The big debate over face masks
The TLDR: Face masks have become a lightning rod for controversy across the world, and their use has been fiercely debated for both political and medical reasons. So do face masks really help stop the spread? Very short answer: Yes, but not by themselves.
Aren’t face masks a must?
First they were not, and now they are. The messaging around face masks has been erratic and confusing. When the pandemic first started, the WHO strongly advised against their use—and other medical authorities echoed its advice. The reason: High-grade masks should be reserved for healthcare workers and those who are sick.
More importantly: Scientists simply didn’t know enough about the disease.
What do we know now?
At the outset, experts thought the disease primarily spread through close contact—with large droplets expelled via sneezing or coughing. What we know now:
- The virus can spread by just talking or breathing.
- It is twice as contagious as the flu.
- People can spread the disease even if they don’t have any symptoms. So coughing or sneezing isn’t necessary.
- Also: The virus has a long 14-day incubation period—when people don’t show any symptoms.
- In fact, people may be most infectious 48 hours before they display symptoms.
But above all, this: The virus is airborne. Early in July, 239 scientists from around the world called out the WHO for denying the obvious: the virus travels longer distances indoors—via lighter particles (called aerosols) that float in the air, and accumulate over time (for more on this, read our explainer). The WHO has since conceded the possibility of airborne transmission.
And this makes face masks essential?
If the virus spreads through heavier droplets in close proximity, the emphasis will be on:
- Social distancing. The WHO recommends staying three feet apart, the US Center for Disease Control advises six feet.
- Hand-washing. Heavy droplets can fall directly on you, or on a surface that you may later touch. Hence, you need to sanitise your hands, and make sure you don’t touch your face.
If the virus lingers in the air, then it matters little that you are three, six or even twenty feet away from the infected person. And washing your hands will do little to protect you if you’re breathing contaminated air.
The case for airborne transmission: Scientists primarily point to superspreader events, where one person infects hundreds. The Atlantic notes that such events rely on three Vs: venue, ventilation, and vocalization:
“Most super-spreader events occur at an indoor venue, especially a poorly ventilated one (meaning air is not being exchanged, diluted, or filtered), where lots of people are talking, chanting, or singing. Some examples of where super-spreader events have taken place are restaurants, bars, clubs, choir practices, weddings, funerals, cruise ships, nursing homes, prisons, and meatpacking plants.”
Hence, face masks: are a must, especially in indoor spaces—even when they are well-ventilated. A new Harvard study looked at the case of the Diamond Princess cruise ship—where one infected person spread the disease to 700 people. As the New York Times notes:
“[G]ood ventilation is not enough; the Diamond Princess was well ventilated, and the air did not recirculate, the researchers noted. So wearing good-quality masks—standard surgical masks, or cloth masks with multiple layers rather than just one—will most likely be needed as well, even in well-ventilated spaces where people are keeping their distance.”
And that recommendation has been confirmed by the Council of Scientific & Industrial Research which advises wearing face masks indoors, as well.
Point to note: The Indian government has made wearing masks mandatory for all public places—indoors and outdoors.
So why is this controversial?
The politics: There have been large protests against face masks in the United States—but it is not alone. Over the weekend, thousands of people in Germany held a ‘day of freedom’ protest, claiming that mandatory face masks violated their freedoms: "We are being forced to wear a muzzle.” In general, democracies with a strong tradition of individual rights have put up the fiercest resistance—be it the United States or the Netherlands.
Even governments do not agree on their use. Trump’s anti-mask rants aside, Denmark, Sweden, and Norway do not recommend covering your face. But Asian countries like Hong Kong, Taiwan and Singapore put on face masks at the very outset—likely because mask-wearing was already a well-established cultural practice. (For more: see Bloomberg News’ visualisation on face-mask usage around the world)
The science: Even experts are split over face masks. A study published in a prestigious journal in June declared that “wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission.” A number of leading epidemiologists immediately dubbed it “dangerously misleading.” They say that while masks “probably do offer a level of protection, there is no way to tease out how much protection masks offer versus physical distancing of 6 feet or more, or hand washing.”
Argh, what does that mean??
A face mask is not a magic shield that will protect you from the virus. They will not work if:
- They do not have multiple layers.
- You do not wear them correctly.
- You constantly fidget with your mask, and therefore touch your face.
- You take them on and off at will—and therefore touch your face.
- Wearing one makes you more lax about social distancing, in general. This risk is very real.
To sum it up: Face masks are absolutely essential. And they are far more necessary indoors than in open, uncrowded outdoor spaces. But masks are not a replacement for sanitisers or other precautions. Just remember the Three Ws: wearing a mask, washing your hands, and watching your distance. The rest is just politics and personal judgement.
Reading list
- The Atlantic has the best reporting on airborne transmission.
- Healthline sums up what a mask can and cannot do. Also: the false tradeoff between hand hygiene and face masks.
- Forbes and Wall Street Journal look at the global divide over face masks.
- Also see: Politico on why the Netherlands refuses to mandate face masks, and EuroNews on the European divide.
- Bloomberg has the best data visualisation on their use across the world.
- Vox explains how the face mask debate reveals serious problems with hurrying scientific research.
- Huffington Post explains the human psychology behind anti-mask movements.
- NPR has the best guide to different kinds of masks, and which work best. Note: N95 medical masks with respirators are strongly discouraged in India.