Understanding Face Coverings and COVID-19

Sometimes in our lifetimes we witness a rare convergence of market need and technology. The market need today is easily identified – the worldwide demand for new personal protection products and innovations that effectively lead to successful mitigation of airborne pathogens for personal safety at all levels of society. The current technology to meet this need are facial respiratory masks that everyone is now required to utilize for immediate protection and an invaluable line of defense against the novel coronavirus.

The starting point in understand the dilemma and concerns all users should have is with the Centers for Disease Control and Prevention’s recommendation that the general public NOT wear N95 facial respirators to protect themselves from respiratory diseases, including the coronavirus (COVID-19). The CDC’s rational is these masks are critical supplies that must continue to be reserved for health care workers and other medical first responders.

Facial masks are intended to only protect the wearer against unintended transmission if a person is an asymptomatic carrier of the coronavirus. According to the American Lung Association, one in four people infected with COVID-19 might show mild symptoms or none at all.  Therefore, using any form of a face mask other than an N95 or better can only help block large particles that might eject through a cough, sneeze or unintentionally launched saliva (e.g., through speaking) and provides only a bare minimum degree of barrier protection from respiratory droplets that are coughed or sneezed around them. They were not conceived to protect anyone from acquiring COVID-19.  Advocating, suggesting, or acquiring the wrong mask protection can become a serious health and financial liability to all concerned.

To compound the situation US State and Municipal governments continue to impose by Executive Order face-covering requirements in response to the ongoing COVID-19 pandemic and purchasing departments, agents, re-sellers, etc., have begun procuring surgical masks, other similar models, and even homemade masks as N95’s are simply not available.  All of these other ‘masks’ will create serious, unintentional health and safety hazards that the public must become aware of.

A ‘facial respiratory mask’ is usually defined as a filtering respirator such as an N95 or better. It is not the same as a square surgical mask or any other form of ‘face covering’. As manufacturing has increased square, melt-blown surgical masks (as example) have become more easily obtainable in large quantities but are a poor substitute for a true facial respiratory mask due to their loose fit which does not prevent the inhalation of airborne pathogens for the wearer effectively. Further, they do not limit the spread of bacteria or virus droplets completely by the wearer due to the mask's aerodynamic features.

A face covering such as cloth, bandanna, or other type of material that covers a person’s mouth and nose is as equally ineffective as a surgical mask. Homemade cloth face coverings are not Personal Protection Equipment (PPE). This is primarily because they provide the wearer little to no protection from exposure to the coronaviruses. Respiratory hazards can also become a legal liability when inadequate face masks become wet, retain saliva, or sweat, and become a growth environment for bacteria and other pathogens that exist in the workplace. Face covering is a generic term!

In the United States everyone apparently expects too much of masks as well. In the public’s mind masks are thought to prevent infection. From here, another problem arises: because surgical masks are thought to protect against infection in the community setting, people wearing masks for legitimate purposes (those who have a cough, say) form part of the larger misperception and act to reinforce it.  Even this proper use of surgical masks is incorporated into a larger improper use in the era of pandemic fear and widespread misconception about the use of surgical masks — that wearing a mask protects against the transmission of viruses — is a serious problem.

The surgical mask communicates risk. For most, risk is perceived as the potential loss of something of value, but there is another side to risk, a systematic way of dealing with hazards and insecurities induced at the present moment to mitigate the spread of pathogens in the air. The surgical mask is a symbol that protects from the perception of risk by offering non-protection to the public while causing behaviors that project risk into the future.

Histories of the surgical mask offer some clues about our contemporary risk profile. The birth of the mask came from the realization that surgical wounds need protection from the droplets released in the breath of surgeons. The technology was applied outside the operating room to control the spread of infectious epidemics. In the 1919 influenza pandemic, masks were available and were dispensed to populations, but they had no impact on the epidemic curve.  At the time, it was unknown that the influenza organism is nanoscopic and can theoretically penetrate the surgical mask barrier. As recently as 2010, the US National Academy of Sciences declared that, in the community setting, “face masks are not designed or certified to protect the wearer from exposure to respiratory hazards”.

