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Comment: The ethics of wearing a mask if you’re not sick and not a health worker

Update 2: Canadian officials are now also suggesting that a non-medical mask would be useful in reducing the spread of COVID-19. But they've stopped short of recommending everyone wear one.
Photo N95 respirator mask
An N95 mask with valve, designed for industrial use, but being embraced for health-care workers because medical masks are in short supply.

Update 2: Canadian officials are now also suggesting that a non-medical mask would be useful in reducing the spread of COVID-19. But they've stopped short of recommending everyone wear one. Wearing a cloth mask would help to prevent a person from infecting others, but would be less effective in protecting that person. The primary ways to avoid infection are to keep a distance from other people, at least six metres, and frequent handwashing with soap and water. The officials are asking that medical masks, such as the N95, be reserved for front-line health workers.

Update: The Centers for Disease Control and Prevention in the U.S. recommended April 3 that everyone, including healthy people, wear a fabric mask in public during the COVID-19 pandemic. Medical-grade masks, which are in short supply, must be reserved for health-care workers. This is a change in stance for the CDC. Canadian officials have yet to take a everyone-should-wear-a-mask position. They have said that face coverings likely help to reduce the likelihood that a person will pass along an infection, but such coverings are less useful in protecting a person.

Fabric masks can take the form of homemade-designs with earloops or headloops that are similar in shape to medical masks; also options: scarves, bandanas, balaclavas, neck tubes, and anything else that will fit over your face and not suffocate you (don't use a plastic bag). The mask must cover both mouth and nose.

Mask use is most effective in preventing the spread of disease when combined with thorough handwashing (at least 20 seconds with soap and water) and social distancing (stay at least 2 metres away from other people). And don’t touch your face with unwashed hands.

There has been fear that mask wearing will prompt some people to skip the other steps, such as social distancing.

Wearing a mask can be hot and uncomfortable and, if you wear glasses, cause them to fog up. It could take a while to get used to wearing a mask. It can be harder breathe when you wear one. 

The U.S. recommendation for everyone to wear a fabric mask in public comes amid reports that some people infected with COVID-19 do not have symptoms.

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Original post: 

Health-care workers need masks to protect themselves when they treat people with COVID-19 and other contagious diseases. But there’s a shortage of masks, especially N95 masks which provide a higher level of protection. Masks have been sold out for weeks in retail stores; hospitals, especially in the U.S., are saying their supplies are rapidly dwindling and orders for more masks are only being partially fulfilled if at all.

Is it proper, then, for healthy people who are not caregivers to be wearing masks?

Many medical officials in Canada and U.S. have been saying that it’s not necessary for healthy people to wear masks. It’s more effective to keep your hands clean by washing with soap and water, don’t touch your face with unwashed hands, maintain a distance from other people, and get enough sleep. People who are sick, who are coughing and sneezing, should wear a mask. So should health-care workers when they are treating contagious patients.

The U.S. surgeon general, in a Twitter message, said: “Seriously people — STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

It’s a confusing message. The masks are not effective for healthy people, yet they are essential for health-care workers.

The nuance seems to be this. Healthy people who are not surrounded by sick people have little to gain by wearing a mask. Leave the masks for those who really need them — health-care workers who are surrounded by sick people. We need to make sure there are plenty of masks for doctors and nurses to help them stay healthy so that they can look after us if we get sick.

[Auto-placed ads selling masks might show up within the text of this article and elsewhere on our website. I am not comfortable with those ads and am asking if they can be blocked.] 

B.C. provincial health officer Dr. Bonnie Henry was asked about the mask issue and offered this reply:

“In terms of us all wearing masks, one it’s a colossal waste of masks and we know that people who aren’t ill and are wearing a mask often fiddle with their face and that can be a risk for them self-inoculating and becoming ill. … We need to keep the masks for where they’re needed. And I do recognize it is an expectation and symbol of respect in some societies that you wear a mask when you’re out to protect others. And I respect that … but I don’t think it’s necessary, and I will continue to say it’s not necessary, unless you’re sick yourself.”

But her message is not being embraced in some quarters.

A small Vancouver grocer, for example, posted a sign saying only people wearing a mask would be allowed into the store.

I have mixed feelings about all this. The impulse for self-preservation is strong: we should be able to wear masks if it makes us feel better, even if the effectiveness is minimal, and could even harm us, especially if we repeatedly wear a contaminated mask because fresh ones are not available. 

But masks are in short supply. So, this approach makes sense to me: if you’re not a health-care worker, don’t buy masks in bulk. Help to make more masks available to those who really need them — workers on the medical frontlines and workers, such as grocery-store cashiers, who have to deal with a high-volume of strangers. Keep a small supply for yourself, in case you get sick. I have no idea about how you would get those masks if you don’t already have them.

Ideally, there should be enough masks for everyone, both health-care workers and the rest of us. 

This line of thinking also makes sense: People who are sick must wear a mask to cover their coughs, but they might be reluctant to do so because they don't want to be singled out. To avoid that, everyone, healthy or not, wears a mask. It all comes down to having enough masks. And we don't have enough. 

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The World Health Organization has videos showing how to wear a mask properly. You can find them here.

Here’s a summary of the advice:

• Healthy people only need to wear a mask if they’re taking care of someone who is sick.

• Wear a mask if you’re coughing and sneezing.

• Mask-wearing is only effective if you also clean your hands frequently with soap and water or an alcohol-based hand sanitizer.

• Make sure your hands are clean before putting on a mask.

• The mask needs to cover your mouth and nose; there should be no gaps between mask and face.

• Don’t touch the mask while you’re wearing it.

• When removing the mask, don’t touch the front; remove it from behind.

• Dispose of the mask in a covered bin; wash your hands.

N95 masks are designed to be used just once. But because of the mask shortage, some hospitals are experimenting with ways to decontaminate masks so that they can be used multiple times.

Much of the mask supply comes from China. Because of the COVID-19 outbreak there, many mask factories were closed until recently, and China has restricted the export of masks so that its own needs can be met.

Mask manufacturing is being stepped up in other parts of the world, including on Vancouver Island. A clothing-manufacturing company here, Salts and West, is making reusable cloth masks, which aren’t as effective as an N95, but can be used if there are no other options. They can also be combined with an N95 to extend the life of that mask.

A batch of N95 masks showed up on the shelves of some Target stores in Seattle, while hospitals there were struggling to get the masks. There was quick criticism and Target has apologized; it is donating the masks to the Washington state Department of Health.

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