Saving Face in the Age of the Virus
Are Masks a Pandemic Panacea?
One of my smartest friends, a computer science professor—one of mine, actually, way back in college—has been posting incredibly useful data about COVID-19 on his Facebook wall. He posts frequently, urging people to stay home, explaining the nature of exponential growth in plain terms, sharing stories of how he and his family are coping with life in quarantine.
In short, he’s a Good Actor, the kind we sorely need as this tragedy plays out.
Recently, though, he posted a lengthy piece that surprised me, both for its unbridled optimism as well as its content. It began with this promise: “There is a simple and cheap way for us to beat this virus!!”
That seems uncharacteristic, I thought. To be fair to him, I think he was very excited about having unearthed some research suggesting that we should all be wearing face coverings, and that doing so will stop disease transmission in its tracks. So who could blame him?
My friend the professor isn’t alone. You may have seen some discussion of this idea in your Twitter feed in the form of tweets emblazoned with the #masks4all hashtag. That idea—that if we all just obtained and wore some kind of face coverings, we’d all be able to resume our lives—is predictably popular. But it’s wrong.
Not that the research driving this bandwagon is unneeded, or without merit. We’re all trying to understand how Italy, for example, can be struck so hard by this virus, while other countries such as Germany and Taiwan seem to be doing much better (as of this writing, at least).
Into this conversation steps the appealing, intelligent, and entirely guileless couple Jeremy Howard and Rachel Thomas, co-founders of five-year-old Silicon Valley software startup fast.ai. As data scientists and ethicists, the married pair are well-positioned to evaluate the avalanche of data beginning to emerge from hospitals, regions, and countries fighting the disease. We urgently need this kind of analysis.
Howard and Thomas reviewed as many as 30 scholarly papers on how face covering interfere with pathogen transmission, and concluded, unsurprisingly, that face coverings can play an important role in slowing or preventing the spread of disease. So far so good. But they go on to advise everybody to make or procure their own face covering—and this is where I part ways with them.
Certainly, there are those who should be covering their faces. (By the way, I’ll be using “face-covering” as a generic term, and “masks” and “respirators” for PPE: medical-grade personal protective equipment.) These fall into two categories: victims and vectors. The former includes seniors, immunosuppressed or respiratory-frail individuals, and others at greater risk of both becoming ill and dying. Vectors include most service-industry workers who are still showing up, either because they work in essential industries or because they simply cannot afford not to. Of course, every vector is a potential victim as well, and vice versa.
But we know that respirators and masks can help prevent disease; and perhaps other types of face-coverings can, as well. That suggests we should expand the face-covering community to include everybody, as recommended by Howard and Thomas. But if that’s so, then why do the Surgeon General, the World Health Organization, and the Centers for Disease Control all tell us not to?
Or do they? The Washington Post has reported that the CDC is considering recommending covering one’s face when outside the home. But, as of this writing, they haven’t yet done so. The questions to be settled seem clear:
- Is widespread face-covering effective?
- Will a sudden rush for face-coverings create yet another burden on the supply of medical respirators and masks available to healthcare providers?
- Will people take more risks if they feel their face-coverings will protect them?
To these I’d add a fourth: is the CDC simply giving up the fight to maintain the quarantine in the face of pressure from both the administration and the public?
Before facing those questions, however, let’s review what they are telling us to do: Stay Home. The reason “Stay Home” works as health policy marketing is because of its brilliant simplicity: Stay. Home. No room for misunderstanding. Kindergartners comprehend that message… and so do their parents. “Losing your patience? Kids driving you nuts? Fresh out of TP, Clorox, chicken, and your desire to get out of bed in the morning? Sorry, but you have to Stay Home.”
“Well, OK then: I guess we’ll just have to Stay Home.”
What’s more, the supremacy of self-isolation as a mechanism for slowing the spread of disease is absolutely undisputed. Combining that effectiveness with the simplest of instructions as to how to achieve it—Stay Home—has been a winning combination in much of the country.
But, as simple and successful as that recipe is, it’s also expensive. Millions have filed for unemployment as their jobs have suddenly disappeared, while the giant vortex sucking corporate valuations beneath the surface has also dragged stock prices, bond yields, and everyone’s retirement savings down with it.
For such a boring activity, staying home has sure made a noisy impact.
No price is too high to save millions of humans from a miserable and premature demise, of course. But could those people be saved by doing something less destructive to the economy? That seems to be the question posed by face-covering advocates.
We know from research like that cited by Howard and Thomas that masks—when used correctly and in combination with isolation, aggressive testing, and contact tracing—can be effective. But masks aren’t an option. We all know the stories of hospital workers making do with substandard or homemade face coverings—or even nothing at all. Our top priority as a nation at this moment must be to protect the healthcare providers who are in turn protecting all of us. Asking a nurse who may see dozens of COVID19 patients per day to sacrifice his mask so that you can feel less anxious about running to the store is not good policy.
With masks off the table, we are left to consider non-medical face-coverings. These may range from a bandana or a strip of cloth torn from a T-shirt, to a professionally sewn mask-like covering. How effective are these types of gear?
The jury is out. The Post article notes a few of the plusses and minuses. Intuitively, face-coverings should at a minimum reduce the number and velocity of droplets you are spewing from your mouth and nose, and they may help reduce face-touching. But even assuming that’s true: how much difference do they make in real-life transmission? And does that anticipated benefit—if it accrues at all—outweigh the cost — if it accrues at all — of diluting the surprisingly successful Stay Home campaign?
And that’s where smart and well-meaning professionals disagree. If it’s a difficult question for them, then how can we laypeople—bivouacking in our own homes, anxiously waiting to see how this all turns out for the world and for ourselves—be expected to make good decisions for our families?
But it could be that the cost/benefit question is already moot—albeit not for good reasons. It seems likely that the pressure from a cowering public and a clueless administration has shown the CDC the writing on the wall: American patience with the Stay Home program is growing thin. Churlish children with cabin fever and a childish president with election fever threaten the incredible consensus of will that has held Stay Home together thus far.
In that case (I imagine the doctors and policy-makers saying to one another), we need a plan to mitigate the collapse of the one program that’s been successful all this time. And that plan clearly has to include face covering. So why not start preparing people now?
The answer is that such preparation risks hastening the end of Stay Home. Tell people that under some circumstances, covering their face will give them added protection against contracting the virus if done properly and in conjunction with other precautions, and what they are likely to hear is: “You can go out now: the mask will protect you”.
And that would create an enormous setback in containment.
If, instead of issuing face-covering guidelines, the CDC instead delivers a strong re-statement of the Stay Home policy, accompanied by an explanation of why face covering—while potentially useful—isn’t yet a viable alternative, perhaps the nation’s backbone (and that of its spineless president) will be stiffened. Perhaps people will self-isolate a bit longer—long enough for rapid testing and contact tracing to take hold, freeing us from our self-imposed incarceration at last.
Americans, however, rather famously do not like to wait, especially when their elected officials and spiritual leaders urge them not to. But I hope we do, because—for the time being at least—face-covering won’t get it done. Let’s steel ourselves for another month of canned food, limited toilet paper, increasingly unkempt spouses, and crazy-making kids, and just Stay Home. Our families and our neighbors are counting on us.
