OPINION: Masks could be part of the solution

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Colombian designer makes masks against covid-19 1:45

Editor's Note: Jennifer Lee is a CNN Medical Analyst and Associate Clinical Professor of Emergency Medicine at George Washington University. Follow her @DrJenLee. The opinions expressed in this column are his. See more of the Opinion section on CNNE.com.

(CNN) - Should we all wear face masks?

From the Centers for Disease Control and Prevention (CDC) they say no. However, in China, South Korea, Taiwan, Hong Kong and the Czech Republic they say yes. In some parts of China, for example, it is mandatory to wear a mask in public. Those who do not do so are detained by the police and can be fined and even arrested. In South Korea, Taiwan, and Hong Kong, health authorities also advise that citizens wear face masks when they are around other people, especially in crowded places (i.e. on the subway).

However, here in the United States the CDC's guide remains: "If you are not sick, you don't need to wear a mask, unless you are caring for someone who is ill and cannot wear a mask." In addition, the CDC continues to state that "masks may be in short supply and should be kept for health workers." In line with this, the general director of health tweeted in February: "Seriously, stop buying masks!"

But as positive cases of covid-19 continue to rise in the United States, a growing number of health experts such as Tom Inglesby, director of the Johns Hopkins Center for Health Safety, recommend wearing masks as a means of preventing proliferation. of the virus. Additionally, the Trump administration is now reconsidering its stance on wearing face masks in public as a preventive measure. Anthony Fauci, director of the United States National Institute of Allergy and Infectious Diseases, said the White House is in a "very active discussion" about whether to recommend citizens wear face masks in some circumstances.

So are the masks really unnecessary or is there not enough?

Since we do not have enough face masks, we must prioritize the supply to those with the highest risk of infection, such as health workers and emergency teams. But we should also be honest with what we tell healthy citizens, to find out if the idea of ​​not wearing face masks in public is really supported by science or is it just an attempt to prevent panic-based shopping and preserve a limited resource for high-risk groups.

The reality is that when citizens are in public spaces, the proper use of face masks can benefit public health. In addition, it should be noted that experts warn that if a mask is used incorrectly, the user may be more susceptible to the virus since he can touch his face more frequently.

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In the United States they must seriously consider the most widespread use of this protective equipment, in addition to hand hygiene and social distancing.

What does science tell us about masks?

We know that the virus is transmitted mainly by respiratory drops produced when an infected person coughs or sneezes. Drops can also be generated by speaking, laughing, singing or just exhaling. They can fall into the mouth or nose of people who are nearby or be carried to the lungs, so people have been asked to stay at least two meters away from each other.

It is also possible that infected droplets are transferred to surfaces and then spread by contact when another person touches the surface and then brings their hands to their eyes, nose, or mouth. This is why public health officials have emphasized both frequent hand washing and surface cleaning.

Institutions like the Mayo Clinic suggest that when a person infected with a viral respiratory illness wears a mask, it protects others from becoming infected because it prevents the drops from reaching other people. On the other hand, we have seen that people can become infected with coronavirus and spread even when they have no symptoms. In fact, it is likely that a significant number of people were infected by those without symptoms who were unknowingly spreading the virus. If they had worn masks before feeling sick, could the spread of the virus have been minimized?

Also, let's be realistic about how easy it is to be less than two meters away from others when we are in a supermarket or on public transport. Wouldn't it be worth having an extra layer of protection? While brief encounters involving minimal interaction with other people may not be high risk, why have we emphasized handwashing and surface disinfection more than facemasks, when this virus is primarily transmitted through of respiratory drops?

Scientific evidence is diverse regarding the effectiveness of masks in containing viral spread when used by healthy people.

READ: The United States has more than 200,000 cases of coronavirus. And carriers who don't feel sick are driving the spread

Some studies have not found a benefit in this. However, many were limited because people did not wear the masks as often as they should. In contrast, the CDC's own 2017 guide on how to prevent pandemic influenza in the community states that “the use of face masks by healthy people could be beneficial in certain situations (for example, when people at high risk of Complications cannot avoid crowded environments or parents care for sick children at home.) "In addition, the use of masks by healthy people could also reduce autoinoculation (for example, touching the nose with the hand after touching a contaminated surface)".

The same logic should be applied to prevent the spread of the coronavirus.

We can also see the effective measures that were taken to delay community transmission of SARS in 2003, as an example of the steps that need to be taken today. A study in Hong Kong found that wearing a mask regularly in public places, frequent hand washing and disinfecting the home was effective in limiting the spread of the virus in the community.

Another study conducted in Beijing established that those who wore a mask outside their homes had seen a 70% reduction in the risk of being diagnosed with SARS during the outbreak, compared to those who never wore a mask.

That brings us back to scarcity. If wearing masks could help reduce the spread of the virus, how do we get more?

Taiwan is a role model. Like the United States, Taiwan was in high demand for masks. Before the pandemic, most face masks sold in Taiwan were made elsewhere, and more than 90% came from China. Last month, the government massively increased private manufacturing so that Taiwan can make millions of masks a day and have enough N95 masks and protective suits for all of its medical personnel.

The Taiwanese government also made it easier for people to buy surgical masks, creating a centralized system to administer and ship them (each selling for less than $ 0.25).

Through this system, more than 2.3 million people were able to buy 7 million masks in the course of a single week. It is noteworthy that Taiwan, a densely populated country with 23 million people, about 128 kilometers from the Chinese coast, as of March 31 has had only 322 confirmed infections and five deaths from coronavirus.

And Taiwan, for the most part, did not close schools or businesses and did not implement a blockade either.

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In an effort to protect citizens with minimal disruption to their daily lives, the United States government must use all authorities, resources, and funding sources to rapidly manufacture or purchase face masks and ensure that they are distributed first, rationally, to the highest risk groups across the country. But then, perhaps we should focus our attention on helping the general public gain access to masks. If Taiwan can increase private sector manufacturing in one month, the United States can also do so.

What can we do in the meantime?

While there is limited research on the effectiveness of homemade face masks made from household materials to block the transmission of drops, some studies show that it is better than wearing nothing. The next time you go to the supermarket, you may want to bring some personal protective equipment at home.

United States masks