By Mike DuBose
Almost as soon as news began spreading—an alarm began rising—about the COVID-19 virus in February 2020, misinformation about the virus has run rampant. Confusion was fueled by inaction from those in positions of power, as well as conspiracy theorists and individuals who insisted that the virus was a hoax. When we published “Coronavirus: Facts You Should Know” in March 2020, the United States had seen about 32,000 positive cases and 400 deaths. Politicians were saying not to worry—they had everything under control. Nearly a year later, it is clear that was not true. As of February 1, 2021, the Centers for Disease Control and Prevention (CDC)’s COVID Data Tracker reports more than 26 million positive cases and 450,000 deaths in America! The numbers continue to climb, with between 2,000 and 4,000 people dying per day in the US.
Confusion persists, with some people claiming the infection and death numbers are inflated and other researchers saying that they believe the deaths are underreported. Even assuming that some deaths have been misattributed to COVID-19 (although there is insufficient evidence to support that such claims are true on a large scale), one can simply not overlook the sheer magnitude of proven cases—or the danger the virus poses to the US population.
Every day, researchers are learning more about how to prevent and treat the novel coronavirus. At this point, they agree that it can affect people differently, is highly transmittable (especially the latest COVID mutations from the UK and South Africa), and that the worst is yet to come. Scientists say that a spike in positive cases, hospitalizations, and deaths will result from holiday gatherings and the cold weather forcing people into enclosed environments without good ventilation.
Fortunately, COVID-19 vaccines are slowly making their way into the population, but most people will not receive them until late spring or summer 2021 due to limited supplies and disorganized implementation. Many Americans want the vaccination, as exhibited by a November 2020 Pew Research Center study where more than 60% of survey respondents said they would “definitely” or “probably” get the vaccine for coronavirus (up from 50% in September). According to some experts, if 70-85% of the population takes both doses of the Pfizer or Moderna vaccines, which are 95% effective in preventing COVID, life could somewhat return to normal by late 2021.
Unfortunately, some form of normalcy will likely take longer to reach. COVID prevention measures, including wearing face masks, have become politicized. Misinformation has been spread about masks, with some thinking that they are ineffective and others insisting that it is their right not to wear them, even though they could be spreading a potentially deadly virus to others.
Many people—myself included—do not like wearing masks. They make it difficult to see a person’s identity and emotions, can be uncomfortable to wear, they can make it a struggle to breathe (with a claustrophobic feeling), and face coverings often muffle one’s voice, making it hard to hear. It is difficult to find high-quality masks for purchase and tricky to remember to bring them into stores. Like me, many Americans are finding them hard to get used to (although professionals in some fields, such as healthcare, wear them all the time with no issues).
Even with all these inconveniences taken into consideration, though, we must ask ourselves, “Does the risk of not wearing a mask outweigh the annoyance of wearing one?” Let’s explore the science, practical perspectives, and research for the answers.
For a more detailed explanation, it helps to understand how COVID-19 enters the body—and the severity of the destruction it can wreak once it is inside. According to the World Health Organization (WHO), “Current evidence suggests that the main way the virus spreads is by respiratory droplets among people who are in close contact with each other.” COVID-19 enters the body through the mouth, eyes, and nose. A person might breathe in the respiratory droplets or heated breath of another individual when standing close by or (less commonly) touch surfaces contaminated with the virus and become infected.
We now know that the virus strikes people differently, and no two cases are alike. Some are asymptomatic, exhibiting no symptoms (although hidden damage could occur). Even though these individuals may not even know they are sick, they still make an impact. According to WebMD.com, 59% of the spread of COVID-19 is due to those who have no symptoms! Most people who are diagnosed with COVID (80%) experience mild to moderate cases with flu- or cold-like symptoms where they feel lousy. The other 20%, however, contract more serious cases and must enter the hospital or ICU and may even die from the virus. Sadly, experts are now projecting that more than 500,000 Americans will die from COVID-19 prior to the end of February 2021!
Now, let’s examine the serious cases that account for 20% of COVID patients. According to the January 2021 Harvard Health Letter, the first symptoms COVID sufferers experience usually include fever, fatigue, headache, sore throat, and/or loss of smell and taste. As the virus enters the lungs, it can lower oxygen levels, make breathing difficult, cause pneumonia and/or blood clots, which can lead to strokes and brain damage. People with asthma are especially affected by these respiratory issues. As COVID-19 makes its way through the body, it can impair the digestive system (especially the stomach and intestines), causing abdominal pain and diarrhea that can last for weeks or even months. It can disable the nervous system, causing inflammation of the blood vessels and brain and producing concentration problems, headaches, memory loss, and brain fog. It may damage the automatic immune system, which regulates breathing, digestion, and heart rate. If the virus impairs the cardiovascular system, a high or irregular heartbeat may result, and some patients experience heart muscle inflammation or infections. Finally, the virus can travel to the musculoskeletal system, which results in severe muscle and joint aches and pains. Some patients experience significant fatigue that can last for months and become debilitating. The Mayo Clinic reports that individuals with underlying health conditions (such as diabetes; cancer; blood disorders; weakened immune systems; obesity; and cardiovascular, kidney, liver, and lung disease), as well as the elderly (age 65 and older), are at the highest risk of experiencing severe symptoms and the most dangerous result: death.
