In the first four months of the COVID-19 pandemic, masks have gone from a “don’t” to a “do.” Both the CDC and the World Health Organization now recommend that people wear masks to slow the spread of the virus.
The number of states with mask mandates like Michigan’s has grown to 28.
Robert Redfield, director of the Centers for Disease Control, reflected the change July 14. “If we could get everybody to wear a mask right now I think in four, six, eight weeks we could bring this epidemic under control,” Redfield declared.
Even conservative Republican leaders like Sen. Mitch McConnell, former vice president Dick Cheney and Fox news commentator Sean Hannity advocate masking up.
That’s a major sea change from early March, when the CDC recommended masks only for health care workers and people infected with the virus.
What has changed?
As the pandemic swept across the globe in late spring, health officials and scientists learned more about how the COVID-19 virus spreads. The newly gathered information, along with a shift in culture in the traditionally mask-averse United States, raised the status of masks as a crucial tool in the toolbox for fighting the spread of COVID-19.
However, the change in messaging has given mask avoiders and skeptics, including President Donald Trump, an obvious talking point.
“A lot of them said don’t wear a mask, don’t wear a mask. Now they’re saying wear a mask,” Trump said in an interview with Fox News’ Sean Hannity last week. “A lot of mistakes were made.”
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recently explained the shift in message in terms of supply and demand. Back in March, Fauci said, health authorities were worried about impending mask shortages that would put health care workers at risk.
“So the initial recommendation was: Don’t put masks on, because we’re going to be taking them away from health care workers,” Fauci said. “That understandably got interpreted as, we didn’t think masks were of any benefit.”
But some health officials said just that.
“The thing is, the masks aren’t effective,” Ingham County Health Officer Linda Vail told City Pulse in early March.
Later that month, Vail was still downplaying the effectiveness of masks for “civilians.”
“Wearing a mask is shown to have some limited effectiveness,” Vail said. “It’s limited, but at least it’s something additional.”
In late February, U.S. Surgeon General Jerome Adams tweeted, “Seriously people — STOP BUYING MASKS.”
Adams, Vail and other health officials worried that masks could give people a “false sense of complacency” and lead to neglect of more important anti-viral practices such as hand-washing.
“If I look at all the tools I have to protect myself from COVID-19, the mask is probably the first thing I would give up, before I’d give up washing my hands, having hand sanitizer, being able to keep space from people,” Vail said in March. “A lot of people are grabbing onto it as the be-all and end-all of protecting themselves.”
But the COVID-19 virus was still new. The CDC warned that public health recommendations might change as more becomes known about how it spreads.
Everyone knew that coughing and sneezing were the heavy artillery for spreading big virus-bearing droplets, but as spring moved into summer, a growing number of studies indicated that the virus also spreads via tiny aerosolized droplets from talking, singing, laughing, even breathing. Worse yet, the person across the table from you, talking into your face, could be carrying the virus without showing any symptoms.
In April and May, The Journal of the American Medical Association and The New England Journal of Medicine reported people getting sick after being just hanging out near people who were infected but had no symptoms and weren’t coughing or sneezing.
A CDC report found that some people, such as especially loud talkers, are “superemitters” of aerosolized particles.
Health officials began to consider the possibility that masks, while not 100 percent effective, might at least stop a significant percentage of droplets from getting out of your mouth into the air.
There’s a good reason the shift in mask recommendations was driven, not by definitive research, but by piecemeal observations and anecdotal evidence. To conduct a randomized controlled experiment would mean doing something blatantly unethical, like putting COVID-19 patients in one room and healthy people in another, with an air vent between.
As the pandemic spread, observational data mounted by the day. Double- and triple-digit COVID-19 outbreaks resulting from choir practices around the country, and at loud-talking bars like Harper’s in East Lansing, added weight to the aerosolized particle theory.
The novel virus inspired some quick-draw, novel research, such as a joint project between Bavarian Broadcasting and two German universities mapping out aerosolized droplets spewing from Bavarian Radio Choir singers. The researchers used high-speed cameras, white light and carrier solutions from e-cigarettes to make the droplets visible.
The study preliminarily found that mask wearing, social distancing of 1.5 meters and good ventilation might enable choirs to safely rehearse during the pandemic.
If all of this science sounds spotty and inconclusive, it is.
Even without the authoritative ring of randomized trials, support for mask wearing mounted as summer approached, boosted by widespread observational studies like the Bavarian choir experiment and a wave of “meta-analyses” in which researchers processed data from previous epidemics.
Acknowledging the growing case for masks, on April 3, the CDC set new guidelines, recommending that people use cloth or fabric “face coverings” (not “masks”) as “an additional, voluntary public health measure.” The World Health Organization was slower to change its recommendations, but followed suit in June.
As spring moved into summer, lockdowns, re-openings and changing rules in various states offered new points of data. In June, researchers at the University of Iowa looked at the COVID-19 infection growth curves in 15 states that adopted mask mandates in April or May. They found that the curve began bending downward a week after adopting the mandate, and shrank to 2% three weeks later. By May 22, mask use may have prevented 230,000 to 450,000 Covid-19 cases, the researchers found. At an overall infection fatality rate of 1.45 percent, that’s as many as 6,500 lives saved.
On June 14, the CDC released a study of two Missouri hair stylists who had the COVID-19 virus but wore masks and didn’t pass it on to 139 clients. “Adherence to the community’s and company’s face-covering policy likely mitigated spread of SARS-CoV-2,” the summary concluded.
Other researchers collected the data available and ran models of various possible outcomes. According to the University of Washington’s Institute for Health Metrics and Evaluation, more than 45,000 deaths could be prevented if 95% of Americans wore face masks in public.
Meanwhile, a wide range of polls showed a majority of Americans support wearing masks. Many put an American spin on the bland uniformity of mask wearing by choosing fanciful fabrics and using them as a vehicle for self-expression.
“Mask wearing is just not something that we’ve ever done as a culture in the United States,” Vail said. “As more businesses open and more employers require it of employees, that will normalize it a little bit more.”
The notion of wearing masks to protect others, not necessarily the wearer, was a confusing idea for many people and it took time to sink in.
The story came full circle when Adams, the surgeon general who tweeted “Stop buying masks” in March, made the message loud and clear at a press briefing earlier this month: “Please, please, please wear a face covering when you go out in public. It is not an inconvenience. It is not a suppression of your freedom. It actually is a vehicle to achieve our goals.”