To Mask or Not To Mask

There's a stark difference between Asian and American cultures regarding the wearing face masks in public - embraced in Asia and shunned in America. And that difference seems to be having an effect on the control of the novel coronavirus outbreak. But before we jump into why that might be the case, I'd like to share something I witnessed on a flight to Florida in early February. 

Source: Jeremy P. Howard, Twitter

Our family was headed to Orlando to celebrate my father in law's birthday. On the flight down from Newark, we were seated behind a young Asian couple and a middle aged white man with Mickey Mouse ears on his head (we'll call him Mickey for the story). I say Asian because I don't know what ethnicity they were because their faces were largely obscured by face masks. The white man (seated directly in front of me) was traveling with a cheer squad but was seated away from the team and the rest of the chaperones. And he was very clearly unnerved by the couple seated next to him because this is what transpired.

NOTE: The couple in our story never actually coughed the whole flight.

I'm distracted by my baby when a woman across the aisle from Mickey says loudly, "Did you just take a picture of them without asking their permission?" Everyone around becomes silent. Mickey sputters something unintelligible and tenses up.

The young man turns to Mickey and pulls down his mask. "Did you just take a picture of us? Why did you just take a picture?" His English is clear and his voice is measured. Lady across the aisle says, "That is really rude. You should delete that picture." Mickey continues to try to ignore both of the people talking to him.

The young man turns to his partner and says something in another language. Then he turns to Mickey and says "I would like you to delete that picture. Why did you take a picture of us without asking?"

Mickey finally responds. "Because I'm uncomfortable. Why are you wearing those masks?"

The young man says "We are wearing these masks to protect ourselves. I'm going to ask again. Please delete that picture off your phone."

But Mickey doesn't do it. He starts playing a game on his phone and acts like the interaction never happened. The couple speak to each other in their native language for a bit and the tension dissipates some. But let's just say it was a very long and uncomfortable flight to Florida for more than just Mickey and the young couple.

1918 Newspaper Ad: Helpful Hints for Making Your Own PPE

Interestingly, the history of many East Asian cultures (like China and Japan) embracing facial coverings dates back to the 1918 flu pandemic, a time when everyone was wearing face masks.

Why didn't this fashion trend stick?

The mask wearing habit has been reinforced in Asia over time as a way to grapple with both poor air quality and pollution as well as infectious diseases like SARS and bird flu. It can also be a bit of a fashion statement. But this tradition is looked at warily (or conversely fetishized) by many in the West - leading to outbursts of xenophobia like what we witnessed on our flight to Orlando.

Currently, both the WHO and CDC do not recommend wearing masks unless: 1) you know you are sick OR 2) you are caring for someone who is sick. But some folks are beginning to question whether or not those recommendations were put in place as a way to try to discourage the rush for N95 masks that has lead to shortages for healthcare workers. The personal protective equipment (PPE) shortages are so severe that many organizations have taken to encouraging people to make homemade cotton masks to provide to employees. It's like 1918 all over again.

Source: John Burn-Murdoch, Twitter

A few days ago a lot of people started to take note of the data compiled by John Burn-Murdoch about how efforts to control COVID19 are going. There is an obvious difference in the doubling speed of the virus in countries that use masks versus those that don't - of course there are a lot of other factors at play, like differences in quarantine policies and testing programs. The fact that more general mask usage didn't stop China from experiencing rapid exponential growth of the virus is a cautionary tale - correlation is not causation, folks. Just because two things occur simultaneously, it is not definitive proof that one thing made the other happen. We need more careful analysis to separate out the truth. Only time will tell exactly how strong of an impact the routine wearing of masks has on flattening the curve of COVID19 spread. 

In the meantime, when interviewed by Science magazine (March 27), George Gao, the head of the Chinese Center for Disease Control and Prevention, said the following:

"The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role—you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others."

Sui Huang, MD, PhD of the Institute of Systems Biology in Seattle recently wrote a piece on Medium to explain this line of thinking further. Here's one of the figures from the article. It suggest that a 2007 study showed that homemade masks reduced the number of aerosol particles inhaled by two-thirds, although they weren't very effective at preventing particles from escaping into the environment. 

On Monday, Dr. Fauci (the infectious disease physician in charge of NIAID and the coronavirus task force) was interviewed on Good Morning America about the mask question. Here's a summary of what he said.

Source: Good Morning America

Sounds like a definite maybe to me. There are several well written pieces in the Washington Post, the NY Times, Wired Magazine and Politico about this topic if you would like to learn more about the push for more mask usage in the US. If you want to learn more about how to make masks to donate to our health care heroes or make for your own family, check out the Joann Fabrics website. Until next time...

Let's be careful out there.