To mask, or not to mask?
While scientists and politicians issue recommendations and mandates about wearing masks during the ongoing COVID-19 pandemic, the topic has been hotly debated among the public.
In July, Source Media Properties asked its readers in Richland, Ashland, Knox and Crawford counties to respond to an anonymous survey seeking their opinions about masks amid the COVID-19 pandemic. In a little over a week, there were 6,029 responses from the four counties, with 1,690 comments.
The results were clear: The majority of people who responded to the survey were in favor of wearing masks. But it was also clear there were still a lot of questions.
We collected 237 questions from readers responding to the question, "What do you wonder about masks and COVID-19 that you’d like us to investigate?" Then we took the most frequently asked questions to a group of experts.
The following questions about masks have been answered by these experts:
• Dr. Susan Fernyak, a Madison High School graduate, infectious disease expert now serving as the chief medical officer at the San Mateo Medical Center in California
• Dr. Joseph Gastaldo, OhioHealth Medical Director, Infectious Disease
• Reed Richmond, Health Education and Communications Specialist, Richland Public Health
Answers have also been gathered from information provided by the Centers for Disease Control (CDC), and stories Richland Source and other media outlets have previously reported.
At the time of publication, a statewide mask mandate is currently in effect, set forth by Gov. Mike DeWine on July 22.
How much will wearing a mask protect me from the virus?
REED RICHMOND: Face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the virus.
A cloth mask is intended to trap tiny water droplets that are released when the wearer talks, coughs or sneezes. Asking everyone to wear cloth masks can help reduce the spread of the virus by people who have COVID-19 but don't realize it.
Cloth face coverings are most likely to reduce the spread of the COVID-19 virus when they are widely used by people in public settings. And countries that required face masks, testing, isolation and social distancing early in the pandemic have successfully slowed the spread of the virus.
Is there data that supports wearing masks prevents the spread of communicable viruses?
DR. FERNYAK: It depends on the type of mask. Surgical masks prevent the spreading of respiratory droplets. Although not 100% effective, wearing a mask made from 2 layers of cloth that cover the nose and mouth, coupled with social distancing should effectively block droplets. Surgical masks and homemade masks don’t provide an air tight seal so these masks won’t protect against aerosol transmission (tiny particles). To prevent the spread of the novel coronavirus, wear a mask, wash your hands frequently, physically distance from others by at least 6 feet, and if socializing, do so outdoors.
Do masks prevent people who might have it from giving it to others?
According to the CDC, the answer is yes, cloth face coverings may help prevent people who have COVID-19 from spreading the virus to others.
I see many people who wear masks but leave their noses uncovered. Does this completely negate the reason to wear masks?
REED RICHMOND: It doesn’t completely make the mask worthless but it does make it less effective.
COVID-19 is mostly spread through droplets expelled through the mouth when coughing, sneezing, talking, singing, or laughing. If your nose is uncovered, sneezing will definitely spread the virus. For the wearer, if the nose is uncovered you are exposing one of the three areas were the virus gets into you: the mouth, nose, and eyes. So having your nose uncovered exposes you to the virus.
How much does just breathing really send particles in the air, and how far?
The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).
What are the best masks made out of?
According to Dr. Gastaldo, face masks or coverings made of a natural fiber like cotton are better than those made of synthetic materials, such as nylon or polyester. The layers of fibers in cotton act as a natural filter, helping prevent droplets from escaping.
Cloth face coverings that cover your nose and mouth are recommended. Aim for a tight fit. When you’re wearing a surgical mask, the white part goes on the inside and the blue or yellow should go on the outside. The metal piece should be gently pinched over the bridge of your nose to fit closely to the face.
Cloth face coverings and surgical masks are equally effective. You don’t need to spend a lot of money to be protected.
If the same mask is used day after day, is it effective?
REED RICHMOND: It would be better than not wearing a mask at all. But you should use a new mask or a freshly washed one each day. The masks traps the COVID-19 virus that is in tiny droplets of water you expel when coughing, sneezing, talking, singing, or laughing. That’s why you shouldn’t touch the front of your mask while wearing it and why a mask should only be taken off using the loops around the ears. And that is also why they should be cleaned regularly. You don’t need to run your mask through the washer. You can had wash it with some warm water and soap, rinse it and leave it to dry.
How safe are masks for long periods of time?
REED RICHMOND: There was a rumor going around that you could get sick from wearing a mask too long. This is totally false (ask yourself why getting sick from wearing a mask has never been reported in other countries where wearing masks is common). Surgeons and nurses often have to wear masks for long shifts and they have no difficulty with that.
