Mask Or No Mask for Covid-19?

I have written several articles on the coronavirus and on masks and healthcare issues. A series of links have been provided at the bottom of this article for your convenience. This article will, however address a different aspect of the virus or on healthcare issues in general.

Mask Or No Mask for Covid-19?

This sounds simple but it is not. There are several forms of transmission. You have blood and fluid- borne transmission, you have contact transmission from surfaces or physical contact with sick people or their bodily fluids and discharges. Some bacteria have spores and thick cell walls and can survive on surfaces for days. Viruses by there structure can only survive for a short time away from their host. Then you have droplet transmission simple cold, and airborne transmission flu or other viruses. Protection for contact isolation (i.e, blood, fluids and surfaces) you wear protective gear, such as an isolation gown, gloves, booties, hair cover and surgical mask with a clear shield, or goggles. Fluid transmission can also occur with sex, use of condom usually takes care of this problem. For viral transmission via airborne the only true protection is either a N95 mask with protective clothing or a total self contained unit that cleanses the air or has its own air source. SARS and other flu-like viruses fall under this last category. To think Covid-19 acts any differently is simply erroneous. You have a final form of transmission, that is via a vector. For example the mosquito with malaria, the rat and infected fleas with the Bubonic plague to name a few.

Safe distances; droplet transmission is typically 3 feet, the particles are heavier and can’t travel as far. However, if you have a person coughing or sneezing, the distance is much greater, that is why you cover your mouth. Airborne distances are different, the particles are smaller and much lighter, the safe distances are usually 6 feet, but these are only guidelines. Normal breathing being taken in account. Sneezing and coughing increases the distances remarkably up to 12 or more feet.

The problem arises when say, for example, you have your hands full and you have to sneeze what do you do? Do you drop the customers food tray so you can cover your mouth, obviously not. So this is where masks come into place. As I stated earlier, the flu and Covid-19 are viruses, they go through regular masks like they aren’t even there. But what they do is reduce the force of the sneeze, cough or heavy breathing and thereby the distance the particles travel. When you are out in nature and are by yourself, masks are unnecessary. However, when you are outdoors and the distances between people is minimal, you should wear a mask. These are truly gray areas. What about beaches on a hot day, masks are probably not necessary, especially when going in the water. By the way, Covid-19 initially inhabits the nares, so a good dose off saltwater up the nose and through the mouth is probably a good way to help clear out early exposures to Covid-19. When inside of enclosed areas, you should wear masks.

Wearing masks for long periods of time can be unhealthy for the wearer. They should be washed or replaced frequently. If you are symptomatic, you should try not to wear the mask for long periods of time, because you are re-breathing all the contaminates in your airways, so social distancing is your safest bet. Seek medical help if your symptoms get worse. Covid-19 is nothing to mess around with.

I know the WHO has said that 3 feet is okay, however, they have been wrong more than right. If you follow my train of thought, you will agree that 6 feet is a safer distance. You may ask what are my credentials. I have been a student of human anatomy and physiology for over 30 years, I have been an RN for close to 20 years, of which more than 10 years has been in the ICU. I have been on the front line with Covid-19 since the beginning, and have been involved in the treatment of a multitude of positive covid-19 patients.

I just came across this photographic representation of how a general type mask works. I discussed this earlier in this article. But it always help to have visual aid.

Does everyone need to wear a mask outside? Experts weigh in.

(Update 1/22/2022)

(Update 4/10/2021)

he days are getting longer, temperatures are climbing, and daffodils are in full bloom. After a long, dark winter shuttered indoors with the threat of COVID-19 all around us, springtime promises a chance to finally break free from the confines of our homes. But do we have to take those deep breaths of fresh air from behind a mask?

A year after cities closed playgrounds and public parks, fearing the spread of the virus in shared outdoor spaces, plenty of evidence has accumulated showing that outdoor transmission is rare. That means recommendations around wearing a mask outside don’t need to be as strict either.

“One of the strongest findings from the literature is that transmission is reduced outdoors relative to indoors,” says Jonathan Proctor, a postdoctoral fellow at the Harvard Data Science Initiative and the Center for the Environment. The reason is fairly intuitive: The virus has plenty of places to go besides up your nose.

