To Mask, or Not to Mask?

The Question Is Whether It Blocks the COVID Virus

Different types of masks were reviewed among 104 medical journal articles | Credit: Daniel Dreifuss

Civil liberties have crashed into a wall of coronavirus as Santa Barbarans struggle with the novelty of mandatory cloth face coverings. The cities of Santa Barbara, Goleta, and Carpinteria have required them for workers and customers at the essential businesses that are open — including food markets, restaurants, and the lines outside of them — but not all county residents agree.

A drive-by rally cruised up and down State Street and around De la Guerra Plaza on May Day in a protest against the statewide shutdown and its catastrophic effect on business. Beaches were on the verge of closing because of crowding the previous weekend, but the complaints included the “fearmongering” prompted by a requirement to mask up. The County of Santa Barbara hasn’t required masks, Health Officer Dr. Henning Ansorg has stated, because the science doesn’t back it up. He’s not alone. Ventura County’s health officer made the same observation. But that may be changing.

A goliath review of 104 medical studies about masks and virus transmission advised that, yes, masks could reduce the death toll from COVID-19. The article appeared at Preprints.org as a not-yet-peer-reviewed piece — a shortcut all COVID-related journal articles seem to be taking — by 19 scientists from a who’s who of research institutes and universities from Cape Town to California. Given the lack of therapeutics or vaccine against COVID, they found, cloth face coverings were a benefit that blocked virus transmission to some degree. Homemade masks even offered an economic edge, especially in light of the second wave of infection expected after stay-at-home restrictions are lifted. A renewed outbreak could cause businesses to endure a shutdown nightmare a second time.


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Cloth face coverings are by no means adequate for medical workers, for whom N95 and surgical masks protect against actively infectious patients. But even cloth coverings made from T-shirts, tea towels, and washcloths passed the droplet-control test — droplets being the primary source of viral spread. Once contained within the cloth, they have less chance of drying out, becoming aerosolized, and lingering longer in the air.

Airborne transmission of the virus was a late realization in the world’s collective COVID journey, and the one that prompted the mask advisory by the Centers for Disease Control. More recently, at Hong Kong University, Dr. Kwok-yung Yuen offered proof through a study involving 52 Syrian hamsters, which have a very similar enzyme receptor to the one used by SARS-CoV-2 to infect humans.

Photo: HarpoenBarriers of surgical masks were placed between cages of infected and healthy hamsters as fans blew from one group to the other.

The hamster study, which was reported in the South China Morning Post on May 17, placed a barrier of surgical masks between cages of infected and healthy hamsters as fans blew from one group to the other. When masks were on the sick hamsters’ cage, two out of 12 healthy hamsters got infected. Putting masks on the healthy rodents’ cage resulted in four of 12 becoming sick. With no barrier, however, 10 of 15 became infected. While surgical masks were examined by Dr. Yuen, who was among the first to isolate the SARS virus in 2003, a related efficacy to cloth masks seems clear. Dr. Yuen earlier conducted hamster studies that determined that plasma from recovered hamsters helped sick hamsters get better.

Different types of masks were reviewed among the 104 medical journal articles, some in relation to rhinovirus and influenza virus, which are smaller than coronavirus in size. One from the Annals of Internal Medicine of four coughing COVID patients found that, compared to no mask, a cotton mask caused a 10-fold decrease in virus. That very small study also determined the inside of the masks produced no virus on a swab, while the outside was covered in them.

When it came to homemade masks that don’t fit as tightly as an N95 or surgical mask, “all types of masks are at least somewhat effective at protecting the wearer,” the review reported. And while the studies agreed that masks alone were no panacea, they found that the public did not view them as one. Hand washing continued among mask-wearers, as did social distancing.

One case report addressed airplane travel briefly. A man who flew from China to Toronto and then tested positive for COVID had worn a mask during the flight. No one on the flight caught the disease, not the 25 people sitting near him nor the flight attendant. Similarly, a case study of a person with influenza who boarded a plane determined the face mask had decreased the risk during the long flight. In fact, a decrease in influenza of 44 percent in Hong Kong after COVID mask wearing and social distancing became widespread was noted in a 2020 preprint at medRxiv.org. Locally, Santa Barbara’s flu season was described as unusually mild.

The thought of wearing a mask for a 15-hour flight might feel unbearable, but consider that dental hygienists routinely live in them for about eight hours a day, as do busy doctors and nurses. Among weary stay-at-homers, actively donning a face mask gave a feeling of self-sufficiency for many, the study determined. Further, a sense of altruism and solidarity was found among communities in which everyone wore a mask. Then there were the economic advantages: One study across multiple countries measured a benefit of $3,000-$6,000 per cloth mask due to decreased positive COVID cases and fewer deaths.

County health’s Dr. Ansorg made his mask advisory clearer at the Wednesday evening COVID press meeting. He pointed out that they inhibit the spread of respiratory secretions: Indoors, in a place with bad ventilation, “It will not necessarily be a complete preventative to keep me from catching it,” he said. “But it has a very close, to 90 percent, chance of keeping me from spreading it.” Mandatory masks were a matter his department was actively considering: “It’s a very serious discussion we have daily, weighing the pros and cons,” the doctor said. “Our point of view is that it does not do a lot of harm, unless you have breathing problems, as from lung disease.” Children under 2 years old are exempt. 

Ansorg worried mask-wearers would develop a false sense of security; he emphasized that hand washing and staying six feet apart from others needed to continue to contain the virus. But outdoors, “If you’re all by yourself, there’s no point to wearing it because you’re not spreading it to anybody.”

That is certainly the case downtown, at the beaches, and on the trails, where a majority of walkers lack face masks but give each other a wide berth as they walk by.


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