To wear a mask or not

Let's not bury the lead:  When you can't social distance, yes, you should wear a mask, almost definitely. Some of that is for you, but mainly it's for everyone else. If you struggle breathing while wearing a mask, you definitely will struggle much more with COVID.

This is another entry in my series on COVID.

How COVID-19 spreads

The virus is more likely to infect someone when there is a lot of the virus. There are 3 general ways that it appears to spread: contact, aerosol, and droplets. (There's a 4th that is difficult to study and seems less likely to be a major channel: fecal to oral.) For contact, you should not touch others, wash your hands a lot, and avoid touching your face. For aerosolized virus, you should avoid situations where a significant amount of virus might gather together, like an un-ventilated room or a large gathering of people.

For droplets, the easiest population measure is masks.  Droplets from singing, coughing, sneezing, yelling, yodeling, monologueing, etc., are caught inside the mask, keeping a large portion of the virus you are caring from getting to others.

Perceived pros and cons

Pros of wearing masks

• You are much less likely to spread COVID-19 to everyone around you, even if you don't know you have it
• You are slightly less likely to get COVID-19 from others, especially if they are wearing masks, and you may get less sick even if you do get infected
• Decreasing spread makes it more likely for contact tracing to work
• Liberals won't be mad at you

Cons of wearing masks

• You will be inconvenienced, both wearing them and having to wash them
• There is a miniscule chance you might get something weird if you don't wash it, or a larger chance you might have a panic attack
• You might think masks work better than they do (especially if you wear them incorrectly) and ignore that social distancing is still important
• You might be scared by a conspiracy theory about masks hurting you
• Conservatives will be mad at you

How masks protect the populace

There are several types of masks.  Here, we are talking about homemade/cloth masks, not N95s or surgical masks, and not face shields. 

Up to half of those infected are asymptomatic, so we should all assume we are infected and contagious. If we do, and we wear masks, the number of cases drops significantly. That drop in cases makes it possible for all the other machineries of dealing with the pandemic to function more effectively, causing a positive reinforcing cycle.

Of course, when people don't wear masks, it causes a negative reinforcing cycle.

So, masks decrease likelihood of spread, and any significant decrease helps every other mechanism.  Masks are not supposed to be 100% effective -- just effective enough to make you less likely to spread it or get it than you otherwise would have.

And, even more "of course," social distancing, hand washing, and all the other items are required, too.  Just make sure you wear the masks well.

Scientific findings

According to the CDC, “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus — particularly when used universally within a community setting.”  This is because the virus transfers most easily when it is in high volume, such as in droplets, and masks catch droplets from coughs, sneezes, and yelling, etc.

A review of 172 studies in 16 countries found that social distancing prevents best, followed by medical-grade masks, followed by cloth masks and eye protection.  If we had universal mask wearing (95%), one study estimated there would be an almost 20% in deaths.  Goldman-Sachs thinks a 5% swing in the economy could be averted by national wearing of masks.

The Mass General Brigham JAMA study found masks decrease spreading. A Science Advances study found that wearing most cloth masks works pretty well, but bandanas and neck fleece don't (so ... wear a mask). 

If you want to see how effective different masks are, here's a neat visual.

Recent findings are also suggesting that you get less sick when you wear a mask, which isn't that surprising if the "more virus = more sick" hypothesis holds true.

Major recommendations internationally

Original advice

There were differing opinions early in the pandemic.  The World Health Organization (WHO) said that people shouldn't wear then unless they were near someone likely to have it or had respiratory problems. Why?  Largely because they didn't want the community at large taking PPE from hospitals, but also because people often wear masks incorrectly and develop a false sense of security that they don't need to social distance.

The US Center for Disease Control and Prevention (CDC) almost immediately (early April) took the opposing stance: The populace at large should wear cloth masks when social distancing isn't possible. Why?  Because it seemed to work in previous pandemic, and the countries that wear masks seemed to be doing better, and health experts generally agreed it would slow the spread.  

Within a month or two, health officials agreed

It took a couple of months, but eventually the WHO changed its stance, and the vast majority of countries had mask recommendations or mandates for the populace.  Why?  Because there are a large number of contagious asymptomatic or pre-symptomatic carriers, and droplets seemed like a major delivery channel.  Masks are especially important in places like the US where the general public is reluctant to social distance for long periods of time.

So, by early June, there was no real confusion left -- almost everyone agreed that social distancing was what you should do, and when you couldn't, you should wear a cloth mask (appropriately).  And, of course, you should wash your wands and not touch your face.

Stupid recommendations (aka, conspiracy theories/myths)

There are a bunch of myths about masks.  Here are a few, and some more, and a few others, and yet a few more:

1. I'm sick, so I shouldn't wear a mask. Masks are for others, and if you are really sick, you should do whatever you can to stay away from this horrible disease.
2. Masks weaken your immune system and make you weaker. Your immune system is mature after early childhood, so you need not worry about this one.
3. The carbon dioxide will poison me/hurt me/something. No.  Health care workers have been wearing these for years, and CO2 can really easily get out. If your lungs are weak enough for this to be a thing, you really, really don't want COVID-19.
4. The metal in the mask helped 5G give me the 'rona. I don't really think I need to debunk this. But this is really something some people share and believe. If you see this, please question everything that person ever has or will post.
5. Masks "activate" the virus.  Viruses don't need to be activated. And if they did, masks have very little impact on your physiology. And nothing else in Plandemic is true, either. 
6. Masks are a ploy for the government to control you. How does that even possibly work? How is this different from every other law? 

What's important

Most important

Everyone agrees that social distancing is much more effective than masking and getting close.  So you never need to wear a mask if you stay away from others.  That's a win for most introverts! Have everything contactlessly delivered while shotgunning bon bons and bingeing Netflix. If you can work remotely, you may be home free.

But really, the most important thing is for you to be safe and to not endanger yourself or others.  A mask is just one part of that larger strategy.

Second most important

People are people, and all this is hard.  Be nice.  Don't get close to people who are obviously trying to socially distance, even if you think it's bunk. Don't be a jerk and get judgy, one way or the other. If you have even a slight bit of empathy, you have questioned your personal stance on this a few times. Give yourself and others some grace, even if they are being a bit jerky right now -- that may be you tomorrow.