Mask on? Mask off?

Sean Rameswaram: It's Friday, April 3rd, 2020, and Fridays should still count for something. I'm Sean Rameswaram, and this is your coronavirus update from Today Explained. There are now more than a million cases of this novel coronavirus in the world. Nearly 4 billion people, half of this thing we call humanity, are in some form of lockdown. Things are getting real in Vietnam. They've banned gatherings of more than two people. Singapore has warned that anyone standing within three feet of someone else could spend six months in jail. Meanwhile, in the United States, several states are still lagging to get with the program at all. They don't have any stay-at-home orders in place statewide. Iowa, Arkansas, Nebraska, the Dakotas. We're looking at you. Dr. Anthony Fauci, the nation's top infectious diseases specialist, says the whole country should be staying inside. But apparently Vice President Pence says that President Trump doesn't want to tell the states what to do. Fauci is also now saying that all Americans should be covering their faces when they go out, not necessarily with a mask, but with something. A cloth, a scarf, your old Dave Matthews band t-shirt. What do you got? Fauci told Fox and friends today that this recommendation is based on new data that says that the virus can spread just when people are speaking to each other in close range. According to President Trump, the CDC is now officially changing its guidelines to say people should be wearing non-medical masks. Much more on masks in today's show. And lastly, in case you were concerned, there will be an Anthony Fauci bobblehead. According to the Associated Press, the National Bobblehead Hall of Fame Museum in Milwaukee, Wisconsin, is working on a bobblehead of Fauci, wearing a suit as he makes a motion, showing how the nation needs to flatten the curve. In case you were wondering if they'd broken our spirit yet, evidently not. Today Explained wasn't a Fauci before it was cool. 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We answered a bunch of questions in each of those episodes. Today, we're going to answer just one because it's a biggie. Hello, this is Matthew calling from Nashville, Music City. But my question today is not about the arts. It's actually about the masks that I see people using on their face. What's the deal with them? Do they do any good if you're not sick? To wear a mask or not to wear a mask. That is the question for many of us right now. Current CDC guidelines say healthy people don't need to wear a mask in public. Health authorities in Asia, where the numbers of COVID-19 cases are improving, say that Americans have it all wrong with face masks. The head of the Chinese Center for Disease Control tells Science Magazine that the big mistake in the U.S. and Europe is that people aren't wearing masks. They believe that even masks made of simple fabrics are helpful. Wearing a mask can decrease transmission by up to 50%. Dr. Anthony Fauci said because asymptomatic people may be able to unknowingly transmit the virus, they're looking at the possibility of changing the recommendations. We're starting to re-examine the possibility that if there are enough masks, should everyone be bearing masks? The president said yesterday that he could actually see a scenario where every American maybe should be wearing a mask. A lot of people have scarves and you can use a scarf. Scarf would be very good. The World Health Organization came out and said the exact opposite. We don't generally recommend the wearing of masks in public. Tonight in a stunning policy reversal, New York City joining California in urging the general public to wear non-medical face coverings to stop the virus. We're advising New Yorkers to wear a face covering when you go outside and will be near other people. And we're going to have to get used to, you know, seeing each other like this. You know, this, excuse me, this will be the look. Today, we're going to try and clear up the mask question once and for all. Joe Allen is here to help. I'm an assistant professor at Harvard's T.H. Chan School of Public Health, and I direct the Healthy Buildings program there. And Joe, what kind of building are you in right now? I'm in a closet in a row house in Washington, D.C. I'm in my new office and actually the new classroom. I'm in my car, like everybody else, making do as best I can. And this happens to be the quietest place I can find in my home. Okay, respect. Joe, you spend a lot of time thinking about air quality and how it affects our health. Let's talk about air quality and the coronavirus. Mask on, mask off. The CDC said off. Now it's saying on. People are very confused, Joe. Yeah, well, I understand that people are confused. And that's simply because the messaging coming out of CDC and this administration has been really confusing. It's been inconsistent. I mean, it was just today that CDC finally came around and gave a firmer recommendation that the general public should be wearing masks. Prior to that, they hadn't been so clear. And the rationale we were assuming was because they didn't want to take away from masks that were intended to go to frontline workers. And that all makes sense and is good and true and right. But the messaging was never there. So the public was left confused and it was an inconsistent message. It works for health care, it doesn't work for the public. So we're at the point now where they're making a firm recommendation, but right away the president undercuts that. And he says, "I just don't want to wear one myself." It's a recommendation. They recommend it. I'm feeling good. I will say that there's good news in this recommendation from CDC. They've said, use non-medical cloth masks. And that's exactly right. We cannot be using the general public cannot be using masks that are intended for frontline workers. What we're talking about here are homemade, non-medical cloth masks. And of course, there's a lot of people between us and healthcare workers. There's also grocery store workers. There's