The Challenges of Community-Masking

On Friday, the White House Coronavirus Task Force and the US Centers for Disease Control and Prevention (CDC) released recommendations for use of cloth face coverings. The debate surrounding large-scale community facemask recommendations has been heating up in recent days and for many, there was a need to feel as if we were doing something.

The CDC’s recommendations focus on wearing cloth face coverings in public settings that don’t allow for social distancing and especially in those areas of increase community-based transmission. The agency emphasizes that social distancing is still the most important tool in this outbreak and that face coverings are only piece to infection control measures. Moreover, the CDC emphasizes that surgical masks and N-95 respirators are critical supplies for health care workers and that the recommended cloth face coverings are not of the same quality.

Many have noted that these recommendations are likely a more political move, to help address the public concern for doing more but also ensuring safety. “With the new guidance, the federal government is trying to walk a line between acknowledging the evidence for public mask use—as well as many people’s desires to take more action to combat the coronavirus—and avoiding further strain on available PPE [personal protective equipment] supplies.” With the constant stream of information on masks, it’s easy to understand why society has fixated on the topic.

However, investigators have found mixed data on broad mask use. Overall, the push has really been focused on use by those with symptoms. Since there have been cases of asymptomatic carriage though, many have pushed for broad mask use as a precautionary measure.

For so many though, it seems that masks are worn as a comfort measure and a way to feel as if they are doing something preventative. Researchers recently noted that with the recommendations of cloth face pieces, there comes a need to educate on their inherent limitations. “Cloth masks are ineffective as source control and PPE, surgical masks have some role to play in preventing emissions from infected patients, and respirators are the best choice for protecting healthcare and other frontline workers, but not recommended for source control. These recommendations apply to pandemic and non-pandemic situations.”

From the infection prevention standpoint, these recommendations pose a challenge. Despite recommendations to stay home, use hand hygiene, and all the other basic infection control measures, it seems as though many people want a more tangible, visual measure for prevention and control. Masks fit that bill.

Unfortunately, this also creates a situation in which cross contamination might occur as even the most trained health care workers can slip when donning or doffing their masks. Moreover, masks are not the sole mechanism for prevention—they are a means to help reduce transmission from infectious people. It is imperative that people continue to perform social distancing, use hand hygiene, avoid touching their face, and environmental disinfection measures.

There are many links in the chain of infection and masks offer one piece. The recommendations for cloth face covers address the public’s need to do something more and feel more proactive in the prevention efforts. To the average citizen, social distancing doesn’t always feel like you’re doing much whereas a mask appears more proactive. It is important to emphasize that these are imperfect, limited protection measures. For many working in health care and public health, it is important we still encourage patients to follow the other recommendations and not to solely rely on masks as a way to protect themselves.

For the general public, these recommendations seek to contain spread by having symptomatic or asymptomatic people wear them while still emphasizing that social distancing is a key method for prevention. Much like the education on properly donning, doffing, and cleaning cloth face covers, it’s important that we take the time to explain the nuances of infection prevention measures and that it’s no singular step, but rather many that help break community transmission.