As the world tries to recover from the devastation that COVID-19 wrecked during 2020, more countries and states are removing mask mandates. Mask wearing is a crucial cautionary measure among others, like social distancing and vaccine differentiated measures. On the other hand, we now have vaccines for protection against COVID-19. Since vaccines give us immunity against COVID-19, can we also stop masking up? In this article, we seek to understand the impact of decreased mask-wearing on public safety.
How face masks stop the transmission of COVID-19
The most common method of transmission of COVID-19 is through bodily fluids. When an infected person coughs or sneezes, the virus is carried by tiny droplets through the air. Anyone standing 6 feet away from the infected person can breathe it in. COVID-19 can stay airborne for 3 hours. Surgical and cloth masks filter fine droplets and particles and slow down unfiltered particles. Depending on quality and thread count, they can block 50% to 70% of droplets. N95 masks are reserved for medical personnel and block 95% of droplets. Masks do not protect the wearer but rather, the people around the wearer. Hence, masks only work when everyone is wearing them.
The evidence behind mask-wearing
Face masks are not useless. There is plenty of evidence suggesting that masks are the first line of defense against transmission of COVID-19. A study found a significant decrease in coronavirus found in respiratory droplets when participants wore masks. (Leung, N.H.L., et al.) More evidence comes from real-life examples. In countries with cultures supporting mask-wearing, coronavirus mortality increased by 15.8% compared to 62.1% in countries with cultures non-supportive of mask-wearing.
The public was ready to respond to mask-wearing early in 2020 in most Asian countries, keeping the mortality rate down. In the USA, the prevalence of mask-wearing was only 17% by May 30th, 2020. The CDC had already put out mask advisories in early April. South Korea began mask-wearing by 4th February, China put out mandates on January 31st, and Britain on June 4th. By May 9th, per-capita coronavirus mortality was 241.8 per million in the USA and 465.3 per million in the UK, but only 5 per million in South Korea and 3.2 per million in China. (Christopher & Ing et al) This shows an obvious correlation between mask-wearing and coronavirus safety.
Recently, a large-scale study involving 340,000 people and 600 unions in Bangladesh was conducted. It found that villages, where mask-wearing was enforced and distributed, had 9% fewer symptomatic COVID-19 cases. However, only one-third of the participants with symptoms agreed to take a blood test. (Abaluck & Kwong et al.) The study was conducted when the Alpha variant was dominant. There is evidence that patients infected by the Delta strain shed more viral particles, so masks are even more effective and important against this strain.
Mutant strains pose a threat to recovery
Some variant strains of the coronavirus are stronger against the vaccine. This is why Pfizer and Moderna, among other vaccine makers, have been encouraging the public to take booster shots. Omicron is the latest viral strain that is circulating. On November 29th, 2021, the WHO put out a warning that Omicron poses 'very high global risk’. We are still not sure how well vaccines can perform against Omicron. Since the world is far from herd immunity, the virus can continue mutating into more dangerous strains. We do not know when the virus will mutate again, and the capabilities of the new strain of the virus. Although there is no way of preventing the virus from mutating, reduced infection rates can help to limit the chances that an advantageous mutation occurs. There is a very real chance that new strains can breach vaccine defenses. We must try, as much as possible, to reduce virus transmission, and masks are an effective way to do this.
Vaccines do not stop the transmission of COVID-19
Some people argue that masks should be optional for children who have stronger immune systems. Reports from schools across the USA contradict this statement. In Georgia, schools with mask mandates reported 37% lower coronavirus cases compared to schools without mask mandates. (Kuehn B.M) This data was taken from a survey involving 169 elementary schools. Children are most frequently asymptomatic cases, and so do not get tested. Children can still spread the virus to adults and more vulnerable members of the public. This conundrum appears in vaccinated people as well. As with children, people also argue that masking should be optional for vaccinated people. Research has shown that although vaccinated people rarely suffer severe symptoms from coronavirus, they can still transmit COVID-19 to others. This has severe implications for unvaccinated people who are more likely to die of coronavirus.
Low vaccination rates
In the United States, 98% of Americans dying of Covid-19 complications are unvaccinated. CDC data shows that unvaccinated people face 11 times the risk of dying from COVID-19 complications compared to vaccinated people. (Dyer O.) Around the world, many people are still unwilling or medically unable to be vaccinated. Furthermore, partial vaccination does not provide enough protection against coronavirus. Partially vaccinated persons are at risk of suffering severe symptoms of COVID-19, or the long-term symptoms of COVID-19, also known as ‘long covid’. Some symptoms of ‘long covid’ are extreme fatigue, chest pain, and shortness of breath. According to the U.S Census Bureau, India is the second-most populous country in the world, followed by the United States, and then Indonesia. Yet, as of December 4th, 2021, India only has 33.4% of the population fully vaccinated, the United States with 59.6%, and Indonesia with 35.8%. Overall, only 42.7% of the global population has been vaccinated, barely half of the world population. This is not enough to achieve herd immunity.
There are large populations of citizens who are not under the protection of the vaccine. These are the people who are most endangered by COVID-19. Until more countries can reach the herd immunity threshold of 70% to 85%, masks must still be worn for the sake of the unvaccinated population. A solution to this is to make vaccination mandatory and/or put in stricter differentiated vaccine measures. Singapore, a country where masks are still worn and where there is a 92% vaccination rate, has been doing this. However, the government boosted the vaccination rate after they stopped covering the costs of COVID-19 treatment for people unvaccinated by choice. If we want to be able to treat masks as optional, stricter laws on unvaccinated people must be put in place. One possible consequence of treating masks as optional without having most of the population vaccinated is an overload of the healthcare system. With more severe cases of coronavirus, hospital wards will be unable to cater to people with other diseases like cancer or cardiovascular disease.
The creation of vaccines for COVID-19 has created yet another dilemma for the world. While vaccines do protect us, not enough people are getting vaccinated. Unvaccinated people are still at risk of death or other severe symptoms of COVID-19. COVID-19 is also a virus that mutates frequently.
Until more people are vaccinated, masks cannot be treated as optional.