delivery workers. There's people working in Amazon warehouses and all the rest. And we're starting to see some issues there. What exactly was the reasoning the CDC provided when they gave this initial guidance? I think we talked about on the show, what we heard was, "we need to save the masks for healthcare workers." Is that the only reason they said don't wear masks? You know, I don't know their entire rationale. I'm not privy to those discussions. And I do understand that as a valid concern. And, you know, I'll tell you right now, I'm in a position where we should be wearing masks, but I've been hesitant to say it publicly because there is that fear, and it's real, is that if you tell people it helps if you have a mask and certain masks are better than others, well, the natural tendency is people to say, "well, I want the best mask to protect myself, my family, my kids." And I'm also glad you brought up the other workers. You know, I tend to call them the hidden heroes here. We spend a lot of time talking about doctors, nurses, and the frontline workers. And yes, their feats are definitely heroic and deserve the recognition. But there are a whole lot of people out there that are allowing the rest of us to shelter in place, essentially, and do this social distancing. And that's everybody from the food supply chain, the grocers, the people delivering packages. And they also rightly have concerns about their own exposure. Yeah. But that's always been guidance for healthcare workers, right? This is the idea of wearing a mask, in particular an N95 respirator type mask, is nothing new for people who work in hospitals. What's unique here is that all of a sudden there's a crunch. This is our first 50-state disaster. It's an international disaster. So there's no relief or save coming from another hospital system who has extra supplies to share. Tell me a little bit more about the rest of the world. How consistent were those CDC guidelines we had up to today that said no mask needed when you look at other countries that have been taking this seriously for much longer than the United States? Well, the U.S. approach is inconsistent with the rest of the world. And I don't think it takes much to notice that we've all seen pictures of people walking around in Asia with masks for a long time. And this is nothing new over there. And it goes back to the SARS epidemic and MERS and other coronavirus. So culturally, it's accepted. In the United States, this is just not something we've done. And so it's different for us. Yeah. Are there other countries that have sort of acclimated to this new idea that like, oh, we should really be wearing masks all the time, even if it creates social awkwardness or social distance, as it might be. Well, yeah, I mean, other countries, certainly the culture has changed. Austria banned people from entering supermarkets without wearing a mask. It's not part of our culture. It's going to be a big change. But it's necessary to take this step and further reduce the spread. And, you know, what seems awkward at first quickly becomes normal. And I even take the example of our, you know, social distancing here and maintaining a six-foot separation between everybody. So the first time I was out for a walk and saw a neighbor and we kept our six-foot buffer between us, it felt funny. And now I don't even think twice about it. In fact, it's uncomfortable and awkward the other way. If someone gets too close, you look at them and think, "are you not aware of the guidance here?" Norms can change pretty quick. And I think that's what you've seen with other countries in terms of mask wearing. Well, tell me personally, since you're talking about your own experience, have you started wearing a mask to the grocery store yet, for example, or are you getting your groceries delivered? Yeah, I have started wearing a mask, but I want to be really clear here that I think the science supports the use of masks, but this cannot be a situation where the public wears masks that are intended for the healthcare system. So when I say I wear a mask, I wear something that's homemade over my nose and mouth. So I'm using a bandana at the moment. We have to walk a fine line here in the messaging. Masks work. I think the evidence is clear there when they're done right and worn correctly. But if that message gets out without the second message following right behind it, that the public cannot go out and start buying masks, then it becomes a disaster. So my message is that masks should be worn, but right now they should be homemade masks. I have one N95 mask. I've had it since like last year when I bought it for when I do like work around the house. Please don't judge me, people. At this point, I think people would take anything. Maybe look for a doctor, nurse, healthcare worker, delivery person in your neighborhood, offer it up for them and go ahead and make yourself a homemade mask. And I can walk through the details about that a bit more if you want. Yeah, let's do that after we take a little break here. We have to do an ad in the middle of our show. That sounds all right. These are really simple. They're just kind of a pleated mask and then they've got of course the elastic bands to hook around your ears. They take, I want to say, about five or so minutes to make one of these. For all guys who don't want to wear them or they can't wear them, it's enough. One is a clean boxers according to your own look. which you choose. Support for Today Explained comes from Built Rewards. These days, it seems like everybody has a rewards program. You swipe your card and you get one cent on the hundred dollars. But with your rent, frequently, you just pay month after month. You never get anything from it other than that roof over your head. Not anymore says Built Rewards. Built Rewards says it lets you earn points on your rent. By paying rent through Built, they say you can earn flexible points that can be redeemed toward hundreds of hotels and airlines, perhaps a future rent payment, your next Lyft ride, and so much more. Your home isn't just where you sleep, it's your community, and Built wants you to go out and do things in the community. 