Posted by As Covid-19 ravages the planet the East-West debate about wearing face masks continues. On one side, Western health authorities including the United States Centres for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) tell us what we have all probably heard a million times on the news already — the general public shouldn’t wear masks because they don’t work.
The CDC says that people who are not sick do not need to wear face masks unless they are caring for someone who is ill with the new coronavirus. We also know that a regular surgical mask will not help much to prevent catching Covid-19 (because they are designed so that the doctor doesn’t spit diseases into a patient’s exposed appendix in surgery) but the N95 respirators will help stop infection if used properly. In other words, they say wear a mask if you are sick and in public to prevent spitting and coughing water droplets on others (or better yet, stay at home) but wearing a mask won’t help you from getting infected. I won’t bore you with a detailed breakdown of all the different types and brand and sub-types of these as most of us with an internet connection have become experts on the subject of protective masks over the past two months.
Current Western epidemiological dogma is that masks will not help prevent the spread of disease in the general public so they tell us not to wear them. The surgeon general of the United States went so far as to send the angry tweet below telling people not to buy masks.
This is in stark contrast to Asian governments which actually do the opposite; tell everyone to wear masks when they are going out, especially if they are in crowded places like subways and shops. Singapore went even further with the government handing out four free masks from the national stockpile to anyone who wanted them. Hong Kong, South Korea and Japan also distributed masks in limited quantities to the public for free.
There are some who want to attribute a cultural difference to the advise on face masks. As this article in The Telegraph attempts to point out, “It’s not just about disease and pollution, in the Far East face masks are a matter of complex etiquette with a fabled history“. “Ineffective, fiddly, and terrible for the environment, surgical masks have nevertheless been seized by the masses amid the coronavirus panic that is tearing across the world. Never mind that diligent handwashing is your best defence against the spread of infection, a bar of soap just doesn’t carry the same dramatic appeal. Indeed, the face mask has long been a staple in Asia, for reasons far more nuanced than just as a barrier to germs and pollution.”
Ummm… no. I can tell you for a fact that there is no long standing historical or cultural reason for the Asian use of face masks. Their use in Japan (especially by the sick on crowded subways) has been common for some time but probably only in recent history (say the last 50 years). Their use in places like Hong Kong was close to non-existent up until SARS in 2003 — I should know because I lived there before, during and after and you could see the difference in behavior and attitudes that the SARS outbreak caused. In other words, there is no long historical or cultural justification to the use of face masks in Asia; just a different, and very recent, interpretation on public health and public acceptance of that advice.
But you sense the depth of the cultural and moral superiority and smugness in the author of that article who, by saying that washing hands is the best way to prevent disease spreading just that it doesn’t have the same dramatic appeal, loads the recommendation with moral judgments. In other words, they are saying that Asians wear the face masks just for show, not out of scientific reality.
A more sensible and balanced discussion on this can be found in this Time article, “Why Wearing a Face Mask Is Encouraged in Asia, but Shunned in the U.S.” This article in the Nikkei Asian Review, “Asians in US torn between safety and stigma over face masks — Clashing cultures and expert advice lead to discomfort and outright racism” concentrates on the dilemma that Asian-Americans face on whether to wear a mask out in public in a society that is outright hostile to those who do. Yes, outright hostility like as reported in the New York Post, “Asian man is victim in latest coronavirus-fueled hate crime.” “The 59-year-old man told cops he was walking south on Madison Avenue near East 104th Street around 9 p.m. when a teen kicked him in the back, causing him to fall to the ground. ‘F–king Chinese coronavirus,’ the kid barked before telling the victim to go back to his country, according to sources.”
While the social and cultural aspects of wearing or not wearing masks is arbitrary, this doctor focuses on the scientific, medical and logical arguments in this Live Science article, “Should you wear a face mask to prevent COVID-19? Experts disagree.” “That said, the public does not need to wear face masks most of the time, said Dr. Otto Yang, a professor in the Department of Medicine and the Department of Microbiology, Immunology and Molecular Genetics at the David Geffen School of Medicine at the University of California, Los Angeles. If you’re out for a walk — in essence, going to a setting where you can be at least 6 feet (1.8 meters) from other people, then I think that not having a mask is fine and that fits the CDC recommendations,’ Yang said. But, in his opinion, ‘If you have to be in a crowded situation, perhaps on a plane or waiting in line at the airport, it might make sense to wear a mask,’ Yang told Live Science. ‘The CDC, it’s like they’re talking out of both sides of their mouth,’ Yang said. ‘One side of their mouth is telling the general public, ‘Hey, you don’t need masks, forget about it.’ The other side is, ‘Health care workers need to wear N95 respirators.’ Is that a double standard?’ Yang said. ‘Are they valuing some people more than others?’