Medical professionals are particularly concerned with the long-term effects COVID-19 has had on about 10% of patients. Roni Caryn Rabin reported in a January 2021 New York Times article that common early symptom anosmia (loss of smell) has lasted for months in some survivors…and may be permanent. COVID “long-haulers” may also experience other long-term effects from their bout with the virus, including breathing, heart, cognitive, and psychological impairment. One nurse we interviewed said her COVID-19 case was mild. However, prior to her infection ten months ago, she was an active runner. Now, she can no longer jog because of the damage to her lungs!
Looking at the potential results of not wearing a mask and contracting COVID, those reasons for why many do not like wearing masks start to seem insignificant. As a person aged 70 years old who has diabetes and who cares about my family and others, I believe that the aggravation of wearing a quality mask for brief periods each day when outside my home is worth the effort to avoid the potential damage COVID-19 could inflict throughout our bodies! In addition, wearing a mask protects not only the wearer but also others around them in the event the person is an asymptomatic carrier of the virus. It is simply the right—and safe—thing to do for everyone.
Because the coronavirus usually enters the body in the form of extremely small, often invisible respiratory droplets or heated breath inhaled through the nose and mouth, face masks play a critical role in preventing the spread of the virus. But what makes a mask effective at protecting against COVID-19? Are there certain styles of mask that work better than others? I examined a variety of masks I ordered in February 2020 from 12 different Chinese and American companies that were being marketed as certified, high-quality face coverings and was surprised with my findings.
John Hopkins University’s guidance on choosing a mask notes, “A good mask has a double layer of washable, breathable fabric that helps keep the wearer from spreading potentially infected droplets into the air.” In its guidelines, the World Health Organization (WHO) recommends that fabric masks have at least three layers; four or five are my preference. Light should not pass through the fabric easily. (Of course, the thicker the mask, the harder it is to breathe through it, so you want to find a good balance.)
The highest quality face coverings that can resist COVID-19, known as the “gold standard,” are made in the US—the “N95” respirator masks (meaning that the masks screen out 95% or more of the germs, particles, and viruses from entering the nose and mouth of the wearer when worn properly). N95 masks are certified by the National Institute for Occupational Safety and Health (NIOSH) and usually have five layers of different fabric overlapping each other at different angles to trap microscopic virus particles. Certified N95 masks do not have ear loops, but rather two rubber bands that stretch from the mask with one line that goes to the top back of the head and the other one around the upper neck. This makes them more difficult to put on and take off than the masks that have ear loops, but when you wear one, you know they are certified to prevent 95% or more particles from entering the mask’s interior!
The major companies that make certified N95 masks include 3M (I like the model 8210), Honeywell, and Kimberly-Clark. These are not easily found on Amazon but are sold by other retailers and can be located by typing in “N95 Masks for Sale” in your internet browser. (Note: avoid ordering the ones with a flow valve that contractors often use; they can expel the virus to others.) My wife and I utilized clinicalsuppliesusa.com for purchasing our masks. At $5 each or more, N95 masks are more expensive than others. Fortunately, though, mask prices have dramatically dropped since the beginning of the pandemic, and it is now easier to find quality face coverings. However, with President Biden mandating masks in certain federally controlled areas nationwide, availability may lessen, and prices may rise.
The KN95 mask is certified by China as being of similar quality to the N95 mask and can be a good alternative if you cannot find N95 masks. Real KN95 masks have similar ratings and processes as those NIOSH uses to certify American-made N95 masks. However, some Chinese companies will place inferior masks in very convincing packaging and claim they are N95 or KN95 masks certified by the government when really, they only capture about 40% of virus particles. Do your research, and avoid using customer ratings, even on well-known reseller platforms. The CDC maintains a webpage with images of counterfeit masks (as well as information to help you determine if a mask you are considering purchasing is truly NIOSH-certified) at https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html.
Quality, certified KN95 masks include any of the following certification numbers and dates imprinted on the exterior side of each mask: GB2626-2006, GB19083-2010, and GB2626-2019. The European certification is EN 149:2001+A1:2009 with categories of FFP2, which screens 95% of germs and FFP3 rated at 99%. If shopping on Amazon, examine the picture of the mask being considered for any of these visible numbers before ordering.
