Some straight talk about masks

Let me start by saying this:  I was sewing masks at a time when fabric was still available at Walmart.  Heck, I even was able to purchase some elastic, though it was not the right kind of elastic for making proper masks.  After the fabric aisle was cleared out, I solicited fabric through Nextdoor-dot-com and eventually acquired a couple 300-thread-count neutral-color bedsheets to sew, and gave away masks to my parents’ assisted living community, to Clearbrook, to various people in the neighborhood, and a food pantry, and then sewed a batch for the family, using strips of fabric as ties until elastic reappeared in stores.

I knew that a fabric mask was not the same thing as a fitted N95 mask, let alone the full protective gear of a medical worker, though I did take care to sew masks with two layers of 300-thread-count fabric and a pocket for a filter, and even got an air filter (the accordion-style material) with which to cut out filters, though I never actually used them.  I was persuaded early on that the face masks would go a long way towards preventing wearers who were infected from infecting others, and that it particularly mattered for those who were asymptomatic or pre-symptomatic.  I also thought there was a good chance that face mask wearing would protect the wearer to at least some degree, because severity of illness did seem to be based, in part at least, on extent of viral load.  And, yes, we all saw the graphs which plotted case rates by country and compared countries which had a practice of masking compared to those which did not.

Did any of this prove the utility of face masks?  No.  And certainly, Dr. Fauci and the CDC were saying early on, “don’t wear a face mask.”  Not, “don’t hoard N95 face masks,” but simply, “fabric face masks are not effective.”  (You can see some of what I wrote here at Forbes, and here and here at my personal blog.)  In fact, a recent FOIA data release revealed that the CDC’s reversal was based on little more data than that very observation of “Asian countries with reduced cases wear face masks.”

But, yes, I continue to send my sons to school wearing face masks.  In the case of my older son, the students are separated so aggressively that this alone places them at reduced risk.  (They are separated too aggressively, but that’s another story.)  In the case of my youngest son, at a Catholic school, they are not spaced 6 feet apart; they are spaced at whatever distance the room they’re in allows.  They use cohorting (which isn’t necessarily classroom-wide; when they rotate out of their homeroom, the two cohorts per grade level sit in the two halves of the classroom with spacing in-between).  And they wear masks.  And, to the best of my knowledge, these practices, along with quarantining after a student has a positive diagnosis, has prevented any spread within the school community.

At the same time, there are increasing reports of double-masking recommendations — which can range from a fairly reasonable approach that a fabric mask helps ensure that a disposable nonwoven mask fits snugly and is one option alongside wearing a mask with a filter or, generally speaking, moving away from the “even a bandana is OK” approach, to an unthinking “one mask good, two masks better, three masks best.”  Reportedly, a school in the area has even notified parents that “double masking” will be mandatory after spring break.

There are also reports of mask mandates in ways that make no sense:  mask-wearing outdoors far from any potential breathers, mask mandates for athletes even when far from other competitors (gymnasts, for instance).

And — let’s face it, there are voices all over twitter who compare the virus trajectory in states with and without mask mandates and proclaim that it has had no effect.  In some cases, the infection rates were already declining when the mask mandate was implemented and it did not drop more precipitously than before, and in others, it continued to escalate or cases rebounded even despite the mandate.  There are contrary voices who say it’s not a matter of legal mandates but that compliance varies, or that, to whatever degree infection rates increase, they would have been even higher without masks.

But — well, let me pause here and ask readers to raise their virtual hands in answer to this question:  “are you familiar with the concept of the ‘cargo cult’?”

During World War II, American troops in the battle to oust Japanese troops landed on remote Pacific islands with uncontacted tribes who observed the substantial supplies that arrived by plane.  They had no understanding of the outside world of technology and manufacturing, however, and believed the supplies were gifts from the gods which they could receive by following the right ritual, which involved, for example, clearing a path for a runway.   (Yes, I don’t have the specifics correct; this is from memory.)  This practice of trying to mimic what they thought were the rituals that would get them these goods were called Cargo Cults.

And it is possible that mask-wearing is a form of Cargo Cult, that we’re copying a superficial practice of the Japanese and Taiwanese which is really only a small part of a bigger picture, and without that bigger picture we are doing little more than constructing these jungle runways.

All that being said, at this point, to the best of my knowledge, we do not have comprehensive studies that provide proof in one direction or another.  To be sure, there are many studies, but they come to conflicting conclusions or are deficient in their methods.  I understand the concerns of those who oppose it, which range from specific-circumstances concerns such as the effect on athletes expected to train with a face mask to the troubles of hearing-impaired people when voices are muffled to the socio-emotional development of young children who can’t see facial expressions, to a broader concern that face mask advocates will lose sight of an end point and will argue for face masks as a permanent feature of life to protect us from colds, the flu, etc.

But, in the absence of slam-dunk studies one way or the other,  it still seems to me to be more likely than not that face mask-wearing does substantially reduce transmission, and on this basis, I would support continuing to require masking in schools and in public places until that point at which, in a given area, all adults who wish to be vaccinated have the opportunity to do so.

Why not “until everyone has been vaccinated”?  Because approval for children will be delayed but the risk children have of serious illness is far, far lower than adults, and that the greatest concern with children is the risk, however little it has been quantified, that they will infect others, and because, ultimately, there has to be an endpoint.

face masks in progress

 

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