“There’s a lot of air in which the droplets and the viral particles can disperse,” says Lisa Lee, a public health expert at Virginia Tech and former official at the Centers for Disease Control and Prevention.

A systematic review published in February found that fewer than 10 percent of reported SARS-CoV-2 infections occurred outdoors. Indoor transmission, by comparison, was more than 18 times more likely. Infections that did occur outside usually involved other risks, such as people mixing indoor and outdoor activities.

Distance, duration, and intensity matter most

Still, the risk isn’t zero, says Saskia Popescu, an epidemiologist at the University of Arizona in Phoenix.

“Outside is protective, but it’s not a total risk eliminator,” Popescu says. “When we’re seeing transmission outdoors, it’s people who are close to each other, talking face to face.”

The three key factors to consider are distance, duration, and intensity, she says. The closer people are, the more droplets an activity is generating, and the longer people are close to one another, the more the risk increases and the more important a mask becomes. As with so much else in the pandemic, infection risk—and the need to wear a mask—hinges on the context.

“It depends a lot on a number of things, including how crowded an outdoor activity is, how much movement there is, if everybody’s facing the same direction versus everybody facing each other, how vigorously people are exhaling,” Lee says. “If everyone is breathing really heavily, their droplets will travel further, so you’ll want a wider berth than six feet.”

Popescu gave a few examples of outdoor situations in which she always wears a mask versus those where she simply keeps one on hand if needed.

“If I’m in a farmers market, I’ll wear a mask because I’m around other people. Even if I can kind of distance periodically, I’ll wear a mask the whole time,” Popescu says. “If I’m walking with my husband on the beach or walking down the street with my dog, I will have my mask with me and I’ll put it on as I see people approaching.”

Basically, if Popescu will be in close proximity to people outside her household, she puts it on. If she can remain at least six feet from others—at a minimum, she emphasizes—the mask isn’t necessary.

Weather seems to have little impact 

As the Northern Hemisphere heads into summer, the risks of outdoor transmission may drop even lower, suggests some preliminary research on the weather’s impact on SARS-CoV-2 transmission. The strongest factor, albeit still with weak evidence overall, appears to be ultraviolet light.

“Our findings suggest that UV might be deactivating the virus and therefore making it more difficult for the virus to spread,” says Proctor, who coauthored a study that showed the association of higher levels of UV light with lower levels of COVID-19 transmission. The reasons for that association are difficult to pin down, he says.

“In terms of empirical studies on climatological factors, sunlight, temperature, humidity, windspeed, etc., it appears that days when you have higher sunlight, you see reduced transmission of COVID over the following two weeks,” says Proctor. “That two-week lag is consistent with the time it takes someone to transmit the virus and then the symptoms to show and to get tested.”

Several studies have also found that cases fall as temperature rises.

“In general, respiratory viruses like cold, dry temperatures, especially SARS-CoV-2,” says Luca Cegolon, a medical epidemiologist at the public health department in Treviso, Italy, and senior author of a commentary on the rationale for wearing masks outdoors. “The mask is not only providing a physical barrier, but it also helps maintain the relative humidity and temperature of the mouth and especially the nose,” Cegolon says. “That interferes with the settlement [the virus’s ability to get a foothold] and replication of the virus and keeps the immune system of the upper airways stronger.”

But those findings are more relevant in the winter and, again, when people gather close together for a long time. Overall, evidence about the virus’s seasonality remains muddled, says Gaige Kerr, an environmental and occupational health scientist at George Washington University, who led a recent research review in this area.

“At this point, we don’t really have a good grasp on the exact impact that various meteorological variables have on the disease,” Kerr says. Influenza and other coronaviruses have seasonality, Kerr says, and lab experiments have shown the SARS-CoV-2 virus lasts longer in cold, dry conditions with low UV radiation. “But those results have not really been reflected in real world data,” he says. “Despite dozens or hundreds of studies, the results are just all over the place, and there’s not a consensus at all. Using meteorology as a basis for changing or relaxing government interventions is really not supported by the science.”

