Why Advice About Masks Seems to Be Constantly Changing

The World Health Organization announced a new guideline on masks late last week, sparking a new wave of criticism about how “they” continue to change their minds. Previously, WHO did not recommend that healthy people wear masks; now they say people over 60 and people with underlying medical conditions should wear masks where it is impossible to distance themselves . They also say that local governments may want to recommend masks for everyone, but they leave that as a verdict for these officials.

Throughout this pandemic, reports of masks – including who should wear which ones – have seemed contradictory. But many important points have never changed.

What is changing, however, is our understanding of which facts are most important and how the harm and potential risks are balanced by the benefits. For example, back on February 7, we posted a message asking you to stop buying coronavirus masks that you don’t need . This was again a recommendation from the World Health Organization, supported by other public health organizations. The information in this post is still correct, but the emphasis on what’s important has changed.

At that time, there were only 12 known cases of coronavirus in the entire United States. If you weren’t one of these cases (or close contact), thought you were unlikely to get infected already. Meanwhile, there was a shortage of medical masks all over the world. Remember what happened to the toilet paper? It was important to prevent panic buying. And with so few cases in a small number of cities, indeed, most people didn’t need masks.

What has changed since then? Basically things like this:

Distribution in society

First, testing was not lagging behind enough to see where the virus actually was. Getting the test in early 2020 requires you to be in contact with someone who has had the virus, or is highly likely to have it, which means the community’s spread could not be detected. It was a failure. And once we figured it out, the overall lack of tests became another failure. By the time we realized that the community had spread, it was too late to track down all the cases and their contacts.

With the community’s spread not being tracked, it was impossible to tell people that they were unlikely to encounter the virus in the wild. We did not know.

It also took a while to learn that people can spread the virus without showing symptoms. Experts are still debating how common asymptomatic (or presymptomatic) spread is, but we now know it can happen. Most of the reasons for using masks are to prevent the spread of a virus that you may not yet know is present.

The presence of a mask

The shortage of personal protective equipment for medical workers has been and remains. If anyone needs a mask during a pandemic, it is them. Health professionals come in contact with people who have (or may have) COVID-19 and they can pass it on to others. For their own health, and for the health of patients and society, it makes sense to prioritize healthcare professionals.

This is why, in an interview on March 8 , Dr. Anthony Fauci said that “people in the United States should not be wearing masks right now.” In the video, he goes on to say that wearing a mask is not harmful, but “it does not provide the ideal protection people think,” and that widespread wearing of masks could contribute to a continuing shortage.

All of this was true and remains true. Since then, skeptics about masks have been sharing this clip to either give people an idea that masks are not currently recommended (hiding the fact that the clip is old), or to make Fauci or the CDC look hypocrites. But the basic facts have not changed.

Cloth masks changed the balance

If medical masks are not available, are cloth masks sufficient? This is an issue that policymakers and health organizations have been debating for weeks.

There is still no definite answer. Cloth masks are not as good as medical masks, but they probably do provide some protection. Will society as a whole be better off when wearing masks is common? This is also not yet clear. Fewer people are likely to breathe out droplets of the virus. People probably don’t make the situation much worse by touching their masks or getting too close to others, mistakenly believing that masks are protecting them.

As much as we would like all our decisions to be based on science, this decision is only a judgment. One lucky change is that we have been able to manufacture and distribute a huge number of cloth masks. People who sew masks for themselves and their friends; sewing companies began to produce them. Before long, getting a mask wasn’t that hard, and it wasn’t that hard to expect people to be able to get one.

Here’s what hasn’t changed

Throughout this timeline, several things have been true and remain true:

  • Both cloth and surgical masks are most useful as source control (for an infected person) rather than protecting you from other people.
  • Cloth masks do not work as well as surgical masks.
  • There is still a shortage of surgical masks and respirators (N95), so if you are not a healthcare professional it is probably best to stick with cloth masks.
  • Masks are not ideal protection and only make sense in addition to distance and other protective measures.

So even though the mask recommendations have changed, all the important things remain true. You should still stay at home when you are sick and keep as far away from people as possible. In this time and place, it makes sense to wear a cloth mask when you cannot keep your distance from other people. And if the rules change again, don’t be surprised. We should expect the rules to change as we learn more and as the situation changes.

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