Dr. Bob Lutz and Dr. Francisco Velázquez: To wear or not to wear a mask, that is the question!

There appears to be four categories of non-mask wearers: 1. It’s not cool or “manly”; 2. I’m too young to be seriously affected by COVID-19; 3. The government can’t tell me what to do; 4. I’m not sure if it really makes a difference.

Those in the first three categories may never decide to wear a cloth face covering, but if you are in the fourth category, here are two reasons why you (and all the others) should: economic health and public health. The shortest route to reopening our community is as simple as everyone doing their part by wearing a cloth face mask. It is a small imposition that will keep everyone safe by slowing the spread. And slowing the spread will allow small businesses to recover, rehire, and even grow while we continue to battle COVID-19.

Although most research has focused on the effectiveness of surgical masks, growing evidence shows cloth face coverings are effective to prevent infection spread. Authors of a recent modeling effort from Cambridge University concluded, “face mask use by the public, when used in combination with physical distancing, may provide an acceptable way of managing the COVID-19 pandemic and reopening economic activity.” (Emphasis added)

Unfortunately, the message about mask-wearing during the COVID-19 pandemic has been anything but consistent. Early recommendations discouraged their use, both to ensure adequate supplies existed for health care personnel as well as because the thinking focused on personal protection. Given universal acceptance in Asian countries that in many situations rapidly “flattened the curve,” and evolving knowledge of COVID-19 transmission that found spread by infected people without symptoms, many nations turned to the use of surgical and cloth face coverings to prevent infection being spread unwittingly. The CDC changed its recommendations in early April: “people (should) wear cloth face coverings in public settings when around people outside of their household, especially when other social distancing measures are difficult to maintain.”

Face masks have been around for quite some time. The first study advocating the use of masks during surgery was published in 1897. In 1905, Chicago physician Alice Hamilton published an article in the Journal of the American Medical Association, reporting on experiments measuring the amount of streptococci bacteria expelled when scarlet fever patients coughed or cried. She also measured the strep bacteria from healthy doctors and nurses when they talk or cough, leading her to recommend masks during surgery.

This is not the first time facial coverings have been debated in the U.S. More than 100 years ago, Americans found themselves experiencing another pandemic. Good ventilation and fresh air were “the best of all general measures for prevention, and this implies the avoidance of crowded meetings,” (BMJ, Oct. 19, 1918). This resulted in the limiting of any type of gathering of people – nonessential meetings were prohibited, saloons, dance halls, cinemas and schools were shuttered, and while funerals were banned, limited church services were allowed.

Some cities in the West, including Seattle, Phoenix and Juneau, Alaska, required the wearing of cotton and gauze face masks. In San Francisco, the “Anti-Mask League” was formed, while the rhyme “Obey the laws/ And wear the gauze/ Protect your jaws/ From Septic Paws” was used to remind citizens of its trial ordinance. Best intentions, however, didn’t demonstrate this intervention to be successful, primarily because while people wore them when in public, they failed to do so when at work and when they gathered behind the scenes.

In Japan, the combination of the 1918 pandemic and a devastating earthquake in 1923 made masking commonplace. Another global flu epidemic in 1934 reinforced this practice, and wearing face masks became the norm in the winter, primarily because of concern of spreading infection to others. Poor air quality has made mask wearing a year-round practice in much of Asia. Mask wearing has even become a fashion statement as well as a means for young people to socially distance themselves.

In the U.S., we have typically associated masks with health care, patients at risk for infection, and the flu season. We have seen the signs at health facilities asking people to use a mask if they are feeling ill, and of course, we follow those guidelines to protect those who are at risk. In this particular pandemic, however, the biggest differences are that we are all at some level of risk to at least contract or carry the disease, and we do not know who might be contagious and have no symptoms.

Beginning June 26, every Washingtonian in an indoor public space, or in an outside public space when unable to physically distance from others, was legally required to wear a face covering. The statewide order, issued by Secretary of Health John Wiesman, was in response to an increasing number of COVID-19 cases documented throughout the state. Soon after, Gov. Inslee issued a statewide order, which began Tuesday, mandating businesses to require customers to wear face coverings in order to conduct business.

What can we all do to halt the spread of the virus? It’s quite simple: Follow the recommended guidelines of hygiene and social distancing and wear your favorite face cover. Ultimately, we all want to be able to enjoy all the great amenities in our community, open our business, enjoy a show or concert, go to the MAC or the symphony. It may not be second nature to all of us, but it’s something we can all do to protect our families, friends and neighbors and safeguard our economic future. Wear a mask!

Dr. Bob Lutz is the Spokane County Health Officer, Spokane Regional Health District. Dr. Francisco R. Velázquez is a Physician Executive.