Spending time outdoors, even mask less, offers health benefits

Instead, the weather’s biggest impact is likely on human behavior. While Proctor’s findings, for example, suggest UV light could be deactivating the virus, other reasons could explain the association they found.

“It could be that when it’s sunny, people go outside,” Proctor says.

People gather inside when the temperature climbs too high or drops too low, Lee says, and that leads to more transmission. In fact, that’s the very reason it’s important for policymakers not to require masks outdoors, says Muge Cevik, an infectious disease physician and clinical lecturer at the University of St. Andrews in Scotland.

“For over a year, people have been under some sort of restriction, our lives have changed significantly, and everyone is just so tired,” Cevik says. “If we ask people to regularly use masks outdoors in every circumstance, it will exacerbate that mental fatigue. Then there’s no place where they can enjoy themselves without any restrictions.”

Outdoor mask mandates also push people indoors, where they won’t be seen gathering but where the risk is much higher, Cevik says. And meeting outside has other public health benefits.

“We can’t really think about public health as only infection control,” Cevik says. “Allowing outdoors to be a place where people recharge their energy through fresh air, joy, physical activity, and social connection is also important from a public health perspective.”

Mask up if the situation calls for it

So, whether people choose to don a mask outside should, again, depend on the activity. Popescu doesn’t see much reason for solo cyclists to wear a mask, though cyclists traveling in tighter groups or around many pedestrians should wear one. Similarly, joggers really only need to put on a mask or pull up a neck gaiter when passing someone.

“If you are running up behind someone jogging, you’ll be running into what they exhale in their slipstream,” Lee says, so wear a mask until you’re past them.

If swimming, masks are obviously impractical, but they’re also unnecessary if people from different households are staying at least six feet apart and no one is shouting directly at someone else’s face, Lee says.

Hikers can leave masks off unless they’ll be passing within six feet of one another. Even then, masks aren’t that necessary for brief encounters or passing unless hikers are breathing heavily. That said, donning your mask has symbolic value as well.

“I do think it’s an important expression of solidarity,” Lee says. “It is an important message that it doesn’t take much to pull your mask on for a few seconds while you’re passing someone.”

Popescu agrees. “It’s a mixture of respect and acknowledging that, even if it’s brief and the risk is very low, it’s the right thing to do,” she says.

Opinion: Don’t Let The Masks Divide Us

different types of protective face mask against blue background - stock photo different types of protective face mask against blue background Kilito Chan via Getty Images
Kilito Chan via Getty Images

As renewed lockdowns and mask mandates become increasingly common, elected officials have succeeded in causing further division and polarization in the United States. 

Americans can now effectively look at one another and see a tangible difference which often leads them to draw the conclusion that perhaps that person has a different ideology than they do (if they are not wearing a mask), but also to make the assessment that they might be physically harmed by that person’s decision not to wear a mask. 

The U.S. Centers for Disease Control and Prevention (CDC) revised its mask guidance last week, sending many Americans into a flurry of confusion, anger, and frustration. After a year of lockdowns and anxiety, with little clarity about the future, Americans have had enough. This is especially true when the so-called “science” on which the experts are basing their policy reversals seems to not only be inconsistent but directly contradictory to past guidelines. 

In May, President Joe Biden told Americans that if they were fully vaccinated, they no longer needed to wear a mask. He and his administration changed that position this week, saying the flip has to do with a new strand of the virus — the Delta variant. Biden said there could be another virus in the future, sending the message to Americans that this kind of back-and-forth policy-making could go on forever. 

Not only does this change in policy do serious harm to the nation’s trust in government institutions, but it undermines the administration’s ultimate goal of getting people vaccinated. Many Americans will not only be less inclined to get the vaccine if they are told that it doesn’t change their lives for the better, but those who got the vaccine will be less likely to follow such instructions and make similar decisions in the future.

