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Pandemic Lessons: Maybe you don’t like masks – but do they work? (Spoiler alert: They do)

Pandemic Lessons: Maybe you don’t like masks – but do they work? (Spoiler alert: They do)

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Masking mandates like the one that exists for public places in Erie County stoke loud opposition, often because people don’t like to be told what to do. They want choice.

But if we set aside policies and isolate science, what is the right choice? In a world where a virus spreads easily and hurts or kills many, do masks help?

The short answer: without question.

For this installment of Pandemic Lessons, we spoke with infectious disease doctors who have long used masks to contain disease, one of the world’s leading researchers on airborne viruses, and the co-author of a just-published study on the effectiveness of face coverings.

Straight up: Do masks work?

They do. But masks don't eliminate Covid-19. Variations in type of mask and how well and often people wear them make a big difference. For the same reasons, the effectiveness of masking is difficult – though not impossible – to study.

But if you start with the basics, and look at the history of the medical field, then yes, masking is an effective way to slow spread.

Infectious disease physicians – along with other doctors, nurses and respiratory therapists – have long used masking in hospitals when a patient arrives with a highly transmissible virus. Long before anyone knew of Covid-19, medical professionals were donning N95 masks when a patient arrived with tuberculosis, a respiratory illness spread through coughing and sneezing. When treating influenza, surgical masks – which today are common everywhere from grocery stores to airplanes – were frequently used.

Simple interventions like those have largely prevented outbreaks of respiratory viruses in hospitals over the years. If they work for medical professionals whose job is to get up close with sick people, won’t they generally work for the rest of us?

“If you both stuff the virus if you’re infectious, and you block the virus if you’re trying not to get infected, it’s going to work, right?” said Dr. Thomas Russo, chief of infectious disease at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. “You don’t need to be a rocket scientist to figure that out.”

But being an airborne-particles expert helps, and we reached out to one.

“There’s more and more evidence accumulating that they are at least partially protective,” said Linsey Marr, a professor at Virginia Tech who has a Ph.D. in environmental engineering and specializes in the transmission of infectious diseases through aerosols. That makes her a rockstar-level expert in the world of Covid-19 transmission.

“Masks are effective, but they are not 100% effective,” Marr said. “No one intervention that we have is 100% effective.”

Marr’s advice: Stop thinking in terms of “safe” and “unsafe” – and add an “er” by combining masking with vaccination, good ventilation and air filtration, and avoiding packed crowds – especially when spread is high, as it is in Western New York.

“What we can do is make things safer,” Marr said, “and masks make things safer.”

People who are skeptical about masks will point out that virus particles are so small that they can probably slip through the mask itself. True?

No.

First, a caveat: The quality of your face covering matters a lot, and while any barrier is better than none, a thin gaiter or bandana is likely to do a lot less good than a multilayered mask. At the opposite end of that spectrum are N95s (and KN95s and similar respirator masks), which are widely considered effective.

Most people, however, are wearing a mask that falls between those two styles – and you don’t have to look far to find someone insisting that microscopic virus particles will slip right through a surgical mask.

Again, it’s not that simple.

“It really will filter out the virus,” Marr said, explaining that the material used to make such masks is like stacking hundreds of chain-link fences unaligned, essentially creating a maze of obstacles a virus particle would have to navigate.

“There are several other physical processes at work that help trap the particles in there,” she said. “There are many different layers.”

How about this argument: In Florida, where mask mandates are largely nonexistent and businesses can generally choose to operate like it’s 2019, Covid rates are low right now. But here in upstate New York, we’re a Covid hot spot. How do you reconcile that with masking requirements?

Pointing toward Florida to say “masking doesn’t work” is another example of simplistic thinking.

Several factors are at play here: First, Floridians and others in the south tend to live more of their lives outside, given the warmer climate. Outdoor air generally allows you to go mask-free.

That said, Florida and other southern states have been Covid hot spots. Look to this past summer – when more Floridians tend to stay in the air-conditioned indoors to avoid the blistering heat. The Delta wave tore through Florida for about two months beginning in mid-July. That was a solid month before New York saw a spike.

Cindy Prins, an epidemiologist and assistant dean with the University of Florida's College of Public Health & Health Professions, pointed to a variety of factors that brought the wave – and subsequent cooling – to Florida first. Among them: Florida’s vaccination rate is lower than states such as New York, meaning when Delta hit, more people there were susceptible.

“You get that wave, you get that peak of infection, and then it comes down because the virus doesn't have a lot of places to go anymore,” Prins said. “It's kind of burned through that susceptible population.”

Another factor: Scientists now know that the immunity from vaccination wanes after several months. Most people who chose to get vaccinated generally hadn’t experienced that waning immunity in summer – but they are now. Today, any adults who got their Pfizer or Moderna shots more than six months ago, or Johnson & Johnson two months ago are being urged by the Centers for Disease Control and Prevention to get a booster.

The bottom line: The Delta wave hit New York in mid-August, as kids were heading to school, and as the immunity of many vaccinated people was waning. That doesn’t mean masks don’t work. It furthers the case for wearing one.

Is there proof that masking works?

Yes. Researchers from Stanford University and Yale University conducted a study, which is peer-reviewed and was published this month in Science magazine. The researchers tracked about 350,000 people from 600 villages in rural Bangladesh, giving them masks and providing education on their use. Over the eight-week period of study, they found that using surgical masks reduced Covid-19 infections by 11% across the population. For people older than 60, infections were reduced by 35%.

And that’s with only “less than half of the population wearing masks,” said Dr. Ashley Styczynski, an infectious disease fellow at Stanford and one of the study co-authors.

In an email with The News, Styczynski noted the importance of role modeling in encouraging people to wear masks, and acknowledged, “In South Asia masking is not as politically charged as in the U.S.”

But the facts are clear: Masking does reduce infections.

“Even if you can't get everyone on board,” Styczynski said, “more masking is always a win.”

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It comes down to several factors, including the Delta variant, the weather, not enough people being vaccinated and the waning efficacy of vaccines for those who did get the shot, according to Dr. Thomas Russo and Dr. Peter Winkelstein.

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