Let's talk about masks, baby! Let's talk about you and me!

There have been a lot of images in the news lately showing people going about their day wearing masks. This makes for good, heart pumping, fear inducing content here in the US. Even as an article urges calm, a photo capturing a sea of cloaked faces raises alarm to those of us not used to seeing such a sight. But what some people don't realize is that casual mask wearing is fairly common place in parts of the world.

As you well know, the illness causing all the hubub is Covid 19, or the Novel Corona virus that took Wuhan by storm this fall and winter. It seems to be highly contagious and just like the common cold, without vaccine or actual treatment beyond supportive care.  It has infected thousands of people on multiple continents and is currently estimated to have a 2.3% mortality rate.  (Although considering how mild the symptoms seem to be in some patients, it’s probable that there are people infected who don’t even know, making the mortality rate lower.)

Now, a case for calm that I keep hearing, a quite compelling one at that, is that Covid 19 isn’t a big deal when compared to the flu.  The mortality rate for flu varies each year and is hard to pinpoint exactly, but it looks like it’s much lower than Covid 19.  However, the flu is everywhere and has been killing humans for a long time. Looking at mortality rates alongside rates of infection, we’re advised that we don’t need to be concerned about Covid 19 because the flu is more dangerous.

OK.  I can see where they’re coming from.  In the states it’s unlikely that we’ll catch this new virus.  However, if I were standing in a group with 199 other people and you told me that we could go on one boat where they’d throw 2 to 4 people overboard or another boat where they’d only throw over 1, I’d probably just elect to stay on land.  A 2% mortality rate is high.  Comparing it to the flu only tends to highlight how dangerous the flu really is.  And in years like this one where it’s hitting children, teens, and young adults harder than usual, I can’t help but notice how we as a society just aren’t equipped to deal with contagious disease.  Covid 19 is the flavor of the month, but it won’t be the last thing to haunt us.

This flu season I’ve seen people falling like dominoes, a few of them landing in the hospital, yet everyone continues to show up.  Sick kids are being hauled back into school because their working parents have nowhere to put them.  Sick adults are dragging themselves into work, infecting those around them because they can’t get the time off.  Even jobs that offer sick pay don’t have a system that accommodates something like the flu or Covid 19.  Taking off work for a week or two of illness is an absurd thought, let alone staying home to self quarantine for the prolonged period that the body is shedding virus.  We need to take a look at our employment and child care systems and make changes and improvements to help us cope with a future that is likely to include more contagious illnesses and pandemics.  But in the meantime, masks can be a tool to help keep us safe.

As I mentioned before, masks are commonplace in certain parts of the world.  But they’ve yet to catch on in the states.  I read a Slate article (https://slate.com/technology/2020/02/fashion-masks-are-wellness-now.html) recently that was mocking the inclusion of face masks in a fashion show.  Like the concept clothing one finds on runway models, the masks weren’t functional.  But they alluded to a future that includes them as an accessory.  I thought the projection of selfishness onto the habit of mask wearing by the author was really interesting.  Hard dying American ideals of self reliance and independence is thought by many to be the reason masks haven’t been embraced here already.  The people who I’ve chatted with about mask usage in Asia don’t seem to talk much about keeping themselves safe.  That’s obviously a motivation, but their focus seems to center around containing spread, protecting the community, and shielding the most vulnerable.  We can make them look as fashionable as we want, but it’s easier to not wear one.  The selfish action is saying that the comfort of the individual outweighs the needs of the weakest among us.

I think that mask usage can and should have a place in our culture.  We don’t need to all rush out and buy up masks.  In fact, we really SHOULDN’T all rush out and buy up masks!  (Just try to find something in stock and sanely priced online right now.  There’s been a run on them!)  There are people in our communities with compromised immune systems who rely on masks to give them a little extra protection and we don’t want to take away their supply.  I’m not so sure that I buy the argument that we need to be saving the supply for healthcare workers.  As far as I can tell, hospitals and doctors’ offices have a separate supply chain from Amazon, but I could be wrong.  That said, my family has masks and uses them on a regular basis.

The pieces that I have read recently that counsel people to disregard mask use tend to say that they don’t help much.  They don’t filter what wearers think they do.  They need to be fitted correctly.  They are uncomfortable and difficult to wear.  One consideration that I don’t hear much about is that wearing a mask can exclude the hearing impaired since they muffle the voice and make lip reading impossible.  I don’t necessarily disagree with any these statements.  I think that when considering a mask, one should first think about their goals, and then select something that works for them, even if that means wearing nothing.

