Dear NP

Dear NP,

I am a healthcare worker in a neighboring county, and I read your column regularly. I know there is widespread resistance to wearing facemasks. As a plea from healthcare workers in general, can you emphasize the importance of face masks and discuss their benefits? As we approach flu season, I fear the worst of the pandemic is yet to come.

Dear Reader,

Thank you for your work – healthcare workers deserve incredible respect and appreciation during this pandemic. Unfortunately, you are quite right about the widespread resistance to facemasks. There is a lot of misinformation out there, and I hope this proves an excellent resource to point people to.

There are several reasons that facemasks are an indispensable tool in managing the COVID-19 pandemic. The first and most obvious one is that it is a mechanical barrier for respiratory droplets. COVID-19 and other respiratory viruses don’t just fly through the air alone – they hitch a ride inside of tiny droplets of fluid from our nose and mouth. Covering the nose and mouth with a soft material keeps them in between the person’s face and their mask rather than flying through the air. This effect is not a mere theory; it is highly supported by scientific evidence.

However, because the masks are better at keeping viruses in than keeping them out, masks only work their best when everybody wears them. Wearing your mask may not keep you safe if everybody around you is not wearing one. This is why the divisive views on mask-wearing in America are especially dangerous – the more people disagree with mask-wearing, the less effect we’ll see from it.

That said, there is evidence that wearing a mask benefits the wearer as well. The CDC cites studies that suggest that masks also act as a filtration layer, blocking some respiratory droplets and viruses from coming in. However, you shouldn’t count on this in every instance. A lot of a mask’s filtering power depends on what material it is made out of and other factors like moisture and thread count. But in general, any mask is better than no mask at all.

Finally, there is increasing evidence that community-wide mask-wearing can reduce the severity of the disease and increase the rate of asymptomatic infection and reduce the number of people infected with the virus. The hypothesis depends on the idea of variolation, which refers to an infection with a virus just large enough to prompt an immune response but not large enough to make somebody sick. This method is essentially how vaccination initially worked, though most modern vaccines use other, safer methods.

The variolation hypothesis says that because masks may not block every single virus particle, people may still be exposed to smaller amounts of the virus, triggering an immune response but no illness, effectively acting as a nature-made vaccine. It certainly is not foolproof, but anything that can be done to reduce the number of sick people is essential.

The New England Journal of Medicine recently published a study offering a variety of evidence for this hypothesis.

First, the CDC reported about a 40% rate of asymptomatic infection as of mid-July – meaning that 40% of people infected didn’t end up getting sick. However, settings with universal face masking have reported double this rate – a full 80%. While asymptomatic infection can make the virus harder to track, a higher percentage of asymptomatic infection is better for the population as a whole because fewer people become ill and require hospitalization.

Further still, the study cites examples where mask-wearing massively increased the asymptomatic rate. A cruise ship in Argentina had an asymptomatic infection rate of 81% when passengers and staff were given face masks. However, earlier cruise ship outbreaks without universal masking had rates as low as 20%. And remember, a lower asymptomatic rate is terrible because it means more people are getting ill.

Ultimately, there’s no scientifically sound reason not to wear a mask and encourage others to do the same. In the worst-case scenario, it’s a small inconvenience. However, the evidence suggests that the benefits far outweigh the inconvenience. The bottom line is that arguments against mask-wearing tend to be political ones, not scientific ones. Unfortunately, those arguments are more difficult to dismantle, but every person who reads information like this and becomes convinced is a small victory.

Keep up your great work. This country needs you.

Dr. Wesley Davis is an Emergency Nurse Practitioner at Crook County Medical Services District and Coordinator of the Family and Emergency Nurse Practitioner program at the University of South Alabama. He encourages readers to send their questions to [email protected]