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Joe, tell me exactly what a mask does for you. When you put one on, what are you avoiding? Are you avoiding putting something out in the world or getting something back or both? There's four different benefits that I see. And also, we have to be clear about what masks we're talking about here. I'm talking about the regular surgical mask, a dust mask, or even a homemade mask made out of a T-shirt or something like that. So you are not talking about an N95 mask, for example. Right. So the N95 mask, this is a professional mask. This is what you've seen that most healthcare workers would be using in an ideal situation. The 95 designation comes because it blocks 95% of the airborne particles. And what I'm talking about here is our masks just for the general public, a homemade mask that can be effective in four different ways. Tell me about them. What are the four? First and foremost, you know, having a mask on your face helps you prevent getting others sick if you're infectious. Every time you cough or sneeze, you're projecting that out. That can land on surfaces. It can land on somebody adjacent to you. So the mask blocks that. And importantly, it's not just for people who are symptomatic, right? We know that this virus can be spread from people who are asymptomatic. So as a general precaution, we could all be wearing this not knowing if we're transmitting it, but it helps if we do have a cough or a sneeze that we're not spreading this out. So that's the first one. Second way it helps is it helps you from other people. Now, an N95 mask provides a layer of protection that's much greater than we would get from a homemade mask. Still, the homemade mask does block some of the larger droplets if someone sneezed near you, and it does create a little bit of a barrier for smaller particles that can float. And they can float around that mask. But the idea here is that something is better than nothing. Okay. Third, I think it's really important that it serves as a reminder to you, the wearer, not to touch your nose or your mouth. As if you happen to pick up some virus from a doorknob that somebody else touched and then touch your own eyes or your nose or your face. So wearing a mask is a reminder not to do that. Good. And last, I think is one of the most important, is that it serves as a social cue. It's a reminder when you're out there that something big is happening around us and we're taking precautions and should be taking precautions. And what might seem awkward at first, I sense will be really quickly be seen as somewhat of a badge of honor. It's telling me, "I care about everybody else. I'm wearing this. I don't want to get you sick." So it becomes an important social cue. I think people have a lot of questions about the first and second benefits that you talked about, specifically how much a scarf or a bandana serves as a means to protect yourself from these respiratory droplets that can get you infected versus an actual N95 mask that's well fitted. Is it a useful substitute or are all these homemade options? I saw one video online of a lady taking a pair of like men's boxer briefs and really quickly turning it into a face mask. And it looked impressive, but I just wondered, does that work? Yeah, it's a good question. And we have to be clear here that it doesn't work as well as an N95 and one that's been fit tested or a surgical mask. And so the idea here is we're throwing everything we can at this to limit the spread of disease. And to be very clear, masks should not be the only thing we're doing, right? It's not a substitute for everything else. It's just one more layer of defense. We still have to wash our hands. We still have to stay six feet away from each other. We should still be staying home all the time. We should only be going out for groceries occasionally or things that are true necessities. So it's not the solution. We wear one of these homemade masks made out of boxer shorts, and then we can just go about returning to our normal lives. That's just not the case. And then so certainly the type of material you choose and the construction of the homemade mask is going to influence how effective it can be. There are some studies showing that if you use 100% cotton, a t-shirt, right, most of us have a cotton t-shirt around the house, can be pretty effective at capturing particles. Again, not as good as a commercial mask, but certainly better than nothing. And we know that, you know, six feet away is the best safety measure for social distancing. But how long can these droplets remain on surfaces? Is it a range depending on the surface? How careful do we have to be when we go to the grocery store and we touch a box of cereal and then maybe decide not to get it? Should we be wearing gloves in those moments too? Yeah, so you have to think about the different modes of transmission here, right? If you sneeze or cough, you get large droplets, some of which you might be able to see, some of which you don't, but they're heavy enough to kind of settle out pretty quick within that six, most within that six-foot buffer. Some of that can contaminate a surface that can then be a point of transference to somebody else. We call that a fomite, an inanimate object that can host the virus for a little bit until somebody else comes along and picks it up. And then third, we have these smaller aerosols. So when you cough and sneeze, you emit an entire continuum of particles, and some can float around a little bit. So, you know, I think it's worth first talking about these different ways we can get the virus, because that then informs the strategies how we control and minimize risk in different environments including at the grocery store. Does the six feet away thing does it actually prevent you from getting close to these airborne droplets? Can they get farther than that if the wind carrying them