by Dr. MarkAlain Déry, DO, MPH, FACOI
Most public health successes are the results of years of research. Vaccines are a good example; the research needed to develop them can take decades. In emergent settings where the luxury of time is absent, however, resolute action is needed.
In 1847, after the Hungarian obstetrician Dr. Ignaz Semmelweis realized the necessity of hand-washing prior to delivering babies, the maternal mortality rate fell from 18% to below 2 percent.
In 1854 the anesthesiologist Dr. John Snow removed a pump handle from the Broad Street pump, and the cholera epidemic in London came to an abrupt end.
Today, we are in a crisis situation with COVID-19. Two of the most effective tools we have to stop the transmission of COVID-19 are physical distancing and masks. Since medical masks are in short supply, the public has been advised to use cloth masks as the primary alternative. It seems like almost weekly, more research documents the effectiveness of facial coverings. These studies range from population-based to mathematical modeling to meta-analysis.
Dr. Michael Osterholm, head of the Center for Infectious Disease Research and Policy at the University of Minnesota (CIDRAP), is one of our country’s top experts on infectious diseases. He has been a strong advocate for the importance of physical distancing. But when it comes to the efficiency of cloth masks, often the most accessible type of protective mask for the public, we believe Osterholm and his CIDRAP colleagues are using their platform to mislead the public.
WCCO radio reported in May that “Coronavirus expert Dr. Osterholm questions guidelines on cloth masks, saying they don’t stand up to the virus’ air assault.”
They quoted Osterholm as saying, “Cloth masks, I think…have little impact, if any.” In another WCCO appearance he stated, “The Minneapolis mask mandate could do more harm than good”. The Cape Charles Mirror featured further remarks from Osterholm, “The stupid masks you wear to the store don’t do anything…If you want to wear a cloth mask, use it. Know that I don’t believe, or none of my colleagues, that this is going to have a major positive impact.”
Hard data contradicts such claims. In countries with cultural norms or government policies that support public mask-wearing, per capita coronavirus mortality increased, on average, by just 5.4% each week. That compares with 48% each week in remaining countries.
Separate analyses of U.S. states and of Google trends and e-commerce data show much the same. In most of these countries and states, medical masks have been in short supply, and many people have instead used more readily available non-medical masks.
Even a simple cloth mask is highly effective for stopping droplets on egress. Modeling suggests that universal mask use may limit or halt the spread of the disease.
Osterholm’s onslaught against cloth masks is particularly troublesome because it comes at a time when mask-wearing has become highly politicized in the U.S. It offers ammunition to people who want to make wearing face masks a personal choice, or even a political statement, instead of a moral imperative.
This isn’t an issue that should have two sides. Given the preponderance of data in favor of mask-wearing, it seems sensible to promote their usage in addition to continued social distancing and hand-washing. Countries that were early to adopt masks (or already had a culture accustomed to wearing masks) have controlled their epidemics more effectively. Collectively, our primary goal should be to find ways to end this epidemic, as Dr. Snow did when he removed that handle from the Broad Street pump.
The purpose of our article is not to vilify any one person. Our goal is to emphasize the importance of masks, and to point out that entrenched beliefs about the type of data needed to adopt public health measures without regard to the urgency of the situation can cause harm.
MarkAlain Déry, DO, MPH, FACOI, is the Chief Innovation Officer and Medical Director of Infectious Diseases at Access Health Louisiana, the largest Federally Qualified Health Center in Louisiana. He is a practicing infectious diseases physician, epidemiologist, & hosts a daily podcast called NoiseFilter which looks at COVID-19 news through the filter of social, economic & racial justice.
Contributing to this story were Jeremy Howard, Distinguished Research Scientist, University of San Francisco, and Vincent Rajkumar, Editor-in-Chief, Blood Cancer Journal