State mask mandates leave gaps
BOULDER, Colo. – Brady Bowman, a 19-year-old student at the University of Colorado-Boulder, and two friends strolled down 11th Street sporting matching neck gaiters branded with the Thomas’ English Muffins logo. Bowman had received a box of the promotional gaiters.
He thinks they are more comfortable to wear than a face mask. “Especially a day like today, where it’s cold out,” he said, with the top of his gaiter pulled down below his chin.
More stylish? Perhaps. More comfortable? Maybe. But as effective? Not necessarily.
With states such as Colorado requiring face coverings indoors to prevent the spread of COVID-19, gaiters and bandannas have become popular accessories, particularly among college students and other young adults. Less restrictive than masks, they can easily be pulled up or down as needed – and don’t convey that just-out-of-the-hospital vibe.
But tests show those hipper face coverings are not as effective as surgical or cloth face masks. Bandannas, like plastic face shields, allow the virus to escape out the bottom in aerosolized particles that can hang in the air for hours. And gaiters are often made of such thin material that they don’t trap as much virus as cloth masks.
As new COVID-19 cases, hospitalizations and deaths surge upward heading into winter, many public health experts wonder if it’s time to move beyond the anything-goes approach toward more standardization and higher-quality masks. President-elect Joe Biden reportedly is mulling a national face-covering mandate of some sort, which could not only increase mask-wearing but better define for Americans what sort of face covering would be most protective.
“Unlike seat belts, condoms or other prevention strategies, we have not yet standardized what we are recommending for the public,” said Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco. “And that has been profoundly confusing for the American public, to have all these masks on the market.”
Masks have been shown to reduce the spread of respiratory droplets that contain the coronavirus. The Centers for Disease Control and Prevention now says that masks not only help prevent people from infecting others but also help protect the wearers from infection.
According to a recent analysis by the Institute for Health Metrics and Evaluation, implementing universal maskwearing in late September would have saved nearly 130,000 American lives by the end of February.
Even so, many Americans still aren’t wearing masks. In some states, they haven’t been required to.
At least 37 states and the District of Columbia have mandated face coverings but show variation in defining what qualifies. States such as Maryland and Rhode Island include bandannas or neck gaiters in their definitions, while South Carolina and Michigan do not, according to a KHN review of the orders. Some spell out the circumstances in which coverings must be worn or establish enforcement policies.
Cloth mask manufacturing was nearly nonexistent in the U.S. before the pandemic, so public health officials opted early in the year to stress the importance of wearing any face covering rather than trying to focus on one standard. As a result, Americans are wearing a hodgepodge of coverings, from homesewn to commercial versions, with various levels of protection.
Dr. Iahn Gonsenhauser, an infectious disease specialist at the Ohio State University Wexner Medical Center, said face coverings generally fall into three categories of effectiveness. N95 masks (not those with valves), surgical masks and well-made cloth masks (constructed of tightly woven material, folded over two or three times, and properly covering the mouth and nose) are in the highly effective category.
Bandannas, neck gaiters and face shields lie at the other end of the spectrum, and most everything else falls in the middle.
The evidence around neck gaiters has been mixed, in part because so many materials and designs are used. But recent testing suggests even the thin material commonly used to make gaiters is nearly as effective as a cloth mask if doubled over.
“With few exceptions, the best mask is the mask that somebody is going to use regularly and consistently,” Gonsenhauser said. “It may be that the best technical mask is not going to be the mask that everybody’s going to be willing to wear all the time.”
Researchers at the National Institute for Occupational Safety and Health have found most of the commercially produced cloth masks block 40% to 60% of droplets, approaching the effectiveness of surgical masks.
“You can’t possibly test everything, but certainly one take-home message is that anything is better than nothing,” said William Lindsley, a NIOSH biomedical engineer. “We haven’t tested anything that has not worked.”
But Gandhi believes it’s time to raise the standards for masks, ramp up the production of disposable surgical masks and encourage, if not order, Americans to wear them. Early in the pandemic, the Trump administration reportedly considered sending masks to every American but decided against it.
Taiwan invested in manufacturing and distributing surgical masks, and it has one of the lowest COVID-19 death counts in the world: fewer than 10 deaths in a country of 24 million people.
“It makes more sense to standardize masks, to mass-produce surgical masks, which are not very expensive,” Gandhi said. “We’re spending a lot more on everything else.”