So let’s talk about the type of masks.  The mask that you tend to see in most photos is the humble surgical mask.  This is the basic folded rectangle of material secured to the face by elastic loops that hook onto the wearer’s ears.  They come in disposable or washable models.  These are the least effective type of masks, although they can accomplish some things.  They are the most comfortable.  We have some washable cotton ones that are downright cozy to wear.  The purpose of the surgical mask is simply to be a physical barrier.  If you are a child or an in and out of consciousness adult who can expect to be sneezing and coughing a lot, a surgical mask can block the aerosol spray that you might not catch.  (It’s hard to vampire cough when you’re asleep!)  You can still breathe well but you won’t be literally spraying your germs around whatever space you are in.  A surgical mask can also help keep fingers out of noses and mouths, preventing kids from spreading their germs or infecting themselves with hard to break habits.  Additionally, some of us find ourselves unexpectedly around someone who does NOT have a surgical mask but seems to be hacking or sneezing all over the place.  Elevators, transit, grocery store lines, interacting with small children….there are lots of times we’re caught off guard with repeated aerosol spray.  You will probably be considered rude if you whip out a mask, but if you’re prone to pneumonia or you’ve got a new baby at home, perhaps it won’t matter to you.  The small, flexible surgical mask is the most portable type and can happily exist in a purse or pocket.

The other two types of masks are not always easy to tell apart, so you’ll need to read the packaging.  N95 and N99 masks filter particulate, 95% and 99%, respectively.  You can get both of these at a hardware store in disposable single piece units, reusable cartridge models, or a cloth washable hybrid from online vendors.  My least favorite is the disposable type.  They are one size fits all, which tends to mean that they don’t really fit anyone all that well, and for filter masks to work they need to be well fitted.  My second choice would be the cartridge type with a rubber portion that clings to your face.  Pros of this type: it’s relatively easy to get a good fit, and you are going to get great performance.  The cons of this type: come on…you know.  You are going to breathe like Darth Vader, no one is going to understand what you’re saying, and you’re going to have this horrific hot sweaty mouth area with a lasting mark.  They’re awful.  The kinds that we wear are washable fabric masks with disposable filters.  These have a valve that helps exhaled air escape quickly, minimizing “puffing” which can affect fit.  When worn alone, they tend to be rated as N95, and the addition of the disposable filter increases them to N99. 

The N95 and N99 masks are harder to breathe in than surgical masks.  N95s make breathing labored.  It’s the kind of feeling that I get used to, but after wearing mine for an extended period, it feels good to take it off.  The N99 is no joke.  If fitted properly, I can’t be very active and still get the air that I need.  It’s distracting and I think about taking if off.  Frequently.  But the protection that you’ll get is powerful.  Fit is important.  I like to use the spongy stickers on the nose area to get a better seal.  Press the enclosed metal clamp down and squeeze around your nose.  Pull and adjust the angles of the straps to get the mask tight on your face.  If you gulp air in fast or exhale hard, the mask should flex with your breaths.  There are test kits that you can order to make sure that it is filtering properly, but in general, if the air is only coming in and out through the material of the mask, you are good to go.

If surgical masks are for just in case, then these are for known exposure.  If I know that I am still shedding virus but need to be in contact with people, I’ll put on an N95 or N99.  Likewise, if I’m caring for an ill person, I’ll wear one of these when I’m within 6 feet of them.  They are also great if you know you’ll be sitting in a high risk area, such as an airplane.  And although I wouldn’t wear an N99 when I need to breathe hard, I’ve worn my N95 before on bike rides or hikes where I encountered high levels of pollution or forest fire activity.

No matter what type of mask you choose, routine is important.  It doesn’t do a lot of good to keep your lungs clean, just to rub your fingers in the germs accumulated on your mask and then touch your eye.  You want to treat your used mask like the dirty thing that it is, and I think that establishing a routine can be incredibly helpful.  When removing your mask, grab it by the ear loops and pull it straight off of your face. If it is disposable, drop it into the trash.  If it is a hybrid, shake the disposable filter into the trash, and then place the mask into the wash area.  I suggest washing them with rags or other items that go through a sterilize cycle, or soaking them in alcohol.  A little ice bucket with lid makes a great soak station for used masks.  After removing your mask, wash your hands with soap.  If I’ve been in a high risk area, I’ll sometimes wash my face at this point as well.  I tend to hand wash my hybrid cloth masks with valves and machine wash the cotton surgical ones. 

So I hope that this answered some questions that you might have had about face mask usage, or at least got you thinking about the issue.  While wearing masks in public I’ve been met with everything from fear to curiosity to anger.  If you see someone wearing a mask, try to remember that their motivations probably aren’t selfish, and that they might be doing a lot more good than it seems.  Remember to wash your hands and maybe we can keep the pandemic part of the end of the world relegated to science fiction.