Yes, public health messages about face coverings have changed since March – but those adjustments stem from a better understanding about the coronavirus – and how it spreads, said Dr. Francisco Velázquez, interim health officer for Spokane Regional Health District.

He also knows that with those changes, though, there’s some confusion about the whens and wheres of mask use. On Dec. 4, the Centers for Disease Control and Prevention announced new guidance again, urging “universal mask use” indoors as the country reaches records for coronavirus hospitalizations and deaths.

For months, the agency has encouraged face coverings in public spaces where it’s difficult to maintain 6 feet of distance from others.

The newest statement asks people to put on masks in most places other than their own homes – and even there if a household member is sick. Also, it’s still OK to go without a mask if outdoors while maintaining distance from others such as for exercise.

“I think there is a lot of confusion regarding the use of facial coverings, specifically masks, both indoors and outdoors,” Velázquez said. “I think that has to do with as we learn more about this virus and see more studies regarding face masks, we update what we recommend.

“The basic premise is in any situation where you aren’t able to maintain the 6 feet of distance, a mask is recommended. But it’s not just the mask that helps; it’s also the distancing. The reason for that is because of the travel of droplets and aerosols.”

Velázquez said face covering exceptions include in households where there are no ill family members, when you’re outside and have a wide distance from others and when in public briefly to take a drink or bites of food.

“Initially in the pandemic, the utility of face coverings or masks at it pertains to the spread of disease wasn’t totally clear,” he said. “We’ve also learned that it’s not just droplets but also aerosols involved that are smaller particles.”

Are you still confused if you’re outside on a walk and pass someone or by yourself in the car? Experts suggest to have that mask handy. Washington state’s online face mask descriptions summarize it this way:

“You do not need to wear a cloth face covering when you are in your own home or in your car, if you are only with people in your own household. You also do not need to wear a cloth face covering when you are exercising outdoors and you have plenty of space. It’s a good idea to keep one in your pocket, though, in case you come across other people.”

Velázquez said it’s not necessary to wear a mask in the car if alone or with household members, but he suggests masks if:

• You’re in the car with people who do not reside with you. In this case, it might be a good idea to also open the car windows for air circulation or avoid using the “recirculation” setting on your air conditioner;

• You’re sick and have other people in the car;

• You feel anxious about being out in public and keeping a mask on comforts you or is easier between quick stops.

Velázquez said some collegiate sports are limiting time and distance for practicing or playing indoors, and there likely will be mask use among college athletes who aren’t doing continuous, strenuous exercise.

Clear face shields aren’t as effective when used alone because they’re open on the sides, he said.

“It’s better than not having anything, but traditionally, if you can wear a face mask, that seems to confer the highest level of protection,” he said.

A face covering itself isn’t effective if improperly worn or poorly fitting to the face.

“Material and fit are important,” Velázquez said. “It needs to cover the full nose and full mouth and needs to fit around your cheeks, so there are no spaces. A tightly woven, two-ply, 100% cotton, multilayer mask is pretty good for most of us, whether indoors or outdoors. I’d reiterate it needs to be snug but comfortable.”

He also echoed the CDC guidance that mask use must go in tandem with the other recommended steps of social distancing, hand-washing, sanitizing and avoidance of touching your face and the cloth covering. Masks should be washed frequently, typically in the washing machine with other clothes.

Grab a mask by the ear loops, and don’t set it down on surfaces that haven’t been sanitized, he said.

The mask has two functions – to make it less likely to transmit the virus if you’re infected and against absorption if someone around you is infected, Velázquez said. The recent CDC report warned that about 50% of transmission of the coronavirus is from people showing no symptoms.

In a recent report, the CDC warned the U.S. has entered “a phase of high-level transmission” as colder weather and the holiday season pushes Americans indoors and said that “consistent and correct” use of face masks is critical to taming the virus.

Mask use is most crucial indoors and in outdoor spaces where social distancing cannot be maintained, the CDC said in the report.

The agency recommended mask use at home when a member of the household has been infected or potentially exposed to the virus.

Its summary also recommends limiting in-person contacts, avoiding nonessential indoor spaces and crowded outdoor spaces, safeguarding persons most at risk for severe illness from infection with SARS-CoV-2 and postponing winter travel.

The CDC lists the guidance that people ages 2 and older should wear masks in public settings when around people who don’t live in their household.

As cases rise in the Spokane region, Velázquez concurred with the need to be more diligent during these winter months.

“Even if we think we’re with people we’ve seen before or places we’ve been to before, you don’t know who can be infected, and they could be totally asymptomatic,” he said.

He said if someone is concerned about wearing a mask because of a health condition such as COPD, it’s best to check with a primary care doctor about steps, such as if a face shield can be used, while also taking advantage of any curbside pickup or delivery options.

The SRHD website also offers quick guides on mask use, Velázquez said.