Will Americans wear masks to prevent sickness beyond COVID-19?

Americans may be adopting masking habits routine for other global citizens who wear them to block the spread of flu and other respiratory diseases.

The mask felt stifling—suctioned to her face in a way that made it seem difficult to breathe. But Susan Hale Gidlow wore it anyway, walking from her Los Angeles home to the grocery store as quickly as she could, dashing in and out, and breathing a sigh of relief when she was able to take it off.

“I felt a little claustrophobic,” the 60-year-old says. Within weeks, though, she grew to love her mask. 

Research has shown that masks offer protection against a variety of respiratory pathogens, including SARS-COV-2, the virus that causes COVID-19. And even as localized mask battles rage across the United States, many people continue to see value in the face coverings that have protected people from COVID-19. 

Gidlow is among a growing number of Americans who don’t plan to abandon their masks when the pandemic wanes. They’re pledging to wear face coverings in crowded indoor spaces and near the sick and frail to protect themselves—and others—from getting sick now and in the future.  

Used in combination with other mitigation measures—such as hand washing and social distancing—masks could find their place in American culture in the long term. 

“Masks forever,” Gidlow laughs.

A recent national poll conducted on behalf of the Washington Post found that nearly 70 percent of respondents plan to wear masks whenever they’re sick, and more than 40 percent say they will don face coverings in crowded spaces no matter what. The poll’s results defied the political polarization that has often accompanied mask wearing: More than half of self-identified Republican respondents plan to wear masks when they’re sick after the pandemic. (About eight in 10 Democrats said the same.) 

Sheela Shenoi, an assistant professor of medicine at Yale School of Medicine, admits she was surprised to hear so many people plan to continue wearing masks. “It’s just been such a fight to convince people that masks are effective and can be a valuable tool” to stymie illness, she says. 

But Shenoi quickly adds that wearing a mask is “something that we all have the power to do for ourselves.” Masking gives people some control over their health when they can’t control a virus itself. In that sense, she says, “I completely understand why people would want to do it.”

A rocky start

Though they’ve never been widely worn in the U.S., masks have been used to prevent disease spread for more than 100 years. In the late 19th Century, a handful of surgeons began to don face coverings during surgery. In the 1960s, the Japanese used masks to prevent the spread of the H3N2 virus. And in the 2000s, mask wearing became common through much of Asia to protect against the coronaviruses SARS and MERS.  

But many Americans were slow to adopt the practice in the era of COVID-19.

Matt Ramirez, a 32-year-old resident of McAllen, Texas, says he wore masks before the novel coronavirus began to spread across the country whenever he traveled on public transit, to ward off any viruses from a fellow commuter. 

“I don't want to minimize the awkwardness of wearing it before the pandemic,” he says. “People would move away from me—even move toward people who were coughing—because of the mask.”

When the coronavirus reached the U.S., the Centers for Disease Control and Prevention initially dissuaded Americans from wearing masks, likely in “a knee jerk reaction to conserve masks for the healthcare workers and to not cause a panic,” says Corinne McDaniels-Davidson, an epidemiologist at San Diego State University. “Hindsight, as they say, is 20-20.”

The agency quickly changed its message as evidence mounted that masks prevent infection from spreading. On a May appearance on NBC’s “Meet the Press,” Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease and the president’s top medical adviser on the pandemic, said he thinks people have gotten used to wearing masks. 

He added it’s conceivable that “people might actually elect to wear masks to diminish the likelihood that [they’ll] spread these respiratory borne diseases,” like influenza or the common cold.

A typical flu season peaks between December and February and has caused as many as 810,000 hospitalizations and 61,000 deaths each year since 2010, according to CDC data. But during the 2020-21 flu season, the U.S. saw only 700 deaths from the flu. Hospitalizations dropped dramatically, too, to their “lowest recorded since this type of data collection began in 2005.”

The country’s unusually low flu season cannot be attributed just to mask wearing, but the CDC says that wearing masks in combination with hand washing, school closures, reduced travel, increased ventilation of indoor spaces, and social distancing contributed to the decline.

Americans “crushed” the flu because of these mitigation measures, McDaniels-Davidson says. 

Meghan Hunter, a 41-year-old resident of Rockland, Maine, says that she used to get “a doozy” of a cold each winter—until last year. And she attributes her health, in part, to mask wearing. Hunter says she plans to continue masking when she’s on airplanes, as well as in airports and other crowded spaces, such as grocery and retail stores, during cold and flu seasons. “I don't miss having colds,” she says.

