To mask or not to mask, that is the question

Last updated date: 13-Dec-2021

CloudHospitalCoronavirusCovid 19General Health

5 mins read


To wear a mask or not has been a divisive dialogue in some countries, especially those such as the United States, where individual freedoms are highly valued, at times even at the risk of the collective good. According to the CDC, face masks are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the mask coughs, sneezes, talks, or raises their voice. This is called source control. This recommendation is based on what we know about the role respiratory droplets play in the spread of the virus that causes COVID-19, paired with emerging evidence from clinical and laboratory studies that shows masks reduce the spray of droplets when worn over the nose and mouth. COVID-19 spreads mainly among people who are in close contact with one another (within about 6 feet), so the use of masks is particularly important in settings where people are close to each other or where social distancing is difficult to maintain. However, many people still have doubts about the actual efficacy of wearing masks in the fight against COVID-19. Most who doubt are individual citizens, some are from the medical field and some are from the viral research field. They have their reasons, of which some of the often-mentioned ones will be discussed here.

While proponents of mask wearing adhere largely to the guidelines and reasonings promulgated by health organizations such as the WHO and CDC, those who oppose have a few reasons often listed as follows:

“Wearing a mask cannot stop the tiny virus coming into the body since masks have huge gaps on the sides”. Well, depends is the answer ( as with most things in life). Masks worn commonly in countries like Taiwan and South Korea do fit tightly around without much air gaps. Masks labeled KF94 in South Korea are equivalent to P2 filtration (EU standards) and filter out 94% of particulate matter. Some novel materials used such as nano filters, actually filter out up to 0.1-micron sized particulates, which is even higher filtration than HEPA standards often associated with air filters, which filter up to 0.3 microns. With a facial form fitting design, these masks do not have the large gaps around the sides.

“Wearing a mask is dirty as one can often touch the mask during use and while wearing it with dirty hands”. Well, that is why one should first clean the hands prior to wearing one. And that is exactly why some people wear masks inside a car, as they prefer to keep them on in order to not constantly touch the mask and end up with a dirty mask.

“Wearing a mask inhibits air flow, which can damage the body due to low oxygen intake”. This is definitely true with traditional melt blown fiber masks standardized by companies such as 3M and Honeywell, however, modern masks made in Korea have much higher air flow, with some barely noticeable and very comfortable to wear for prolonged periods.

“Wearing a mask will not stop the virus intake”. This is yet another contested point as the notion of viral load is key according to some researchers. In other words, yes, a mask no matter how good will not stop 100% of the virus coming inside the body. However, the concept of viral load is important to note. Just like a battle against a formidable enemy is easier to win if the attackers are coming to fight in a narrow lane rather than in a wider formation (think Battle of Teutoburg Forest by Arminius against the Romans or Sparta against Persian attack), many people with normal immune systems may actually fare much better fighting against a miniscule viral load rather then a large load at once. Some even surmise the low viral load provided by wearing a proper mask can act like a low dose vaccine and facilitate immunity in healthy non-immune compromised persons. 

Finally, some say “wearing a mask is an assault on individual freedom”. Yes, that is true to some extent, but if one believes to be part of a society, sometimes the greater collective good should be considered even at the temporary cost of individual freedoms.

The facts are starkly different in places that weigh in individual freedoms far more than collective safety. If we peruse the numbers from countries like Taiwan, South Korea and the United States, all other factors assumed to be similar (although in reality, all other factors such as obesity, heart conditions, access to healthcare are different), those nations that adopted the proper mask use early on have a visible advantage. Korea with a population of 52 million, only has 303 deaths attributed to COVID-19 while the USA with a population roughly six times that of Korea, has almost 163K deaths, or about 90x the deaths when population adjusted. Taiwan is even more incredibly low at only seven deaths in the entire nation.

In closing, as with many things in life, the devil is in the details. But, to summarize, if one wears a well-made mask that is comfortably breathable yet functional (as with KF94 masks and similar masks), it can significantly help lower the societal costs of having to undergo total lockdowns.

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