Yes, there is the major contradiction in the medical advice in that on one hand, health professionals have brainwashed the entire Western population into thinking face masks are useless and offer no protection while they themselves complain that there are not enough masks for them to use to protect themselves. But then the CDC itself decides to change policy and say that even surgical masks are good enough for front line medical staff to use in the face of an acute shortage of N95 respirators. If the medical-speak of the CDC is too difficult to decipher, the Washington Post summarizes it well in this article, “Face mask shortage prompts CDC to loosen coronavirus guidance“.
So the truth is that while the N95 respirator, used properly, is effective in preventing you from catching Covid-19. Surgical masks, while not ideal, does offer some protection against infection and certainly help prevent the infected from spreading contagions to others. But in the face of supply shortages, we are told not to hoard or use them so that our medical professionals who face the greatest risk of infection have an adequate supply of them. I can relate to and agree with that assertion; except that’s not what they tell us. They tell us that it is useless for the general public to wear them. Surely the real answer is that in an ideal world where we have an infinite supply of free masks, everyone should wear one in public during a pandemic. But of course we don’t have an infinite supply so we have to ration out the supply that we have in the face of shortages.
We also have this Asian count-point from Science in an interview with George Gao, director-general of the Chinese Center for Disease Control and Prevention (CDC), “Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says.” “The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.” Dr. Gao’s comments clearly illustrate the stark difference in advice from national health authorities in Asia versus the West.
I couldn’t agree with this Dr. Gao more. We know from various studies that many carriers of Covid-19 are asymptomatic. As pointed out in this Discover article, “Asymptomatic Carriers Are Fueling the COVID-19 Pandemic. Here’s Why You Don’t Have to Feel Sick to Spread the Disease.” Basically, people are running around who don’t feel sick and have no symptoms and are spreading the disease unknowingly. But if everyone, or most everyone, wore masks in public, the number of people who unknowingly spread the disease is dramatically reduced. The problem is, in the face of mask shortages and after years of brainwashing people into believing that masks are useless — or worse, wearing a mask makes you a target for societal backlash; it is pretty much impossible for the CDC and WHO to make a volte-face now and tell the public its a good idea to wear masks.
It’s like my Japanese electronic bidet (Toto Washlet) that I have had installed to wash my nether regions for over a decade. So many Westerners are appalled at the mere concept of it even though the bidet itself is a European invention. Heck even the word bidet is French. But then I ask them one simple question. “You are wearing your brand new $1000 designer sneakers to the park and you accidentally step in a pile of steaming dog poop. I offer you a choice of a roll of toilet paper or a garden hose to clean them off. Which do you choose?” Yeah, the logic then becomes obvious even though their first reaction to the concept of my electronic bidet is generally one of revulsion and disgust. But old habits and ideas die hard, even in the face of facts like, “A rectal surgeon says bidets are way healthier than toilet paper, but the average American still uses 3 rolls every week.” Over 90% of Japanese households and public toilets have electronic bidets installed but yet virtually nobody in North America uses them. Another great example of a East-West divide and just like the face-mask debate, one in which the Western logic falls short despite all the attempts to spin it as being more rational and scientific.
And then you also get the politicization of the Covid-19 pandemic. Like this Vox article, “The myth of authoritarian coronavirus supremacy. China wants you believe its political system stopped coronavirus. That’s a lie.” “The unanimous verdict of political scientists and public health scholars I spoke with is that the theory of authoritarian superiority in this crisis is wrong: There is no evidence that one type of political system has performed systematically better against Covid-19 than the other. China’s response, while eventually good, was criminally slow early on — as was Iran’s, another notably authoritarian regime. Meanwhile, democracies like South Korea and Taiwan had some of the best responses anywhere on the planet.”
