The Case for Everyone to Start Wearing Masks or Bandannas

On Wednesday evening, Eric Garcetti, the mayor of Los Angeles, gave the people of his city a message regarding masks: if you really must go out on the street, for whatever reason, cover your mouth and nose. But don’t go out and buy N95 or surgical masks. Medical workers in hospitals thick with covid-19 cases need those, and there are not enough even for them. For everyone else, a cloth mask, home-sewn or rigged up, or even a “tucked-in bandanna,” combined with social distancing, would at least be a start. “We’re going to have to get used to seeing each other like this,” Garcetti said. “This will be the look.” He told people in the city to post images of themselves wearing masks on social media with the hashtag #laprotects.

There is much that remains uncertain in the epidemiology of the novel coronavirus. The best reason for wearing even non-N95 face masks, as the science writer Ed Yong noted in a summary of the evidence in The Atlantic, is not that they will absolutely shield you from the virus—they probably won’t—but that “they can stop viruses from getting out.” In other words, masks prevent their wearers from spreading virus-bearing droplets. Los Angeles was ahead of New York City in closing schools; Garcetti’s advice sounds like something else that should probably have been issued here and in other hard-hit areas already. The reasoning was clear even in what were, as of Thursday, the Centers for Disease Control and Prevention’s hedged directives regarding masks. Currently, they say that “a facemask should be used by people who have covid-19 and are showing symptoms. This is to protect others from the risk of getting infected.” But there is growing, strong evidence of asymptomatic and presymptomatic transmission of the virus. So how do you know if you have covid-19, in the absence of testing? The C.D.C. has said that it is considering issuing even stronger guidance on masks and face coverings, but, logically, it’s there already.

In a city like New York, with some fifty thousand confirmed cases, it seems like a matter of responsibility to act as if you are infected—there is a chance that you might be—in a way that will protect others. Covering your mouth and nose if you go out is one way to try to do that. (Questions like how far an infectious droplet can travel have not been entirely resolved; there are some indications that it can reach farther than the often-mentioned six feet if, for example, propelled by a vigorous sneeze.) Austria already hands out masks to everyone going into a grocery store; that is a sensible measure, particularly considering the risks that clerks are bearing to keep everyone else supplied. A point Garcetti emphasized is that a mask is not a get-out-of-social-distancing-free card: “To be clear, you should still stay at home. This isn’t an excuse to suddenly all go out.” The goal may be to protect other people more than you, but that is a pretty good goal. In an opinion piece for the Times, with the title “Why Telling People They Don’t Need Masks Backfired,” Zeynep Tufekci, a technology writer, noted, “If the public is told that only the sick people are to wear masks, then those who do wear them will be stigmatized and people may well avoid wearing them.” The way to counter that is to normalize mask-wearing. And unlike, say, rushing a drug to the public without adequate testing, there is no harm in wearing a bandanna or a homemade cloth mask, which takes nothing away from anyone.

There is an odd sort of American exceptionalism at work in our reluctance to wear masks. Perhaps we have become too used to archly dismissing the widespread wearing of masks in certain Asian countries, not only during pandemics but in regular flu seasons; there is a notion that they make people look silly, or maybe even weak or timid. But Hong Kong, Taiwan, and South Korea, where mask-wearing is prevalent, seem to have broken the back of the pandemic, and the U.S. has not. Masks are certainly not the only reason for that—testing has been crucial—but that is no reason to dismiss them, particularly when our own situation is so volatile. (Also, we are not doing the amount of testing we need.) If nothing else, it is facile to attribute such success only to extreme restrictive measures that would never be acceptable in a democratic society when mask-wearing, which has been a large part of the response, can be the most democratic gesture available. Covering your face is like casting a vote for the pandemic to end. That can be, as Garcetti suggested, the new American look.

And, yes, there is a point to wearing something that falls short of the standard of an N95 mask. The value of N95s is that, if properly fitted, they can protect their wearers from most particles, even those in finely dispersed, aerosolized form. This is what you might encounter, say, intubating a patient, or in an emergency room where a large number of people are exhaling the virus. But the broadest way the virus spreads is through droplets, and a cloth mask can help to stop a lot of those, particularly, again, if the mask-wearer is the one who is infected. Some materials are better than others; tightly woven cottons are good. The Times has a pattern and instructions for making one, if you can sew. (For those with sewing machines and more skills, the craft community has organized efforts to make masks for health-care workers; designers such as Christian Siriano have been involved in similar efforts, and the fabric conservators at the Metropolitan Museum of Art have joined in.) Indeed, the C.D.C. has said, in its directives to health officials and medical-care-industry leaders, “In settings where facemasks are not available, HCP”—health care professionals—“might use homemade masks (e.g., bandana, scarf) for care of patients with covid-19 as a last resort.” Those same instructions acknowledge that they are not ideal, particularly in a hospital setting. By wearing a bandanna on the street, any person can head off the day when an exhausted nurse or doctor, slumped in a hospital corridor, has to tie on a bandanna before attending to yet another covid-19 patient.

Why hadn’t the public been told to do this earlier, in clear terms? Why, indeed, did the Surgeon General initially discourage healthy-seeming people from wearing masks? Politico referred to the confusing message as a “mask mystery,” especially given that other governments are recommending their use. A widely acknowledged answer is that there are not enough medical-grade masks, and the government fears that people would rush to buy any that are left to find. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, in answer to a question from CNN’s Jim Sciutto about telling the public to wear masks, said, “The thing that has inhibited us a bit is to make sure we don’t take away the supply of masks from the health-care workers who need them.” In a briefing on Tuesday, President Trump, as he sometimes does, carelessly acknowledged this truth, saying, with regard to masks, “I mean, one of the things Dr. Fauci told me today is that we don’t want them competing, we don’t want everybody competing with the hospitals. We really need them.” Trump advised wearing a scarf—“everybody, a lot of people have scarves”—twirling his hands to show how one might be worn. And this is, indeed, the best that the richest country in the world can offer now.

Amy Davidson Sorkin