Recently a medical doctor put a mask on and went out for a 22-mile run to prove that wearing a mask for a long period of time and during physical exertion does not have a negative effect on oxygen levels. Click here to read his story.
Are there health hazards associated with wearing masks, especially for those with asthma or COPD? Is breathing in your own carbon dioxide good for you?
DR: GASTALDO: Masks do not inhibit your oxygen level. Wearing a mask does not lower your oxygen level, it does not interfere with higher levels of carbon dioxide. That is a fallacy and a fiction, there is no science behind that.
The CDC does list exceptions for certain medical conditions but they’re very vague. One that’s very vague is people with severe lung conditions. If somebody has mild asthma, that is not a severe lung condition that would interfere with them wearing a mask. Why people think they need not to wear a mask for their medical condition does not count. Anxiety is not a medical condition to not wear a mask. Wearing a mask does not decrease your oxygenation.
If someone has a medical condition that makes it difficult to wear a mask, wouldn’t they be extremely high risk if they were infected with COVID-19?
DR. GASTALDO: People with severe lung conditions on significant amounts of oxygen are people who really shouldn’t be leaving the house, and probably rarely leave the house to begin with.
Are there any places to buy a face shield locally?
In April, we reported that Cooper Enterprises in Shelby began using its existing equipment to make plastic face shields. The shields are disposable and designed for healthcare workers to help prevent the spread of illness. The products consist of a plastic shield, head strap and clip, all machined by Cooper Enterprises.
One caveat to a face shield - according to the CDC, it is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles. The CDC does not recommend use of face shields for normal everyday activities or as a substitute for cloth face coverings.
Who is responsible for enforcing the mask mandate?
On July 17, we reported the Mansfield Division of Police can enforce the mandate, though it is the department’s hope the community will voluntarily comply and that enforcement is the last option. A hotline has also been created to report non-compliance of the mask mandate.
Will we be required to mask for future viruses?
DR. FERNYAK: Possibly. It depends on how the virus is transmitted, how easily it spreads, and how deadly it is.
What are the symptoms people infected start out with? What percentage of those infected end up in the hospital?
According to the CDC, people with these symptoms may have COVID-19: Fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.
Data from the Ohio Department of Health on July 29 showed there were 87,893 total cases of COVID-19 in Ohio and 10,553 hospitalizations, with 2,513 ICU admissions. That equals a 12 percent hospitalization rate and a 24 percent ICU rate of those hospitalized.
Do asymptomatic people with COVID-19 have a temperature (a fever)?
DR. GASTALDO: No. A fever is a very imperfect symptom of COVID-19. You can have COVID-19 and you can have asymptomatic COVID-19 with or without a fever.
COVID-19 is a virus. It is medically proven a virus cannot be cured with antibiotics. What category are the drugs being used to fight COVID-19?
DR. FERNYAK: There is no cure for COVID-19. There are several therapy-related options including, but not limited to, antiviral therapy (e.g. Remdesivir), immune based therapy (e.g. COVID-19 convalescent plasma or SARS-COV-2 immunoglobulins), and adjunctive therapy, which includes Vitamin C & D, Zinc and antithrombotic therapy. There are many additional medications that are being studied for use, but not enough is known to use them outside clinical trials or monitored programs.
The best approach for a COVID positive person to improve their health is to get plenty of rest, stay hydrated, and take fever and pain reducing medications.
How long does the virus live on surfaces?
According to an article published by Harvard Medical School, a recent study found that the COVID-19 coronavirus can survive up to four hours on copper, up to 24 hours on cardboard, and up to two to three days on plastic and stainless steel.
The best way to protect yourself from germs when running errands and after going out is to regularly wash your hands with soap and water for 20 seconds or use hand sanitizer with at least 60% alcohol.
The CDC recommends cleaning frequently touched surfaces and objects every day. These include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.
How long does a person need to be near a person with the virus to be exposed?
COVID-19 spreads mainly among people who are in close contact (within about 6 feet) for a prolonged period. Cloth face coverings are especially important in times when physical distancing is difficult.
Factors to consider when defining “close contact” include proximity, the duration of exposure (longer exposure time likely increases exposure risk), and whether the exposure was to a person with symptoms (coughing likely increases exposure risk).
Recommendations vary on the length of time of exposure, but 15 minutes of close exposure can be used as an operational definition. Brief interactions are less likely to result in transmission; however, symptoms and the type of interaction (did the infected person cough directly into the face of the exposed individual) are important.
In general, the more closely a person interacts with others and the longer that interaction, the higher the risk of COVID-19 spread.
Why wasn’t there this much concern with the swine flu and other similar diseases?
