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To mask or not to  mask.

It has been three years since an unusual virus emerged from Wuhan, China to cause the most serious pandemic in a century. The turmoil that it has caused is not just medical but has spawned economic ruin for many businesses, disruption of children’s education from kindergarten to college and public distrust and disgust for politicians and medical authorities. One of the most contentious issues is the effectiveness of masking. Has near-universal wearing of face masks made a difference?

Like many medical issues, “It depends.” It depends on the type of mask, how long it is worn, the circumstances in which it is worn, and how it is worn. The last issue is the most maddening to those of us in the world of infectious diseases.

Persons who wear a mask that covers the mouth but not the nose, and who might be shedding the virus from their upper airway, not only contaminate the space around them but are depositing virus particles on the mask itself with every downward nasal exhalation. When they touch the mask they contaminate their hands and everything that they touch. It should be noted that contaminated surfaces such as doorknobs, light switches, computer keyboards and money are seldom sources of infection, but hands are another matter. Hands are usually warm and slightly moist, conditions that prolong the survivability of the virus.

Making cloth masks became a cottage industry in the early months of the pandemic. A cloth mask, especially one that consists of only one layer, is pretty – but it’s pretty useless. Infected persons who wear such a facial ornament can actually increase spread of the virus, thinking that they are safe to be around when they are not. One can also become infected while wearing a cloth mask, since those little buggers can easily pass through such an ineffective barrier. To quote one researcher: “If you can smell smoke through a mask you are also inhaling viruses into your respiratory tract.”

The N95 mask is the gold standard, but only if your standards are very low. It was not designed for medical purposes; the so-called “medical N95” mask gives a false sense of security. It does work, however, to lower the risk of transmission provided that it is fitted properly, that the fit is verified by another person, that it is not worn for more than a few hours– nobody knows how much is a “few” – and the wearer does not touch the mask – ever! The WHO recommends changing the masks every time they are touched!

In a study of several types of masks by the National Institute for Occupational Safety and Health it was found that a medical mask – the blue-on-the-outside-and-white-on-the-inside one that is worn by most people, 48 percent of cough aerosols and 58 percent of exhaled aerosols got through the  mask. This was improved significantly (but not reassuring to me) by wearing a second cloth mask. Fifteen percent of cough aerosols and 9 percent of exhaled aerosols still got through.

So is masking worthwhile? It is as long as it’s the right type of mask, is fitted properly, is not touched, and is not worn for more than about six hours. Just don’t expect it to be completely protective. After all, Saint Anthony (Fauci) wears two at a time, has received four vaccines and tested positive twice in about one month.