You can read the article yourself and it does make many valid points. Lost in its attempts to preach why democracies are good if not better at controlling pandemic outbreaks is a small and not so subtle fact which I will get to in a moment. “On these metrics, the gold standard for a good national response comes from a cluster of three East Asian countries — South Korea, Taiwan, and Singapore (Hong Kong is also often mentioned, but it’s not exactly an independent country).” Well sorry Vox, but before you get so smug about it, Taiwan is not exactly an independent country either. “Two of those are large democracies, the other an authoritarian city-state.” Yeah, South Korea and Taiwan would probably not be classified as being large either land area or population wise while Singapore, which is technically a democracy would probably take umbrage at your classification as an authoritarian city-state. So Vox is not exactly the most knowledgeable, impartial nor accurate publication but we already knew that.
What Vox misses even though it is dangling right in front of their faces is that all four of these places are in Asia where public health policies (such as promoting the wearing of masks in public) are much different than in the West. So while Vox attempts to create a false narrative about democracy versus authoritarianism in controlling the pandemic, it misses the simple one which is all the places that have been best able to contain the virus, including authoritarian China (and Singapore if you believe the Vox propaganda) are in Asia. Even the democracies that Vox likes to laud so much are relatively new having mostly endured authoritarian dictators from the end of WWII in 1945 until 1988 (Korea) and 1996 (Taiwan). The population is more likely to support strong government controls such as those including self-isolation, closure of public places, and quarantines than those in the West. One has to ask the simple question. If the gold standard of national responses to this pandemic outbreak are all in Asia (where all governments promotes the use of masks in public) while the uncontrolled surge in infections are in Europe and America (where all governments tell its citizens not to wear masks); maybe we should revisit our assumptions and advice about how useless public use of masks are.
There are also cultural and physical realities that impact on why Asians are willing and believe wearing masks in public is useful. Asian cultures are generally based on group responsibilities — not individual rights and liberties. Packed cities with crowded mass transit and high-rise apartments are the norm; not the exception like New York City is in the West. It is impossible to maintain six feet (2m) social distancing in Tokyo, Beijing and Hong Kong when the population of one city is the same as the entire population of Australia. Thus, Asians tend to wear masks in public and accept restrictions on movement more readily (including quarantine and lock downs even though our apartments are tiny), especially during a pandemic event. On the other hand, Europeans and Americans (and their health authorities) seem to believe that washing their hands means they can keep doing their God-given human right to attend Mardis Gras, football games and rock concerts — until it is way too late and the governments order them not to. Like the now infamous Brady Sluder said in an interview on a crowded beach in Miami during spring break, “If I get corona, I get corona, I’m not going to let it stop me from partying,” before touching his face.
Put in another way, we are probably stuck with this coronavirus pandemic for at least probably the next 12 months or maybe more until an effective vaccine and/or treatment is found. Unless you want to continue to lock down the entire population for the next year (and suffer the massive economic consequences of that decision), eventually wholesale restrictions on people going to work and businesses opening will have to be relaxed. Social distancing, under this scenario will become increasingly difficult so people who need to be at work in a factory or warehouse will need to move about and be in contact with other people. Without widespread use of masks in public (provided they are available and society makes them acceptable without discrimination of those wearing them), there is a high probability of a resurgence of infections and spread of Covid-19; the so-called second wave of coronavirus.
There is hope that the propaganda and bias against the wearing of masks in public in the West is changing. We have this recent New York Times article that says, “More Americans Should Probably Wear Masks for Protection. Experts have started to question whether masks may offer at least some protection to healthy individuals and essential workers.” “But studies of influenza pandemics have shown that when high-grade N95 masks are not available, surgical masks do protect people a bit more than not wearing masks at all. And when masks are combined with hand hygiene, they help reduce the transmission of infections.”
“When researchers conducted systematic review of a variety of interventions used during the SARS outbreak in 2003, they found that washing hands more than 10 times daily was 55 percent effective in stopping virus transmission, while wearing a mask was actually more effective — at about 68 percent. Wearing gloves offered about the same amount of protection as frequent hand-washing, and combining all measures — hand-washing, masks, gloves and a protective gown — increased the intervention effectiveness to 91 percent.”
“It’s still hard to tell what percentage of people are truly asymptomatic because many go on to develop symptoms a few days later,” said Dr. Neil Fishman, the chief medical officer of the Hospital of the University of Pennsylvania. “What we do know is that individuals can shed virus about 48 hours before they develop symptoms and masking can prevent transmission from those individuals.”
