COVID-19: WHY WE SHOULD ALL WEAR MASKS — THERE IS NEW SCIENTIFIC RATIONALE

The official recommendation in the United States (and other Western countries) that the public should not wear face masks was motivated by the need to save respirator masks for health care workers. There is no scientific support for the statement that masks worn by non-professionals are “not effective”. In contrary, in view of the stated goal to “flatten the curve”, any additional, however partial reduction of transmission would be welcome — even that afforded by the simple surgical masks or home-made (DIY) masks (which would not exacerbate the supply problem). The latest biological findings on SARS-Cov-2 viral entry into human tissue and sneeze/cough-droplet ballistics suggest that the major transmission mechanism is not via the fine aerosols but large droplets, and thus, warrant the wearing of surgical masks by everyone.

The surgeon general tweeted: “STOP BUYING MASK, they are not effective…”. The Center for Disease Controls (CDC) states that surgical masks offer far less protection than the N95 respirator masks (which also must be perfectly fitted and only professionals can do it). The CDC recommends that healthy persons should not wear masks at all, only the sick ones. These guidelines are not rooted in scientific rationales but were motivated by the need to save the valuable masks for health professionals in view of a shortage. But they may have had unintended consequences: stigmatizing those that wear masks in the public (you are a hoarder, or you are contagious!)

Contrast this with the cultural habit, the encouragement, or even mandate to wear masks in Asian countries — which have now “flattened the curve” or even have had a flatter curve from the beginning.

Sure, surgical masks, and improperly worn N95 respirator masks, do not offer perfect protection. But if the stated goal is to “flatten” the curve (as opposed to eradication of the virus), we have to abandon the black-and-white thinking, and embrace shades of grey. We cannot any longer claim that masks “are not effective”. We cannot allow the perfect to be the enemy of the good. What if a however partial protection afforded by leaky surgical or even self-made masks reduces transmission probability to an extent that is similar to that of the recommended (equally imperfect) distancing by more than 6 feet from each other or “not touching your face”? It could then double the impact of non-pharmacological intervention (NPI) on flattening the curve (FIG. 1).