a certain way? How close do you have to be to an infected person to actually get exposed? Yeah, it's a great question. And by saying winds, we can talk about outdoor, but also indoor where it's slightly different, right? So the idea of staying six feet away, it protects you from large droplets, which tend to settle out, but it also protects you from the smaller aerosols that disperse and can be airborne because, you know, these disperse too. So like anything else, you don't want to be that close. My friend and colleague, Lindsay Marr at Virginia Tech, likes to describe it similar to how you think about someone who's smoking. When they exhale, right, it's stronger, more concentrated right near them. And a few feet away, it's a little less, and 10 feet away, maybe you don't even notice it. So the same thing is happening with particles or viral particles as somebody exhales. So the idea of staying six feet away is protective against the large droplets, but also against the finer aerosols that can float around and stay in the air for longer times. You know, outdoors, less of a problem where you have wind and full dilution. Indoors, it becomes a little more interesting. And how long can it stay on a surface indoors? Well, in the air, it can stay, you know, for a couple hours. But again, it'll be dilute. So the more time and with air exchange or fresh air coming in and out, right, as the house breathes as it normally does, it dilutes. So that's good. And on surfaces, the virus can survive up to 24 hours on cardboard, for example. But there again, it's also over time, it's diminishing quickly. And this is why, you know, I wrote an article recently in The Washington Post talking about the risks from receiving a package or going grocery shopping. And I describe the risks as low and manageable because, you know, by the time you receive a package, if anything was on it, there's a time lag until you receive it. And even in the worst case, a driver coming up, delivering an Amazon package, sneezes right on your box right before they hand it to you. And that person's infectious and it's shedding a high viral load. And you take that box, you can still take some simple steps to protect yourself. It doesn't have to be this anxiety-producing feat, right? You can put that box down, let it sit outside, or if you have to bring it inside your house, just put it right down inside the door, let it sit for a couple hours. And again, the virus goes away and becomes less of a problem. And then you wash your hands. So, you know, some simple precautions. And later, if you open up that box, open it up, take the box, recycle it outside, wash your hands again. And in that way, you start to disrupt the causal chain, right? The presence of a virus on any kind of surface alone will not get you sick. It's whether that transference happens. And the way to break that chain is being careful and washing your hands. What I'm getting here is that what's really important right now for Americans and people across the world is to just take all of these precautions in concert, is stay six feet away, social distance, stay at home, wash your hands, don't touch your face. And when you go out, cover your face, be it with a mask or whatever you've got at home, a bandana, a scarf, some men's boxer briefs, hopefully new. I guess what I wonder then is, why didn't the CDC just come out and say that in the first place? It's fluid, and they're trying to give the best guidance. And I think you had exactly right. I mean, you're trying to throw up as many barriers as you can to getting this virus or getting infected. And so it's this all-in approach. You're exactly right. It's cleaning services, it's washing hands, it's covering your cough, it's staying six feet away from people. In your home, it's opening windows to let in more fresh air. So, you know, it's all of these strategies. And right now, do we know which one works best? No. Will we ever? Maybe, but probably not. And also, it doesn't really matter. None of these are so onerous or so burdensome that you would choose one and say, "well, I have a mask on. I guess I don't need to wash my hands." There's no such thing as zero risk. And so the ultimate goal here is just to minimize risk. Joe, thank you so much. And thanks for making time for us from your office slash car. Yeah, yeah. Likewise, from your closet. It's nice to join you. Yeah. Joe Allen is a professor at Harvard School of Public Health. He's also the author of a brand new book called Healthy Buildings, How Indoor Spaces Drive Performance and Productivity. I'm Sean Rameswaram. This is Today Explained from the Vox Media Podcast Network. Liz Nelson is Vox's editorial director of podcasts. The Today Explained team includes Bridget McCarthy, Efim Shapiro, Halima Shah, Jillian Weinberger, Noam Hassenfeld, and Amina Alsadi. Cecilia Lay checks our facts, and the mysterious Breakmaster Cylinder provides a lot of our bops. But this bop is, of course, by the legendary Bill Withers. Today, we found out that Bill's life ended on Monday. His family said it was due to heart complications. Lean On Me is probably the first favorite song I ever had. I remember my dad playing it when I was four years old and asking him to play it again and again. It seems like the perfect song for this moment, so we had to play it today. Bill didn't give a lot of interviews later in his life, but he granted a rare one to Anna Sale and her podcast, Death, Sex, and Money. It became the very first episode of that show, Death, Sex, and Money, and they put the conversation at the top of their feed today to celebrate Bill's life, look for Death, Sex, and Money and give it a listen. Sometimes in our lives We all have pain We all have sorrow But if we are wise We know that there's Always tomorrow Lean on me when you're not strong. And I'll be your friend. I'll help you carry on. For it won't be long till I'm gonna need somebody to lean on. Please swallow your pride If I have faith You need to borrow For no one can feel Those of your needs That you won't pay