“Wearing a mask can also reduce the likelihood that people will touch their face, which is another mode of transmission of the virus from contaminated surfaces to unsuspecting individuals, Dr. Fishman said. ‘For individuals working in certain essential industries, where they still have to go out every day, I think wearing a mask makes sense,’ Dr. Fishman said. ‘If everyone in the community wears a mask, it could decrease transmission,’ Dr. Fishman said. ‘But unfortunately I think that we don’t have enough masks to make that effective policy in the U.S.’
Maybe its time for President Trump to stop blaming China and patch things up with President Xi Jinping. As the New York Times reports, “The World Needs Masks. China Makes Them — But Has Been Hoarding Them.” “China made half the world’s masks before the coronavirus emerged there, and it has expanded production nearly 12-fold since then… Since then, China has undertaken a mobilization of wartime proportions to expand its output of disposable surgical masks. Daily production soared from about 10 million at the start of February to 115 million at the end of the month, according to the Chinese government.” But I think Trump has already figured this out given his clear volte-face when CNN reports that “President Donald Trump said Tuesday that he has decided to pull back from associating the novel coronavirus with China, which he had previously done by calling it the ‘China virus’ or the ‘Chinese virus.'”
Update 1 (29 March 2020): Well, it looks like other people in the West and in the media are starting to wake up and see what was really brutality obvious. I’m not saying that wearing a mask is the be all to end all and should not be seen as a substitute for social distancing and hand hygiene, but the continued blithe dismissal of public mask wearing by Western health authorities in the face of common sense and the facts cannot be left unchallenged. Here’s a great chart illustrating the point from the Financial Times.
If you want a clean version of that chart, you can find it here at Science Magazine.
Update 2 (31 March 2020): And Canada, like always, comes late to the party. The Canadian Brainwashing Corporation finally ran this article today, “Some health experts questioning advice against wider use of masks to slow spread of COVID-19.” Chief Public Health Officer Dr. Theresa Tam, “Putting a mask on an asymptomatic person is not beneficial, obviously, if you’re not infected,” Tam said Monday. Dr. K.K. Cheng, director of the Institute of Applied Health Research at the University of Birmingham in the U.K., said that Tam’s advice makes a dangerous assumption — that an asymptomatic person is not a spreader. “The important thing about this coronavirus is that some patients start to shed virus, and become infectious, even before they have symptoms. In public health, a principle is we try to limit the source of harmful exposures rather than do mitigation, if we can. Hand-washing is a form of mitigation. I’m not suggesting in the least that people should stop washing hands. It’s very important. But if you’re out in public in a supermarket, or in a subway train or on the bus, I think it makes a lot of sense for everyone to wear a mask.” It doesn’t take a rocket scientist of a doctorate in epidemiology to figure out this basic logic, so why are Western health authorities so obstinate in their unwavering hatred of masks for the public?
Well, not all. Austria just made wearing face masks compulsory in supermarkets. “As of the moment, these masks are handed out in front of supermarkets it will be compulsory to wear them in supermarkets,” Chancellor Sebastian Kurz said, adding that the aim in the medium-term was for people to wear them in public more generally as well. “In the Czech Republic, the growth of news is low whereas in other parts of Europe the pandemic is largely out of control. This occurred after the government announced it was compulsory to wear something covering a part of your mouth and nose when leaving your residences – such as a home-made mask or a scarf on March 18.” This is despite the fact that home-made face masks are much less effective than even the disposable surgical masks that the WHO tells us not to use.
Of course it is embarrassing for the government and public health authorities to turn around now and tell us to wear masks in public after months of bombarding us with propaganda that masks are useless. But as the National Post points out, “Official nonsense on masks, travel bans is killing Ottawa’s COVID-19 credibility“.
“Furthermore, we have been told over and over again that any measures carriers might implement — temperature sensors, for example — simply don’t work. ‘The positive predictive value of screening is essentially zero,’ the authors of a widely cited 2005 study reported, based on Canadian airports’ experience with thermal scanners during the 2003 SARS outbreak. One of the authors of that study was Theresa Tam, who is now Canada’s Chief Public Health Officer. She’s the one doling out all the science that Trudeau insists underpins every single decision he and his ministers make. It’s more than a bit awkward — but not as awkward as federal Health Minister Patty Hajdu’s immortal March 13th dismissal of travel restrictions: ‘Canadians think we can stop this at the border, but what we see is a global pandemic, meaning that border measures actually are highly ineffective and in some cases can create harm.’ Five days later, the border slammed shut.”
