Why should we wear a mask

Given that we are nearing the one year anniversary of the first COVID-19 case (November 17, 2019), there are some who continue to ask if face masks help slow the spread of the coronavirus (SARS-CoV-2) that causes COVID-19.

The answer is an unequivocal yes; face masks combined with other preventive measures, such as frequent hand-washing and social distancing, help slow the spread of the virus.

These discoveries led public health groups to do an about-face on face masks in April 2020. The World Health Organization and the U.S. Centers for Disease Control and Prevention (CDC) now include face masks in their recommendations for slowing the spread of the virus. The CDC recommends cloth face masks for the public and not the surgical and N95 masks needed by health care providers. The same is true for the Public Health Agency of Canada led by Dr. Theresa Tam.

So why are so many people still resistant to wearing a mask when they enter public domains? Why have governments been so reluctant to mandate what is most likely the more proven measure that can save thousands of lives? Why are some businesses in many rural communities refusing to comply with some saying it is their right to refuse? Some even claim that COVID-19 is a hoax!

What finally convinced public health officials to change their guidance in favour of masks were rising disease prevalence and a clearer understanding that both pre-symptomatic and asymptomatic transmission are possible even common. Studies have found that viral load peaks in the days before symptoms begin and that speaking is enough to expel virus-carrying droplets.

A recent study published in Health Affairs on June 2020, for example, compared the COVID-19 growth rate before and after mask mandates in 15 states and the District of Columbia. It found that mask mandates led to a slowdown in daily COVID-19 growth rate, which became more apparent over time. The first five days after a mandate, the daily growth rate slowed by 0.9 percentage-points compared to the five days prior to the mandate. At three weeks, the daily growth rate had slowed by 2 percentage-points.

Other studies have looked at coronavirus deaths across 198 countries and found that those with cultural norms or government policies favouring mask-wearing had lower death rates. For example South Korea diagnosed its first case of COVID-19 on the same day the USA diagnosed theirs. South Korea, where masks are mandatory and a cultural norm, has reported a total of 350 deaths. The USA has reported almost 200,000 US citizens dead from COVID-19. Stated another way, South Korea has seven deaths per million whereas the USA has 593 per million. Who is doing better?

If that is not enough, two compelling case reports (CMAJ April 2020) also suggest that masks can prevent transmission in high-risk scenarios. In one case, a man flew from China, and subsequently tested positive for COVID-19. He had a dry cough and wore a mask on the flight, and all 25 people closest to him on the flight tested negative for COVID-19. In another case, in late May, two hair stylists in Missouri had close contact with 140 clients while sick with COVID-19. Everyone wore a mask and none of the clients tested positive.

Researchers predict that 80 per cent of the population wearing masks would do more to reduce COVID-19 spread than a strict lockdown and would save thousands of unnecessary deaths and permit our economy to function. It has been opined that wearing a mask is not only a protective health measure but an inoculation against a major disruption of our economy.

Masks should not be worn by children younger than 2 years old, as well as anyone who has trouble breathing, and anyone who is unconscious, incapacitated, or otherwise unable to remove the mask without assistance. Those who feel claustrophobic need to weigh the risk to themselves or others of not wearing a mask.

Then there are the libertarians who are convinced that wearing a mask limits their freedom. It is important to point out that society imposes limitations on free will when the greater good is at stake. Bicycle helmets and speed limits are two that come to mind. The defenseless elderly, the person post-organ transplant, the person who must use immunosuppressive drugs for cancer, those with compromising respiratory conditions all need the consideration of their neighbours and friends if they are to be kept safe. For them COVID-19 can be a death sentence. Wearing a mask shows these people that we care for their well-being.

The premier of Quebec recently announced penalties for people failing to comply with mask regulations. He is running ahead of the blow given what is happening in British Columbia, Alberta, Ontario and his own province. Recent surges in Covid case numbers suggest that Canada may be entering the much dreaded second wave. Dr. Anthony Fauci, head of the National Institutes of Health in the US, issued a warning last week that Americans need to ‘hunker down’ this fall and winter as COVID-19 pandemic will likely worsen.

In sharp contrast to Quebec’s Premier LeGault, the Nova Scotia Minister of Health, Randy Delorey, told reporters the province doesn’t plan to take a “strong-arm approach to enforcement.”

Delorey said the directive about wearing masks is part of the public health order. He said failure to adhere to the order could result in “fines and other provisions,” but added there are no plans to enforce it. As a result, human nature defaults to the path of least resistance and so we have some convenience store owners and other public establishments endorsing (and some actively discouraging) lax practices on masks both for their workers and patrons.

We have reached a pivotal point where Nova Scotia will be defined as a real star coming out of this pandemic with an infection and death rate that are the envy of the world, or we will drop the ball and adopt a cavalier approach based on “out of sight out of mind” thinking. We have been fortunate to date but given our demographics and our already stretched health system, the tipping point will come when the annual flu and the surge in COVID-19 converge over the next few months.

Getting your annual flu shot, wearing an appropriate mask in the appropriate way, and practicing the other tenets of washing one’s hands, and social distancing will reduce our communities’ viral load.

Citizens of this province need to demonstrate their resolve to be compliant with public health recommendations by refusing to patronize establishments who are not following the guidelines, by insisting that staff in these establishments honour both the spirit and the letter of the guidelines.

We need to continue to be “Nova Scotia Proud” to preserve our place as one of the better performers in this pandemic. We each have to do our best to wear masks in public.

Dr. Bob Martel

West Arichat