By all means, wear a face mask. Just don't think it will make you invincible

01/04/2020

Should we or shouldn’t we all wear masks? When asked if the public should wear them, the CDC has recently shifted their position from a no to a maybe to a sure. The research is quite clear; masks could be a useful tool in reducing the spread of the virus from a contagious individual. But this relies on two assumptions to be of immediate utility: we use masks that do not compete with the needs of healthcare professionals, and that masks are worn by both symptomatic and asymptomatic individuals.

As a country, we do not have enough masks for healthcare workers. We must have a widely available substitute before advising the public to wear masks. And, as a society, if we cannot even convince potential asymptomatics to defer their spring break plans, will they wear masks? It seems the root issue is something more pernicious – we need to focus on behavioral change.

A popular example of masks’ protective proof is through comparisons between the western and eastern world. South Korea, Singapore and Taiwan have had the best results in combating this coronavirus, while Europe and the US are seeing record highs in cases and deaths. The crux of this argument is the belief that donning face masks will imbue us with the same viral protection as citizens of these other nations – but neglects the myriad, intertwined societal and behavioral factors at play.

Those eastern countries have much in common other than wearing masks and keeping the virus at bay. Their community-oriented cultures reveal that unified social behaviors and personal sacrifices are effective in defeating a virus that thrives in chaos. Such air-tight behavior is what therefore enables loosening of social distancing measures, as once the virus becomes a threat (again) those individual behaviors will collectively adjust (again). Meanwhile, the pandemic responses in the US and Europe have had little cohesion, with rules varying wildly by state and region – resulting in lax individual behaviors and an increase in deaths. It would be difficult to isolate the effect of masks in these cultures, as their ubiquity is part of what makes them protective. Masks work because they are worn on top of layers of well-perfected behaviors.

Masks are not the cure. With a virus there is no silver (or copper) bullet. A lifetime of research on antivirals for other deadly diseases tells us that finding a true cure is unlikely before a vaccine is approved. So, in that approximately 18-month interval before the vaccine, our best offense hinges on our ability to make behavioral changes together, as a society. If we do not wish to take up more invasive measures, such as surveillance and centralized quarantine, then we must become far more stringent in our efforts to change the behaviors we can individually control.

Experts frequently say that we are practicing social distancing. We were practicing hand-washing, and now we are practicing social distancing. The phrase “practice” is apt because it conveys that it will take time to adapt. South Korean leadership introduced the concept of social distancing early on, with persistent messaging to help establish it as the new normal. One Korean professor explained that they’ll know social distancing has been achieved once it becomes as second nature as separating recyclables – underlining the long-term mindset their culture upholds.

We are not there yet. We see forecasted deaths decline and immediately assume the war is over and the current social measures unnecessary. Rather, the projections with fewer deaths are the result of us starting to learn social distancing. If we consider masks as a substitute for the more fundamental changes we need to make, the masks may end up providing a false sense of security and actually unravel our efforts.

Masks for the masses is not dealing with the real problem. Putting on a mask will not give us superpowers. They will not make social distancing unnecessary. We have more practice ahead. Thankfully we have role models whose hard work and sacrifice makes our workload appear enviable, whose own lives rely on our behavioral changes. We already have masked heroes: our healthcare workers. Let’s do our part to protect them.