Even though masks have been a part of our culture since April, few things seem to have bewildered Americans more during the coronavirus pandemic than when and where it’s necessary to wear a mask. The Centers for Disease Control and Prevention — after initially discouraging widespread use of them — has recommended for months that Americans wear masks “in public settings,” especially “when around people who don’t live in your household.”
Now, the World Health Organization has issued updated guidance on the use of face masks to prevent the spread of COVID-19 — and it’s very clear that masks should be worn often. “WHO advises that the general public should wear a non-medical mask in indoor (e.g. shops, shared workplaces, schools) or outdoor settings where physical distancing of at least [3.2 feet] cannot be maintained,” the guidance says.
The organization also says that people should wear a mask indoors “unless ventilation has been assessed to be adequate…regardless of whether physical distancing of at least [3.2 feet] can be maintained.”
The guidance stresses that masks are especially important for people with a higher risk of severe complications from COVID-19 — individuals over the age of 60, those with underlying conditions like heart disease or diabetes, chronic lung disease, cancer, cerebrovascular disease or immunosuppression. These people “should wear medical masks when physical distancing of at least [3.2 feet] cannot be maintained,” the guidance says.
This isn’t the first time public health experts have recommended continuous masking indoors. Back in August, Dr. Deborah Birx said in an interview with CNN that those who live in COVID-19 hotspots — or with high-risk individuals — should think about wearing masks in their living space. “If you’re in multi-generational households and there’s an outbreak in your rural area or in your city, you need to really consider wearing a mask at home,” said Birx.
Dr. Amesh A. Adalja, senior scholar at the Johns Hopkins Center for Health Security, tells Yahoo Life that the WHO’s recommendations make sense based on what scientists now know about COVID-19 and its spread. “If you’re in a place where you don’t have the benefits of an outdoor breeze to disperse particles, there’s going to be some level of risk present,” he says. “A lot of that can be dissipated if people are six feet apart, but there are situations in which the virus can be dispersed more than that distance.
Dr. Saskia Popescu, an infection prevention epidemiologist at George Mason University, said ventilation is a critical element of preventing the virus’s spread which is often hindered indoors. “The push for masks indoors has always centered around those environments that are close quarters and with other people,” Popescu told Yahoo Life in an earlier interview. “More recently, the emphasis for indoor masking has been reiterated in relation to ventilation and that even if you can socially distance, masks are important when you’re around others and ventilation may be inadequate.”
Popescu says that early recommendations about maintaining a safe distance between individuals may have convinced people that “as long as they stuck to six-feet distances, they could be unmasked,” which isn’t true. “I think we placed a lot of initial emphasis on masking and social distancing when you leave the house, and that gave the impression that if you could maintain social distancing, a mask somehow wasn’t necessary, which isn’t the case,” she says. “Really, the communication is that we use social distancing, hand hygiene and masking as a team approach to try and avoid transmission.”
Dr. William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine agrees and endorses wearing a mask in the house. “The value obviously would be that you are providing additional protection to people of advanced age and people with serious underlying illnesses, extending the protection that you were being careful about outdoors into the actual home,” says Schaffner. “And doing it where there is much more frequent contact, and closer contact, for prolonged periods of time.”
Risk tolerance matters, though, Adalja says. “For those who are risk-averse, it may make sense to wear masks at home around vulnerable individuals,” he says. “Certain people also may feel more comfortable with masks worn around them.” This practice may also be a good fit for households that include people with different risk tolerance levels, especially if some members of the household are regularly going out and are not stringent about following CDC guidelines, while others are more cautious, he says.
The CDC has been clear that masks are effective at helping stop the spread of the virus by “prevent[ing] respiratory droplets from traveling into the air and onto other people when the person wearing the mask coughs, sneezes, talks or raises their voice.” It’s a claim that has been backed by multiple studies showing that universal mask-wearing has the potential to not only slow community transmission, but stop it entirely.
Wearing masks is particularly important around those who have a condition that may weaken their immune system, putting them at risk of more severe illness from COVID-19. According to the CDC, the list includes individuals who have cancer, those who have undergone a bone marrow or solid organ transplant, those taking immunosuppressing drugs or those with HIV. Birx added in her CNN interview that individuals living in a household where some members have comorbidities, such as high blood pressure and obesity, should consider wearing a mask too.
For those who fit these criteria, or are living in a community with rapid community spread, wearing a mask inside the home may make sense. But Dr. Angela Rasmussen, a virologist at Columbia University, is skeptical about whether it will actually happen. “I think it’s reasonable to ask people to wear a mask when they are at home with high-risk individuals, but there will be some times that this is just not possible: while eating or drinking, bathing, grooming, et cetera,” says Rasmussen. “I think it’s unlikely that a lot of people will adopt these precautions, however, particularly in states with leadership that has been very opposed to masks in general. The people who are adamantly opposed to wearing masks in grocery stores are probably not going to be persuaded to wear masks all the time in their own homes.”
Dr. Richard Watkins, an infectious disease physician in Akron, Ohio, and a professor of internal medicine at the Northeast Ohio Medical University, tells Yahoo Life that people should take care to wear masks in other people’s homes. “Making people wear masks in their own home is probably a bridge too far,” he says.
Schaffner agrees but thinks there may be a “spectrum of adherence” to the recommendation — meaning those who have been more “conservative” about the protections may adopt the guidance and those who are resistant to mask mandates and other recommendations may not. “It’s a new idea of people are going to have to think about it,” says Schaffner. “It won’t be widespread very rapidly for sure.”
By: Abby Haglage and Korin Miller
This story was originally published on Aug. 8, 2020, at 6:31 p.m. E.T. and has been updated to include the World Health Organization’s latest guidance on masks.
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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