“Indeed, Tam is asking a lot of Canadians to set aside a lot of common sense right now. There is ample evidence that face masks — even homemade ones — can provide significant protection to the uninfected. But Tam warns only of the potential pitfalls: Masks can provide “a false sense of security,” lead to more face-touching or make us forget to wash our hands. “Putting a mask on an asymptomatic person is not beneficial,” she said at her Monday press conference.
That makes sense to a lot of medical professionals. A lot of regular people, however, are pretty sure they know how to wash their hands and not touch their faces. When officials say “masks don’t work,” a lot of regular people hear “we have an inexcusable shortage of masks for frontline healthcare workers so please give us your masks.” When officials say “you don’t need to be tested,” they are likely to hear “we have inexcusably few tests available and not enough lab capacity to process the ones we have.”
Update 3 (3 April 2020): The debate is finally over as the CDC, WHO, and even President Trump finally spin 180 degrees and now advise the general public to wear masks. The SCMP neatly encapsulates the capitulation of reticent health experts in this article, “To mask or not to mask: WHO makes U-turn while US, Singapore abandon pandemic advice and tell citizens to start wearing masks.”
“’There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit,’ said Dr Mike Ryan, executive director of WHO’s health emergencies programme, as recently as Monday. All that changed this week. On Friday, both the US and Singapore switched to advising citizens to wear masks when they leave their homes. The WHO also made a U-turn itself, with Ryan saying: ‘We can certainly see circumstances on which the use of masks, both home-made and cloth masks, at the community level may help with an overall comprehensive response to this disease.’ [President] Trump said wearing a mask would be voluntary, and he was unlikely to wear one himself. ‘You can do it. You don’t have to do it. I am choosing not to do it. But some people may want to do it, and that’s OK. It may be good. Probably will — they’re making a recommendation. It’s only a recommendation, it’s voluntary.’ he said. ‘Wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens – I just don’t see it.’”
This issue has been more than just an intellectual exercise for me as it is a life and death issue. By telling the public not to wear masks, health authorities are essentially opening up those who wear masks to abuse and ridicule verbally, mentally, and even physically. In fact, I would go as far to say they are enabling these ignorant people by putting a facade of respectability on their attitudes and behavior. Like in the Time article I tagged earlier, “Cheryl Man is usually the only one wearing a face mask on her New York City subway train. She notices this, but other people on the train notice, too. Usually she just gets odd stares from other commuters. But on Tuesday morning, when she was walking to school, a group of teens jeered at her and coughed in her direction. ‘I felt very humiliated and misunderstood,’ says Man, a 20-year-old student and research assistant who is ethnically Chinese.” I feel for her as I have experienced it myself.
More importantly, the advice against the public wearing masks was just plain wrong as if flew in the face of mounting evidence globally that broad spectrum mask wearing by the public does help contain the spread of the coronavirus. We will never know how many lives might have been saved if stubborn Western health authorities had acted earlier; but at least they have finally given in to the science and fact-based evidence that they continually say their decision making is supposed to be based upon.
Update 4 (16 April 2020): Trump administration, CDC and Cuomo finally agree on one thing: Americans should wear face masks — a timeline of U-turn. “On Wednesday, Cuomo ordered all New Yorkers to cover their faces in public when they can’t maintain a proper social distance. ‘You’re walking down the street alone? Great! You’re now at an intersection and there are people at the intersection, and you’re going to be in proximity to other people? Put the mask on.'”
“Also Wednesday, New York Mayor Bill de Blasio called for all grocery stores in New York, the epicenter of the coronavirus pandemic in the U.S., to insist that customers wear masks while shopping. ‘I’m asking every store to put up a sign that you’re required to wear a face covering. This is another one of the things we have to do to protect each other,’ he said at his daily press briefing.”
Well that simple and obvious step took forever for America to take and at the time of this writing, only Los Angeles and New York have made it mandatory. L.A.’s coronavirus mask order is now the law. 5 things you need to know. “If you are going to a grocery store, pharmacy or doing other essential shopping in Los Angeles, you need to be wearing a mask or face covering.” Beginning Friday, a new city order requires both shoppers and workers to wear a face covering.