A number of studies continue to demonstrate the inefficacy of the surgical mask in public settings to prevent transmission of the influenza virus. The mask simply has not been shown to be effective in such circumstances. However, this stance is complicated by supporting reasons, which relate to problems of supply, cost, distribution and feasibility: panic might occur if the availability of masks were limited; public purchase of masks might limit the availability of masks in health care settings where they are required; and not all members of the public can afford to purchase masks — if masks are recommended by public health authorities, there could be an expectation that they will be publicly funded and made available by public health programs.

The dimension of supply constitutes tacit acknowledgement that people expect masks to be available in pandemic situations. And they do, if the evidence of popular cinema can be believed. Western society has already emerged into a present reality in which citizens are conditioned to want masks on the basis of media representations of pandemics. The same annex on public health measures refers to the “false sense of security” that a mask can psychologically provide, but the converse is the real risk is posed to a government unable to mollify its population.

We all act out our collective anxiety. In many Asian countries wearing masks even when there is not a pandemic reinforces the idea of a possible future of pandemic. The problem of affect in political terms is a contagious one: fear spreads among the public, leading to intensification of risk management — the classic example being 9/11 and the war on terrorism. Fear of infection risk spreading communicably becomes an ironic pun. Pandemics occurred in 1918, 1957, 1968, 2003 and 2009. Thus, the conversation changes from if the next pandemic will occur to when the next pandemic will occur. Because we are currently “in a pandemic again,” our existence is book-ended by the realized threats of the past and the reasonable threats of the future — to our detriment, with this detriment masked by the surgical mask itself.

In the United States everyone apparently expects too much of masks as well. In the public’s mind masks are thought to prevent infection. From here, another problem arises: because surgical masks are thought to protect against infection in the community setting, people wearing masks for legitimate purposes (those who have a cough, say) form part of the larger misconception and act to reinforce it.  Even this proper use of surgical masks is incorporated into a larger improper use in the era of pandemic fear and widespread misconception about the use of surgical masks — that wearing a mask protects against the transmission of viruses — is a serious problem.

The surgical mask communicates risk. For most, risk is perceived as the potential loss of something of value, but there is another side to risk, a systematic way of dealing with hazards and insecurities induced at the present moment to mitigate the spread of pathogens in the air. The surgical mask is a symbol that protects from the perception of risk by offering non-protection to the public while causing behaviors that project risk into the future.

Histories of the surgical mask offer some clues about our contemporary risk profile. The birth of the mask came from the realization that surgical wounds need protection from the droplets released in the breath of surgeons. The technology was applied outside the operating room to control the spread of infectious epidemics. In the 1919 influenza pandemic, masks were available and were dispensed to populations, but they had no impact on the epidemic curve.  At the time, it was unknown that the influenza organism is nanoscopic and can theoretically penetrate the surgical mask barrier. As recently as 2010, the US National Academy of Sciences declared that, in the community setting, “face masks are not designed or certified to protect the wearer from exposure to respiratory hazards”.

A number of studies continue to demonstrate the inefficacy of the surgical mask in public settings to prevent transmission of the influenza virus. The mask simply has not been shown to be effective in such circumstances. However, this stance is complicated by supporting reasons, which relate to problems of supply, cost, distribution and feasibility: panic might occur if the availability of masks were limited; public purchase of masks might limit the availability of masks in health care settings where they are required; and not all members of the public can afford to purchase masks — if masks are recommended by public health authorities, there could be an expectation that they will be publicly funded and made available by public health programs.

The dimension of supply constitutes tacit acknowledgement that people expect masks to be available in pandemic situations. And they do, if the evidence of popular cinema can be believed. Western society has already emerged into a present reality in which citizens are conditioned to want masks on the basis of media representations of pandemics. The same annex on public health measures refers to the “false sense of security” that a mask can psychologically provide, but the converse is the real risk is posed to a government unable to mollify its population.

We all act out our collective anxiety. In many Asian countries wearing masks even when there is not a pandemic reinforces the idea of a possible future of pandemic. The problem of affect in political terms is a contagious one: fear spreads among the public, leading to intensification of risk management — the classic example being 9/11 and the war on terrorism. Fear of infection risk spreading communicably becomes an ironic pun. Pandemics occurred in 1918, 1957, 1968, 2003 and 2009. Thus, the conversation changes from if the next pandemic will occur to when the next pandemic will occur. Because we are currently “in a pandemic again,” our existence is book-ended by the realized threats of the past and the reasonable threats of the future — to our detriment 'masked by'  surgical and cloth products.