How masks work

Plenty of viruses are transmitted in ways, such as gastrointestinal pathways, that would make masks ineffective, Shenoi says. Ebola, for instance, is spread when people ingest or come into contact with infected bodily fluids. Masks are most effective against airborne viruses, such as influenza, rhinovirus, or respiratory syncytial virus (RSV)—pathogens that are transmitted through droplets coughed, sneezed, or spit out from an infected person. 

Masks work to prevent disease spread in two ways. They block virus-containing droplets from making their way into the air, where they can be inhaled or otherwise infect others, such as by landing in their eyes. “If someone is coughing or sneezing or talking—expelling infectious droplets into the air—mask wearing disrupts that transmission pathway,” Shenoi explains.   

Masks also protect uninfected wearers: They act as a barrier to large respiratory droplets—and even some small aerosols—by preventing them from landing on people’s noses and mouths.

Droplets and aerosols are balls of saliva or respiratory fluids that can carry viruses. But droplets are larger—at least the diameter of a strand of human hair, says Jose-Luis Jimenez, a professor of chemistry and aerosol expert at the University of Colorado. They infect a person when they land on the eyes, nostrils, or mouth. They’re visible, “like when someone is excited and they’re talking and you see them [droplets] fly through the air,” Jimenez describes. And they’re easier to protect against: Almost any cloth in front of a person’s face would do the trick, Jimenez says. 

Aerosols, however, are much smaller and they linger in the air. “They behave like smoke; they follow the air current,” says Jimenez. Like smoke, they can cause damage when they’re inhaled.   

While most masks will offer some protection against aerosols, studies have shown that masks with moderate to high yarn counts and visible raised fibers—like the texture and thickness of a hand towel or lightweight flannel—perform almost as well as N95 masks, the same masks that medical professionals wear during surgeries. (N95 masks are now widely available, and Jimenez recommends that people who want to wear masks purchase them.)

Jimenez says the fit of a mask also makes a difference in how well it protects against airborne viruses. “As healthcare workers know, a mask that fits well is one that leaves a mark on your face when you remove it,” he says. A properly fitted mask seals against the face without gaps.

A 2020 study showed that loosely folded face masks and bandana-style coverings were the least effective in stopping the smallest aerosolized respiratory droplets laden with SARS-CoV-2. But well-fitted masks—including homemade and off-the-shelf cone-style masks—slowed the aerosols down and reduced the number that permeated the fabric, the same study showed.

“We don't necessarily need every single person to be wearing an N95 because, ideally, we’re not just masking: We're doing all of the things that can prevent the spread of disease,” McDaniels-Davidson says. “In general, the best mask is the one that’s comfortable and that you will wear.”

Todd Archambault, a 35-year-old resident of Canton, Ohio, says that he doesn’t love wearing a mask, but he’ll continue to do so after the pandemic is over whenever he’s sick. He often works with older adults, Archambault says, and “I want to do my part” to help others stay safe.

Hunter, the Rockland, Maine resident, says that the pandemic taught her we can’t always determine who is most vulnerable to viruses. “It feels really responsible to keep [wearing masks] if you have symptoms,” she says.

Who should wear masks

Mask wearing is most effective when a high proportion of people are doing it, McDaniels-Davidson says. In that sense, she likens mask wearing to vaccination: “The more people who are vaccinated, the better off we all are in the community.”

Not everyone will choose to wear a mask in the long term. Some may find them bothersome—simply too uncomfortable to wear over the long term. Others may suffer medical conditions, such as emphysema or pulmonary fibrosis, or mental health complications, such as severe anxiety, that make mask wearing untenable or even dangerous. But many people can still derive (and provide) benefits from mask wearing under certain conditions and in certain situations.

Shenoi recommends masks for people who are immunocompromised and who have underlying conditions—those who are most susceptible not only to severe COVID-19 outcomes, but also to hospitalization from other respiratory viruses. Healthy people might consider wearing them in crowded indoor places. 

“For these respiratory viruses, we know the danger is indoors,” Jimenez says. He suggests that people wear masks in hospitals or on public transit, such as airplanes.

Jimenez adds that he’s often flown to Spain, where he is from, and “about half the time, I’ve ended up with a cold. Certainly next time I’m going to be wearing my N95 the whole trip.”

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