DR. FERNYAK: The number of deaths due to COVID-19 is unprecedented compared to H1N1. Over the course of one year, there were 12,469 deaths due to H1N1. Some states in the U.S. have had more than 10,000 COVID-19 deaths in a single day. Not only is COVID-19 deadlier than H1N1, individuals infected with H1N1 responded remarkably better to antiviral medication (Tamiflu). Comparing both viruses for the purposes of creating a vaccine is like comparing apples to oranges. We were confident that creating a vaccine for H1N1 would be effective, safe, and delivered quickly to at risk groups. Creating a safe, effective vaccine that can be disseminated and used quickly after Stage 3 clinical trials will present greater challenges.
When a new virus emerges, we don’t initially know its characteristics (e.g. how contagious it is, how many people are hospitalized, how deadly it is, etc.). In 2009, when the swine flu (H1N1) emerged, we saw that it infected many people, with a much lower rate of hospitalization and death than we are seeing with COVID-19. This was partially due to partial immunity that many over 60 years of age had, to prior exposure of other H1N1 strains. We are not seeing partial immunity from prior infection to COVID-19. All of these are factors that affect how impactful a virus will be.
Do hospitals and medical facilities get paid for positive patients vs. non-positive patients?
DR. GASTALDO: Hospital systems don’t get paid more if you’re a positive COVID test or a negative COVID test. If you come to the hospital and you're admitted for any reason, there is a charge associated with that, regardless of if you have COVID-19 or not.
Do they count people twice after being diagnosed?
There is no evidence to support this theory. According to the Ohio Department of Health, if a person takes multiple tests, those tests are added to that person’s case file, not as new separate cases. Click here to read more reporting from The Cincinnati Enquirer on how positive tests are reported.
How common are false positive COVID-19 tests?
DR: GASTALDO: It’s a complicated question. It does happen, but you have to interpret it with the clinical context of what’s going on with the patient.
When someone first gets infected with COVID-19, you are very likely to have a non-detected test, or a false negative test. Most people when they get infected with COVID-19, their highest viral load is at day 5 or day 6, then after that the viral load in their upper respiratory tract goes down. After that your viral load is higher in your lower respiratory tract.
What we’ve had happen before is people come in the hospital, they have COVID, and the swab in the upper respiratory tract is not detected, but when they put a tube down them it becomes detectable.
The other thing we do recognize is that if you do have a false negative when you swab your upper respiratory tract, your viral load is low, and at that point in time with a low viral load, you’re thought to not be as infectious.
Is a mask mandate a violation of the U.S. Constitution?
According to the American Constitution Society, the answer is clear: “In the face of a virus spread through respiration where a significant percentage of contagious people have no symptoms, abundant medical justification exists for a state or local government to consider this a necessary public health measure.”
Professor of history at Ashland University John Moser adds that a federal mask mandate may indeed be a constitutional violation (there is not currently a federal mask mandate in place). However, at the state and local level, he described it as a “classic 10th amendment issue.”
“The states, depending on their own laws, might well be able to impose them,” Moser said.
The 10th amendment helps define the relationship between federal and state governments. It states, “the powers not delegated to the United States by the Constitution, nor prohibited by it to the states, are reserved to the states respectively, or to the people.”
Chief Justice John Roberts of the Supreme Court stated in a recent case, “our Constitution principally entrusts ‘[t]he safety and health of the people’ to the politically accountable officials of the States ‘to guard and protect.’”
How do we reconcile conflicting government recommendations?
DR. FERNYAK: There is not a correct answer for this question. Ultimately, we are all responsible for any recommendations based upon the science that may close sectors of society while reducing the spread of disease. Economics also conflict with health equity as the most vulnerable populations, including people of color, are impacted at a higher rate by the virus while having a higher rate of job loss as essential workers. Balancing keeping workers employed while treating the root causes of high COVID infections due to poverty (crowded housing, etc.) may conflict with resource recommendations.
How do we know what to believe?
REED RICHMOND: Great question. There are so many sources for information out there and it’s easy to get overwhelmed and confused.
Richland Public Health suggests that you use good trusted sources for information like the CDC (Centers for Disease Control and Prevention), ODH (Ohio Department of Health) and your local health departments. Those sources are using science-based evidence to give people the best advice to keep them safe. Always be skeptical when you hear someone make a claim about COVID-19 or other health issues, especially anything on YouTube, Twitter, Facebook, or other social media. Fact check claims by using a Google Search and rely on answers from medical professionals and scientists. Anything that’s legit will have been tested and verified for accuracy (vetted by other professionals) and will list their sources. That’s something that’s not going to happen when someone is simply expressing their own opinion.