The mask has now become a political statement. When CDC guidance allowed vaccinated individuals to stop wearing face coverings, the assumption could be made that people who were still wearing masks had decided against getting the vaccine — even though many Americans most likely stopped wearing masks once this guidance was decided, regardless of their vaccination status. At this point, someone who has decided not to get vaccinated has done so at their own freedom and own risk. 

If I hand you an umbrella in a rainstorm, and you refuse to take it, it is not my responsibility if you get drenched. 

The same goes for vaccines — but now those in charge of our scientific and political establishments have created a way for Americans to potentially visibly identify those who disagree or agree with them. The mask is now political.

This is bad for the country.

In his essay, “Live Not By Lies,” Soviet dissident Aleksandr Solzhenitsyn pressed his peers to avoid living their life by the lies of others. He wrote about this practice as the best way forward, the best way to push back against oppression. 

He wrote

Our way must be: Never knowingly support lies! Having understood where the lies begin (and many see this line differently)—step back from that gangrenous edge! Let us not glue back the flaking scales of the Ideology, not gather back its crumbling bones, nor patch together its decomposing garb, and we will be amazed how swiftly and helplessly the lies will fall away, and that which is destined to be naked will be exposed as such to the world.

Solzhenitsyn offered a piece of understanding to people who were afraid to speak out against the lies that surrounded them: 

We are not called upon to step out onto the square and shout out the truth, to say out loud what we think—this is scary, we are not ready. But let us at least refuse to say what we do not think!

Do not repeat things that you do not believe to be true. Find out the facts for yourself, and push the truth out in the smallest of ways. Wherever you fall in the mask and vaccine debate, don’t let it divide us.

We must not allow the ruling political elites to divide us further in the name of “science.” 

We must not adhere to the notion that a person who does not agree with us, who does not make the same choices that we do, is dangerous and will harm us.

This does not end in a good way.

Why most of us should be wearing N95 masks

The short answer: Because they’re the most protective, and they’re finally widely available.

(Update 1/21/2022)

N95 respirators have long been the best disposable face coverings for protection against airborne viruses, but until recently, they were scarce.

When worn properly, N95s can filter out at least 95 percent of particles in the air, including the virus that causes covid-19. Only pricey air-purifying respirators or hazmat suits offer better protection.

Early in the pandemic, the U.S. stock of N95s was too depleted even to meet the sudden, dire needs of front-line health-care workers. The Centers for Disease Control and Prevention told us to save the most protective masks for essential workers and sew our own.

After two years of ramped-up production, high-quality N95s are widely available to consumers, and the Strategic National Stockpile contains more than 750 million.

Some experts recommended that more people wear them after the delta variant emerged last summer, and on Jan. 14, the CDC updated its recommendations to tout their effectiveness and remove caveats about short supply. The White House plans to give away 400 million N95s in the next few weeks to help stifle the spread of the highly transmissible omicron variant of the novel coronavirus.

How N95 masks work

It is made of polypropylene fibers that are 1/50th the size of a human hair, blown together in a random web to create an obstacle course for particles.

N95s come in several shapes and carry a mark from the National Institute for Occupational Safety and Health (NIOSH) to show that they are authentic. Some look like domes, others a bit like duck bills. This flat-fold, three-panel type is popular in hospitals.

It is made of polypropylene fibers that are 1/50th the size of a human hair, blown together in a random web to create an obstacle course for particles.

Air flows in and out of the microscopic spaces between the fibers, allowing the wearer to breathe.

The fibers carry an electrostatic charge that attracts passing particles like a magnet. Large particles bump into the fibers and easily become trapped. The more particles are captured, the denser and more effective the fibers become.

The tiniest particles can move between fibers, but they are constantly jostled by air molecules. All that pinging around makes them likely to eventually hit a fiber and become trapped as well.

The most difficult particles to capture are small enough to slip between fibers but stout enough that they don’t bounce around a lot. Coronaviruses typically fit into this midsize category. However, the electrostatic charge is effective at grabbing particles of all sizes out of the air.

Who should not wear an N95?

Nearly everyone over age 2 needs to wear a mask in at least some situations, but the CDC stopped short of recommending that everyone switch to N95s, saying basically that the best mask for you is one that fits well and that you’ll wear consistently.

