To Mask Or Not To Mask?

To mask or not to mask... that is really the question on everyone's lips this year. 

When COVID-19 cases began to escalate throughout the world, people quickly began to hoard surgical masks as a means to protect themselves from the growing pandemic. However, health and government officials were quick to discourage the public's use of face masks in fears that shortages of PPE would cripple the healthcare system. 

Debates have raged on both for and against the usage of face masks, but as the COVID-19 cases continue to soar dangerously high throughout the world, would the implementation of wearing face masks help in any way?

In the Situation Report - 73 by the World Health Organization, there are 3 main routes of COVID-19 transmission: symptomatic, pre-symptomatic, and asymptomatic.

According to the WHO's report, symptomatic transmission refers to a person being transmitted the disease via a person showing signs and symptoms that are consistent with the COVID-19 virus infections. However, the virus' incubation period (from the time when the person is exposed to the virus until when the symptoms begin showing) can take up to 14 days before a person shows any symptoms, and case reports and studies of contact tracing investigations have documented that pre-symptomatic transmission via infectious droplets and touching of contaminated surfaces is possible. 

Based on a report by the Centres of Disease Control and Prevention, an investigation into the 243 cases reported in Singapore during the period 23rd of January to the 16th of March, identified that presymptomatic transmission is the most likely explanation for the occurrence of seven clusters within those 243 cases. [Read the CDC's full report here].

Many who are presymptomatic have also been shown to have little to no symptoms of the COVID-19 disease. According to a journal article by The New England Journal of Medicine, Arons et al. reports a finding taken at a skilled nursing facility in Washington State where more than half of the residents (27 of 48 people) were asymptomatic at testing, but were found to have tested positive for COVID-19. The viral loads were reported to be similarly high in the four symptom groups - those who had typical COVID-19 symptoms, atypical symptoms, those who were presymptomatic and those who remained asymptomatic. [Read the full journal article here].

With the knowledge that even if one does not have visible symptoms for COVID-19, they can still actively transmit the virus to other healthy individuals. The CDC explains that emerging clinical and laboratory studies are showing that wearing a face mask of some kind over the mouth and nose, can help to reduce the spray of droplets when one sneezes, coughs, breathes, and talks. Thus in settings where people are within close proximity to each other (less than 1.8metres), it is recommended by the CDC to wear a face mask. [For more information on CDC face mask recommendations, read the full article here].

But what are the main benefits of wearing a face mask?

When worn, face masks can help minimize the amount of viral respiratory droplets spread in the air, thus aiding in preventing a person from spreading the virus to others - especially for those who are presymptomatic and asymptomatic. 

Another secondary benefit comes from the deterrence of touching our face when wearing a face mask. With the virus still being viable and detected on plastic and stainless steel surfaces after 72 hours (based on a published study by The New England Journal of Medicine), it is possible that our hands will come into contact with surfaces that are infected with the virus. According to University of Leeds, UK virologist, Stephen Griffin: "Wearing a mask can reduce the propensity for people to touch their faces, which is a major source of infection without proper hand hygiene". 

Without testing, it is difficult to know whether you are positive for COVID-19, especially given the evidence that it is possible to be presymptomatic and asymptomatic. With spring coming into season in various countries, comes allergies which can make it even harder to tell who is really unwell. In addition, if there are also inadequate testing facilities, a lack of contact tracing apps, ineffective isolation for people who are sick, and the overall challenge of getting everyone to actually stay at home - by choosing to wear a mask in public, you are aiding in protecting other people from you in the case that you do have COVID-19.

With medical-grade masks and N95 masks still being in shortage and in high demand in healthcare systems, the CDC recommends that people wear cloth face coverings in public settings, especially where recommended social distancing measures are difficult to maintain.