If your mask fits poorly, it could leave huge gaps which really reduce what effectiveness it has. More importantly, bad fit could cause you to fiddle with the mask, making you touch your face. If you find this happens to you, make sure you understand what good fit feels like, and adjust your mask if necessary to make it more comfortable (or find or make a better one!).
If you have difficulty breathing normally through a mask, you should definitely consult a professional before wearing one. This could be due to a physical or psychological condition, and you shouldn’t try to bull through.
Children or other people who can’t be trusted to clearly express themselves if a mask is giving them trouble should not wear one, or be monitored very closely if they do.
If you’re buying up disposable surgical masks that health care workers need right now, don’t. But you knew that already, and anyway, there’s currently no evidence that non-medical masks aren’t just as good for limiting community spread. A hypothetical question: what’s more effective for protection, a generic flat surgical mask that has great big gaps at the sides and around your nose, or a contoured non-medical fabric mask that hugs your face like a glove? Maybe someone should run a study.
Some non-medical masks are being made with various filtering materials, like vacuum bags and Gore-tex and so forth. Be aware that some of these can be stiff, abrasive on sensitive skin, or make breathing difficult, tempting you to pull down the mask whenever you’re not near people. This is obviously a problem if you then put it back on again with contaminated hands. Use your common sense — if something is too uncomfortable to wear, it’s probably not going to work for you in the long run.
Masks are going to get a whole lot less comfortable as the weather gets warmer. It’s something to consider if you suffer from any heat intolerance conditions. On the other hand, if you have a pollen allergy, masks could do double duty this spring!
In conclusion
So the next time you see someone in a mask, try to be grateful to them for doing their part. They may or may not be helping themselves, depending on lots of factors, but they are probably helping the community at large.
And if you’re an employer who’s been discouraging your staff from wearing face masks, think long and hard about what they’re really for, and consider following the example of cultures that recognize that some things are done for the benefit of everyone, not just yourself. In times like these, we can’t afford to let culture shock and prejudice keep us from doing anything that might help.
Stay safe, stay rational, and remember that we truly are all in it together this time.
Next blog: Fit matters in bras and shirts, fit matters in office chairs, and fit REALLY matters in face masks. Let’s talk about how to tell good fit from bad, and how to find (or customize) the right mask for you.
DISCLAIMER: Felix & Kitty are currently offering washable, reusable fabric masks for sale; we are matching each mask sold with one donated to an essential worker or someone in need, such as grocery store employees or people in shelters. This means that sales are going mainly into funding mask donations. We don’t make any significant net profit, never mind anything approaching a living wage, from mask sales. All the thoughts I express in this article are my honest opinions, and I’m saying these things because I think they need to be said.