For instance, if you find N95s uncomfortable, or you prefer ear loops to head straps, maybe you’re willing to sacrifice a bit of protection.

According to the CDC, well-fitting N95s are the most protective, followed by KN95s and surgical masks. Chinese-made KN95s are supposed to be of a standard comparable to N95s, and many are of high quality, but they do not go through the NIOSH approval process. “Loosely woven cloth coverings” are the least protective.

Beware of the many counterfeit N95s and KN95s on the market. The CDC website has a list of approved models and examples of counterfeits. There are no NIOSH-approved N95s for children, although some manufacturers claim their products meet N95 standards. Children under 2 should not wear masks at all, and people with certain disabilities may not tolerate them.

For everyone else who wants one, there should be enough N95s to go around.

How to choose and care for your kid’s masks

The best mask is a mask your child will tolerate

(Update 1/21/2022)

This year’s back-to-school supply list has an important line item: masks. With a rise in the delta variant, school mask mandates and recommendations from major medical groups that all children 2 and older should be masked in indoor group settings have sent parents into a mask-buying scramble.

With a dizzying variety of choices around not only brands, but types of face masks and how to care for them, parents have largely been left to fend for themselves as they try to protect their children and others. We asked infectious-disease specialists, pediatricians and other experts how parents should parse the mask questions.

What kind of mask offers the best protection for kids?

There is a short answer and a long answer. The short answer is: A mask your child will tolerate. “The most effective mask is a mask a child will wear and fits them properly. That’s much more important than the filtration characteristics between the three different kinds of masks,” says Eric Toner, an internist and senior scholar with the Johns Hopkins Center for Health Security.

The three types of masks that Toner referred to are cloth masks, surgical masks and N95s (plus their cousins, KN95s and KF94s).

Finding a mask your child will keep on during the school day was a point of common emphasis among all experts we spoke to. Yvonne Maldonado, a pediatric infectious-disease specialist at Stanford University and chair of the American Academy of Pediatrics’ Committee on Infectious Diseases, says the “bottom line” is that “the best mask is the mask the child will actually wear.”

The longer answer is that, compliance across mask types being equal, there are differences but not tremendous ones. Toner says all three types of masks are effective at what is known as “source control,” or stopping the spread of the virus outward if your child is the one infected. In terms of blocking incoming particles, all masks greatly reduce inhalation of virus-laden particles, with N95s blocking the most.

Even with the differences in filtration, though, all the experts we spoke to agreed that — even in the face of the delta variant — either a double-layered cloth mask or a surgical mask offer the best balance between wearability and protection. (To check if a cloth mask is double-layered, you should be able pull the separate layers of fabric toward opposite ends as if it were a double-layered blanket.)

Should kids wear N95 masks?

It is probably not necessary for kids to wear N95 masks, and it could actually backfire. “A well-fitted N95 is uncomfortable to wear, and I am very doubtful that most kids would tolerate them for very long,” Toner says, adding that “they are at great risk for not being used properly.”

Emily Levy, a pediatric infectious-disease specialist at the Mayo Clinic, concurred. Levy noted that even health care professionals treating active covid-19 patients only wear N95 masks during procedures such as intubation; otherwise, they are in surgical masks. “An N95 is a medical grade mask. It has never been tested in children for safety or efficacy,” Levy says. “We don’t have much safety or efficacy data for children with different facial structures and respiratory patterns [than adults].” This includes the KN95s and KF94s. Although there are many masks that appear to fit children and are called KN95 or KF94, they often have not been regulated by a governing body in the United States.

Are cloth masks with filters the best option for kids?

It is something of a grab-bag. “Filters are a bit controversial because it’s a bit unclear what kind of filter it is,” says Levy. “So in general we recommend staying away from filters.”

Aaron Prussin and Linsey Marr of Virginia Tech’s Department of Civil & Environmental Engineering, who have created a public spreadsheet of child mask recommendations, write that they only recommend filters that “spans the mask. Smaller filter inserts are less effective because it is easier for air to flow around them rather than through them.”

How do I get my child to wear a face mask all day?

