Why the U.S. is changing its mind on coronavirus face masks

April 3, 2020, 10:12 AM UTC

In his daily COVID-19 press briefing on Wednesday, Los Angeles Mayor Eric Garcetti stood at the podium and looped the straps of a black cloth face mask around his ears, as he urged L.A. residents to wear face masks for the first time.

“This will be the look,” Garcetti said, his voice muffled by the mask. “[W]earing these on the streets is something that will help us all control that spread, and most importantly, when we go to the grocery store or something, keep those frontline workers from getting sick.”

His announcement served as a sort of precursor to what’s expected to be a massive shift in U.S. public health policy. The Centers for Disease Control and Prevention (CDC) is considering changing its guidelines from advising that only sick people or those taking care of the ill wear masks, to recommending that everyone wear face coverings in public regardless of their health.

The shift aligns the U.S. with places like mainland China and Hong Kong, where people have worn face masks en masse during past outbreaks and this one. The U.S. has long eschewed the practice as unnecessary, but the nature of the coronavirus has forced it to suddenly change its tune.

Changing tack

New data appears to be behind the CDC’s reexamination of its existing policy. Director Robert Redfield said on Tuesday the agency was “aggressively” reviewing its face-mask guidance after reports that up to one in four people infected with the virus could be asymptomatic. That means many coronavirus carriers may not take measures to keep from spreading the virus—like wearing a mask—because they’re not aware they’re infected. A blanket policy of mask adoption guards against asymptomatic patients’ spreading the virus they don’t know they have.

Los Angeles Times
Athena Hayley, founder and CEO of Love My Neighbor Foundation, tries on a homemade mask in L.A. The U.S. is inching toward mass adoption of masks, long a standard practice in other countries amid outbreaks.
Genaro Molina—Los Angeles Times via Getty Images

Studies in Singapore and the state of Nebraska have also indicated that coronavirus particles may remain in the air and on surfaces longer than previously thought, meaning it’s important to keep particles from being breathed out and breathed in. Masks help in that regard.

“The idea of getting a much more broad community-wide use of masks outside of the health care setting is under very active discussion at the [White House Coronavirus] Task Force,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN on Tuesday. “The CDC group is looking at that very carefully.”

Confirmed U.S. cases of COVID-19, the disease caused by the coronavirus, topped 245,000 on Friday, more than double the next highest case count, Italy, which had 115,000.

“The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks,” George Gao, director-general of the Chinese Center for Disease Control and Prevention, told Science.

Wearing a face mask prevents virus-transmitting droplets from a person’s mouth or nose reaching someone else and infecting them. N95 respirators and surgical masks are designed to prevent the spew of tiny particles containing the virus; homemade cloth masks or bandannas are more permeable, but may still help to prevent community transmission if everyone wears them.

“Anything that can even be 1% effective, 10% effective, 50% effective, is something we should do. So I hope that the CDC will move forward with that,” Garcetti said on Wednesday.

Garcetti noted that face coverings don’t need to be hospital quality—given the dire shortage of personal protective equipment in U.S. hospitals—but should cover the nose and mouth and can include bandannas and fabric masks.

“My feeling is if people want to do it, there’s certainly no harm to it. I would say do it. But use a scarf if you want rather than going out and getting a mask,” President Donald Trump said on Tuesday, adding that officials didn’t want ordinary citizens “competing” against hospitals for masks.

The Internet is awash with tutorials on how to craft DIY face masks with cotton cloth and ribbons. One tutorial for sewing a homemade mask has amassed over 2.5 million views on YouTube since it was posted on Feb. 7.

Catching up with Asia

In starting to embrace face masks, the U.S. is playing catch-up with some of its peers, especially those in Asia. In Hong Kong, for instance, everyone is wearing face masks amid the outbreak. On streets, in office lobbies, and aboard public transportation, people sport pale-hued surgical masks. Some wear more heavy-duty N95 respirators; others double-layer masks or supplement them with goggles or plastic visors that shield the entire face.

Customers wear face masks at a McDonald’s in Hong Kong, with empty tables surrounding them.
Miguel Candela—SOPA Images/LightRocket via Getty Images

Hong Kong’s face mask habit arose out of the SARS crisis 17 years ago. The city was badly hit by the disease, accounting for 40% of total SARS deaths. The U.S. has no comparable recent experience, something that Garcetti recognized in his press conference when he said he had been looking at “countries who have a tradition” of wearing masks.

In Japan, China, South Korea, and other parts of Asia, face masks are common—and not just during the current pandemic. People don masks if they are sick with the flu, when air pollution spikes, and even to accessorize an outfit.

“We associate [mask-wearing] with other parts of the world, but those parts of the world started to do that because of some of the health scares that they had been through in the past,” Garcetti said.

Though public opinion is starting to change, many in the U.S. are “reluctant” to wear a face mask because doing so is still “a symbol that you’re sick in some way,” said Priscilla Wald, a professor of English at Duke University and the author of Contagious: Cultures, Carriers, and the Outbreak Narrative.

But face masks may become more normalized, Wald said, and even when the pandemic abates, wearing masks in daily life may “become something that is customary everywhere,” for when people have the common cold, because of air pollution, or during allergy season.

“I like the idea of people understanding not just that they’re protecting themselves but more importantly that they’re protecting other people,” Wald said.

In his press briefing, L.A. Mayor Garcetti acknowledged that mass mask-wearing may seem “surreal” to Americans unfamiliar with the practice. Right before donning his mask, he added, “We’re going to have to get used to seeing each other like this.”

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