Guy Steward: The Mask Debate

The talk ramping up over the possible mandating in New Zealand of face masks in indoor environments from Alert Level 2 up, in order to prevent transmission of COVID19, is of more than passing interest to us laypeople. There’s debate worldwide about their effectiveness – maybe they are, maybe they aren’t – and even expert opinion has been far from settled.

Some, such as the Centers for Disease Control and Prevention (CDC) (April, 2020), and #MASKS4ALL believe that everyone should use them.

There are others, focusing on handwashing and isolation, who maintain that the aerosol particles are too fine to be blocked by most masks and the virus is mostly spread through skin contact.

And there are those well qualified who are uncertain about it (e.g., Paul Glasziou, Professor of Medicine, Bond University and Chris Del Mar, Professor of Public Health, Bond University, Science Alert, April, 2020).


According to the WHO (June, 2020), “Advice on the use of masks in the context of COVID-19”, people with symptoms should wear one. However,

At present, there is no direct evidence (from studies on COVID19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19. (p.6)

And –

At the present time, the widespread use of masks by healthy people in the community setting is not yet supported by high quality or direct scientific evidence and there are potential benefits and harms to consider…. (p.6.)

They mention that when transmission[i] is widespread or social distancing not possible, or in situations of high population density (which, by the way, including bad ventilation was also a factor in the pneumonic epidemics of the plague), it’s possible for a government to consider encouraging people to wear masks. The WHO also cites reasons such as “pre- and asymptomatic transmission”, “observational evidence”, and “individual values and preferences”. So,

…WHO has updated its guidance to advise that to prevent COVID-19 transmission effectively in areas of community transmission, governments should encourage the general public to wear masks in specific situations and settings as part of a comprehensive approach to suppress SARS-CoV-2 transmission. (p.6)

And,

the decision of governments and local jurisdictions whether to recommend or make mandatory the use of masks should be based on the above criteria, and on the local context, culture, availability of masks, resources required, and preferences of the population. (p.7)

Their information is updated as more evidence comes in, so there’s understandable reticence to be conclusive.

Aspects of arguably less importance include the fact that face masks prevent the decoding of facial language through observation of the whole face, an essential aspect, however, of daily human interaction. The deaf also cannot read a speaker’s lips. Adults’ ability to read children’s feelings is limited, and vice versa. Bonding through early face recognition between mothers and babies is hindered. And that vital form of communication, the smile, is all but lost. (Psychologists acknowledge that the simple act of friendliness inherent in a smile impacts significantly on people’s mental health.) Naturally, strategies around these can be employed for brief periods, but long term there may be significant psychological and emotional implications, another reason why some simply prefer not to wear them.

Children and possibly some of the elderly who are unused to wearing them (as most of us in New Zealand are) tend to fumble with their masks, dropping, tearing, and pulling at them. Others may not wear them enough or may wear them wrongly (potentially also giving authorities the chance to shift blame).

Out on daily walks, I notice that those not wearing masks tend to make eye contact and greet, while mask-wearers usually sidle silently past. Ludicrously, the other day, I observed some of the mask-wearers returning on the loop, puffing and sweating, with their masks in all directions except over their mouths.

There’s the question of how comparable the two pandemics really are, but during the 1918 Spanish flu pandemic, strains of which survived until the 1950s[ii], face masks were mandated in San Francisco, with arrests and $5 fines (no doubt onerous in those days), and controversy and protests. However, the masks that were worn then were purportedly not greatly effective.

So, if there was argument around the use of face masks then, over a hundred years ago, what’s the bet that with an outbreak of something similar a hundred years from now, there’ll still be ongoing debate about it.

Guy Steward is a teacher, musician, and writer.

Footnotes:

[i] “We did not find evidence that surgical-type face masks are effective in reducing laboratory-confirmed influenza transmission, either when worn by infected persons (source control) or by persons in the general community to reduce their susceptibility (Figure 2). However, as with hand hygiene, face masks might be able to reduce the transmission of other infections and therefore have value in an influenza pandemic when healthcare resources are stretched.” EID Journal (CDC), Volume 26, Number 5—May 2020

[ii] (R)esearch indicates that descendants of the 1918 virus…probably also circulated continuously in humans, undergoing gradual antigenic drift and causing annual epidemics, until the 1950s…. H1N1 viruses descended from the 1918 strain, as well as H3N2 viruses, have now been cocirculating worldwide for 29 years and show little evidence of imminent extinction. (Taubenberger, J.K. & Morens, D. M. 1918 Influenza: the Mother of All Pandemics, Emerg Infect Dis. 2006 Jan; 12(1): 15–22) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3291398/