Helping your child build good mask-wearing habits is generally more important than the materials the mask is made of. Several experts suggest including the child — particularly if they are younger — in the mask selection process. “If children have a role in picking out a mask or decorating it, that can be really helpful in keeping the mask on their faces,” says Maldonado.

Bergen Nelson, a pediatrician with the Virginia Commonwealth University Health Systems, talked about practicing and making a game out of it. “Say, ‘This your superhero costume — you’re a superhero, wear your mask! Superheroes wear masks!’ ” she says. “Depending on the age and developmental level of the child, you can get them motivated in different ways. Some kids are very motivated to know that they’re helping prevent the spread, some kids like to be the superhero, some kids might need an incentive: ‘If you can go the whole time with your mask on, you can get a reward at the end of the day.’”

Despite conventional wisdom, Nelson adds that in her experience, children have overall “done really well” with mask-wearing. “They’ve been amazingly flexible and resilient and willing to do their part.”

How bad is it if my child has a tendency to wet their mask by licking or chewing on it?

This turns out to somewhat depend on the mask type. It is not ideal for any mask to get wet, and you should work with your child to limit wetting, but Toner explains that surgical masks (and N95s) lose an enormous amount of their protective ability when wet. Surgical mask material, he said, “depends on electrostatic charge to catch the particles, and if it’s wet, it loses the charge, and the efficiency goes way down.” If your child is prone to having a wet mask, going the cloth route is probably advisable.

How often should I change or wash my child’s mask?

Fairly frequently. Levy says her rule of thumb is, “If you can see that the mask is soiled — markings externally or internally — it’s probably time to wash it, and if it’s disposable, it’s probably time to get rid of it.”

Changing masks is especially important for younger children who tend to get close to each others’ faces, as respiratory droplets of covid or other germs can sit on the mask. While surface transmission of covid is rare, Nelson noted that a child who touches their germy mask and then touches an orifice in their face could increase their risk of getting sick.

If a disposable mask is not soiled, it may be ok to reuse a couple times. The concern with reusing disposable masks is the loss of shape and a tight fit. “If your goal is source control — to keep from spreading the virus to other people — even if you wore them 100 times, you’d still have good source control,” Toner says. “They just start losing their efficacy for protecting you.”

The Centers for Disease Control has a helpful website with information about cleaning and otherwise caring for masks.

Where should I get my child masks?

The good news is that masks that meet the bar the experts laid out — minimum of double-layered cloth — are widely available, and the message from experts is to not stress about finding the perfect mask.

If you are trying to be more discerning, the spreadsheet put together by Prussin and Marr, as well as one put together by mechanical engineer Aaron Collins, offer specific recommendations.

Elliot Haspel is the program officer for education policy & research at the Robins Foundation in Richmond, and the author of Crawling Behind: America’s Childcare Crisis and How to Fix It.

Conclusion

I have discussed Masks on a few of my articles. I don’t believe that masks are necessary in the outdoors, unless you are in close proximity for prolonged periods of time. I don’t agree the individuals that are mentioned in my update. Mask wearing has nothing to do with health and everything to do with power. Put a mask on when you are walking on a trail or a park is insane. The chance of infecting someone in an incidental contact during a walking pass-by is infinitesimal. But I try to be unbiased in my articles and I do my best to educate the reader, by posting the most up to date information available.

Resources

nationalgeographic.com, “Does everyone need to wear a mask outside? Experts weigh in. A lot of factors can affect whether to keep your face covered while strolling, biking, or jogging outdoors”, By Tara Haelle; thedailywire.com, “Opinion: Don’t Let The Masks Divide Us,” By Charlotte Pence Bond; washingtonpost.com “Why most of us should be wearing N95 masks: The short answer: Because they’re the most protective, and they’re finally widely available.” By Aaron Steckelberg and Bonnie Berkowitz; washingtonpost.com, “How to choose and care for your kid’s masks: The best mask is a mask your child will tolerate.” By Elliot Haspel; COVID-19 and the Global Predator: We Are the Prey.” By Peter R. Breggin MD and Ginger Ross Breggin;

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