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The ongoing dialogue over masking has, too often, = degenerated into feuding. It’s unfortunate that one public health pandemic tool has become politicized and polarizing.
First of all the evolving science on masking has been misquoted and requoted by laypersons and experts.
The authors of “Universal Masking in the COVID-19 Era,” published last year by the New England Journal of Medicine, have worked to clarify the position they took on masking in public settings. The authors intended to push for more masking with their article — however their intent was altered by the deletion of by an important sentence as their piece was shared across social media channels. Opponents of masking seized on this sentence:
“Wearing a mask outside health care facilities offers little, if any protection from infection.”
Those opponents have ignored the author’s following sentence:
“This applies only to passing encounters in public spaces, not sustained interactions in closed environments.”
Public settings are quite varied — they range from walking in our own quiet downtown Wilmington, with plenty of space for staying more than 6 feet from our fellow neighbors or having just hopped off Amtrak to visit our neighbors in crowded New York City’s Times Square, where we bump each other as we walk. Sitting in church worshiping and listening to the choir next to our fellow parishioners; enjoying a concert, sitting next to unknown concertgoers; sitting on the bus for 45 minutes on our ride to work; and working with others or attending school for 6 or more hours daily are all very different public settings. These public activities provide opportunities for longer and closer interaction with the respiratory exhalations of each other; including those knowingly or unknowingly infected with COVID-19.
There is consensus and evidence-based science on masking in healthcare settings. The answer to masking in public settings continues to evolve during the ongoing COVID-19 pandemic. We have learned some things that can be applied now if we all take a deep breath.
An important study published last year in The Lancet, titled “Physical Distancing, face masks, and eye protection to prevent person-to person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis,” drew on 172 studies from 16 countries and 6 continents. The data demonstrated that use of face masks — N-95 or similar, surgical masks and 12 to 16-layer cotton or gauze masks — did result in reduction in infection risk and was stronger with N95 masks.
Early in the pandemic there was a shortage of personal protective equipment, including N-95 masks. Healthcare professionals asked the public to reserve those masks for our frontline workers who did not have enough to protect themselves and at the time we did not yet have a vaccine. Public health practitioners were innovative and suggested cloth masks including homemade masks. Initially, as a public health measure, masks were recommended and sometimes mandated. We now have free, excellent, safe and effective vaccines against COVID-19 available to everyone 5 and older in the United States. Since vaccines became available, public health recommendations were tailored and vaccinated immunocompetent persons could put their masks away except in certain dense or high-risk settings.
The recent change in public health masking recommendations back to masking in public settings is due to the high transmissibility of the Omicron variant, despite vaccination and boosting. The Omicron variant is highly transmissible. Additionally, there has been a decline in neutralizing antibodies produced by the COVID-19 vaccines — though they are still proving to remain highly effective in preventing hospitalization and death. The majority of patients now being hospitalized or dying from COVID-19 are either unvaccinated or vaccinated patients who are immunocompromised.
Mask use should be community-, venue- and also time-specific.
Right now is the time in Delaware to wear your mask with ongoing high community COVID-19 transmission, as our hospitals deal with a surge of cases and deaths. Omicron is highly infectious and even the vaccinated and boosted can spread it — although thankfully it is unlikely that they will develop severe disease or die if they are immunocompetent. The good news is the Omicron surge is peaking and will pass and then it will be safe if you are vaccinated, boosted and not immunocompromised to take off your mask again.
Nonetheless, we have to get used to the fact that we may have to put our mask back on in 2 weeks or next year — the couse of the pandemic prevents us from knowing anything with surety.
We have to get comfortable living in our new normal; COVID-19 will likely become endemic at some point with occasional surges or epidemics around the world, including here in Delaware. Endemic viruses persist in a population or region at a constant rate or occurrence. An epidemic is a sudden and large increase in occurrence of disease within a population.
During COVID-19 surges like we are having now, masking — along with the obvious vaccinations and boosters — will remain one of our tools to reduce infections, hospitalizations and excess deaths. We’ve been living with endemic influenza virus our entire lives; it typically jumps up to epidemic proportions every winter and, once in a rare while, jumps up further to pandemic proportions.
No masking proponents do have some legitimate concerns such as the need for facial expressions to be seen by young children to ensure a healthy emotional state and assist in their critical early learning. And I learned from the recent op-ed by the University of Delaware college who noticed reduction in learning and interaction in the college classroom with the “conversation muting masks.”
Masks are not permanent but should be viewed as a temporary public health measure to help us all get out of this pandemic.
Carole Guy is a pulmonologist in Wilmington.
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