Masking in the light of a pandemic

In light of the article published today on CBC, within which Dr. Theresa Tam (the top dog at the Public Health Agency of Canada: our chief public health officer) has reconsidered her previous position, and now come out in favour of cloth masks for public usage, I figure its time to bring a little science into the discussion.

It’s a very odd time in history. We are, for the first time in our lives, dealing with a worldwide health crisis. One that is shaking our societies and their fundamental beliefs to the core. Things are changing, and doing so very quickly. Recommendations from doctors, governments, and scientists are constantly changing and it is hard to keep up with everything we are supposed to be doing or not doing. Our lives have been upended, and we are facing a wealth of uncertainty.

So what are we supposed to be doing? Me? I spend a lot of time crying in the bathroom to my baby succulents. Between the emotional breakdowns, I’m trying to continue the work on my thesis and take care of the kiddo (thankfully, as a scientifically minded ,12 y/o introvert, they are taking it all in stride). But specifically in relation to C19 (covid-19, the novel coronavirus for anyone who has been living under a rock the last couple of months) I am staying home. I’ve been home since the beginning of March, and yes I’m going stir crazy, thanks for asking. But it’s not just about me. I am self-quarantining for us all, and yes, that carries with it myriad mental health risks, but right now the physical risks for many outweigh my personal mental health load.

Self-quarantine is the most important thing we can be doing right now. It is vitally important that we shelter in place. And yes, I am well aware of the classism present in the idea that this is possible for all people. I am oh so vitally aware and the inequities of our current social and political system pains me a great deal. But for those of us with he privilege to be able to do so, it is VITAL that we do. Not sure what is okay in terms of quarantine? Take a peek at the visual below:

Now, while I know many of you reading this will be able to shelter in place without great hardship due to the many services being offered (like door to door delivery, curb side pick up, and free shipping or drop off) there are many people who don’t have that capability. Like, for example, the people doing said deliveries or those working in the grocery industry or supplying said industry via sales or manufacturing. So, for everyone who cannot stay home because they are considered essential (and no, don’t get me started on the fact that our “essential” workers should be given choice in whether or not they risk their lives or families or that they should be being compensated hugely for doing so should they choose to) the new recommendations in both the US and here in Canada are now to be wearing cloth masks.

This is one of those recommendations that has changed, and done so recently, reflection a complete 180 on behalf of doctors and scientists and governments. These kinds of turn arounds can be confusing, and is one of those areas where I believe many of us struggle in knowing what and who we can trust. At the same time? This is one of the things I love about science… we can change our position based on the best information we have. So when we know better, we can begin doing better – and yes, that sometimes means we do an about-face as Dr. Theresa Tam has done.

The article published by CBC News can be found at https://www.cbc.ca/news/politics/non-medical-masks-covid-19-spread-1.5523321. And it includes references to the many studies which Dr. Tam took into consideration when making her new recommendations.

There is a study which has been floating around, and is being used to promote the idea that home made fabric masks should not be used can be found at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4420971/, and it can seem rather damning when reading it without some history and background information. The issues with referring to this publication in terms of the use of fabric masks in the public sphere, is that it was a study done within hospitals and of medical professional use. And there is no doubt at all, that hospital and medical staff should continue to have access to the current recommended disposable masks. All of these masks should be being diverted to hospitals, clinics, and veterinary practices as that is where the greatest need and risk is present.

It is clear that cloth masks within these illness laden environments are not nearly as effective as the currently recommended medical appliance masks. However, the control group were widely using these medically recommended masks thus the control group should be disregarded. In a proper control group, no masks would be used, however that would breach any and all ethical guidelines for human endangerment. So the only two colours which should be considered on this graph are the cloth masks and the medically rated masks. And it is clear that the medical masks provided greater protection IN THIS STUDY. That said: no one study should be considered in a vacuum and it must be considered on its individual merits amidst greater context. And one bit of context that needs to be addressed is the usage of the cloth masks and their treatment by hospital employees/study volunteers.

Volunteers were only provided with minimal cloth masks, and very little in the way of instruction on their use and maintenance. The medical masks are what they were trained to use, and they discarded them on multiple occasions daily. The cloth masks were worn all day, and then hand washed between wearings. That is not going to stand up to the intense usage in a hospital situation. Having an adequate number of cloth masks, with proper training on their use and cleaning would likely have had an impact on the results.

So what does any of this have to do with the recommendations for the public? Not much. But its important to know the research being done in order to make an informed choice for yourself and your family. A cloth mask is going to provide some protection, enough in fact that it is being recommended that anyone in public spaces wear one. Considering we can spread the virus when we are not exhibiting symptoms is part of why this spreads so quickly. Before we even know we are sick, we are spreading it rapidly and wildly. Wearing a fabric mask helps protect those around you, and is something we need to be doing.

Now, there are definite right and wrong ways of making or handling your mask. Items that are great to use in making your own are things like hypoallergenic pillow cases, and t-shirts, or anything with a high thread count folded and sewn into multiple layers. But even a bandana folded and secured with hair elastics will do the trick. Want to ensure added protections for yourself? Utilize things like vacuum bags, furnace filters, and other household items designed to reduce allergens from circulating in your home. These can be stuck between the mask layers. Additionally, and arguably even more important than the mask material and construction itself, is the need to avoid handling your mask.

Try your very best not to touch your mask after putting it on. Once you have completed your necessary tasks and have returned home, strip off your mask by the straps. Avoid touching the exterior surface! And immediately wash it along with your hands. Just as hand washing with soap for at least thirty seconds will kill the germs on your skin, it will do the same for the germs your mask has gathered.

Homemade fabric masks are just one small thing we can do to safeguard the people we care about, and those we build community with. No, they aren’t as effective as medical grade masks, and they can give some people a false sense of security (which may encourage certain individuals to take risks they might not otherwise), but when used correctly and with thought and intention, they can help limit the spread and thus – as we have all become all to used to hearing – flatten the curve.

So yeah… the science may not be black and white, it may not be easy, and it may be evolving and changing at a rapid pace. But know that people like Dr. Tam are doing their best to evaluate the situation and make decisions that will protect Canadians as best they can. She is considering the science, reading the papers, and making her recommendations based on the best available information.

Be safe! Take precautions! And for damn sure, if you are one of those who has the choice to do so, be responsible and shelter in place. We are in this together, we need to protect the most vulnerable amongst us. Our measure as a society is not in how profitable our businesses are, but in how we treat and protect those who need our care, empathy, and compassion. We may screw that up a whole lot of the time, and the best way forward is often obscured and difficult to see, but this is one of those rare times where we know exactly what we should be doing. So if you can? Stay the hell home!