According to the National Institutes for Health (NIH), cloth masks (some homemade) have been used by consumers to protect the wearer from respiratory and COVID-19 infections. The filtration effectiveness of cloth masks is generally lower than that of medical-grade masks and respirators such as the N95 and KN95; however, multilayer cloth masks, designed to fit tightly around the face and made of water-resistant fabric with a high number of threads and fine weave, may provide reasonable protection. USA Today recently reported that two layers of thick cotton (600 threads per inch), combined with a third layer of synthetic material, proved to be the most effective combination for homemade masks.
Avoid mask alternatives like bandannas and gaiters—as noted by Johns Hopkins University, “A bandanna tied around the face does not work as well as a mask because it is open at the bottom. A gaiter (a tube of thin, stretchy knit fabric that can be worn around the neck and pulled up to cover the nose and mouth) is usually too thin to provide adequate protection.” Likewise, wearing only a see-through plastic face shield (with no mask) is not recommended; heated breath can still escape the shield, and the virus can come in through the same openings. Of course, wearing both a mask and shield, as doctors treating the virus-infected patients often do, will provide maximum protection. Although interchangeable coffee filters inserted into a mask are very effective at filtering out microparticles, they can impair breathing and are no longer recommended.
If you can find them, I recommend wearing N95 or KN95 masks rather than homemade fabric ones. If I am not wearing my N95 mask, I like the five-layered POWECOM KN95 masks that are sold in a package of 10 on Amazon for less than $25. The US government has assessed their efficiency at about 93%. If I am going into a setting where the virus may be present in close quarters, I will wear an N95 plus a cheap 3-layer disposable surgical mask on the outside of it, then throw the cheaper mask away when exiting the building. Amazon sells 50-packs of these three-layer surgical masks for about $25, such as Jointown or WMS Wisconsin Medical Supply surgical three-layer masks from Amazon. However, I would not recommend them as your sole mask since they do not fit tightly around the face! Also, if you are attending a special event, you can always add a colorful mask on the outside of your N95 or KN95 mask for style.
To determine if your N95 or KN95 masks have been tested and certified by the government or to learn more about COVID-19 protective equipment, visit these websites:
Your mask should fit tightly around your face, mouth, and nose (many have metal in them that allows you to pinch the nose area, so it fits snugly). You know you have properly fitted your mask when it puffs in and out when you breathe—if air doesn’t pass through it easily, viruses will not, either! It is worth noting that beards can impact the effectiveness of masks and increase your vulnerability since they prevent a tight seal. Also, women are encouraged not to wear makeup when using masks since makeup can contaminate the interior of the mask and damage the fabric, reduce filtration, and limit sterilization.
Although some individuals fear that their oxygen levels will be impaired by wearing a mask, research opposes that theory. As a test, I used a KN95 mask for extended periods of time, and an oximeter showed that my oxygen levels never dropped below 98%. (As a side note, an oximeter that sells for less than $30 on Amazon can alert you when your oxygen levels drop below the minimum 90%, which might suggest you are infected but asymptomatic. The new Apple Watch Series 6 performs the same function.) However, if you have chronic respiratory, cardiac, or other medical conditions that make breathing difficult, you should consult with your doctor before wearing a dense mask such as an N95 or KN95 just to be safe or consider a three-layer surgical mask.
Before putting on a mask, sanitize or wash your hands. Never touch the front of the mask, where the virus can live for days, or the inside of the covering; instead, use the ear loops to fit the mask tightly onto your face. When you are ready to take off the mask, use the ear loops to remove it. If you touch the front of the mask (as many unknowingly do when adjusting or removing their mask) and then touch your face, you risk the virus entering your body!
Even if you and another person are wearing masks, you should still avoid close contact since even the best mask screens 95% of virus particles. There is always a risk of spread! The danger is even greater when you enter public areas like stores and restaurants where people may not be wearing their masks correctly (or may refuse to wear them, even though government regulations require it, or take them off while eating). According to experts, the most dangerous places in terms of spreading the virus are houses of worship, hotels, bars, cafes, restaurants, grocery stores, and family or social gatherings. We advise against dining inside bars or restaurants (unless sparsely populated) since you will need to remove your mask at some points to eat and drink, and the HVAC systems in such places recirculate air that could be contaminated with the virus. Takeout meals are a good alternative. We also recommend avoiding elevators when possible. Before going into any enclosed area with others, it is worthwhile to check if people appear to be wearing masks correctly. Some individuals incorrectly wear their masks covering their mouths but not their nose, which follows the law but creates a situation where they can spread the virus. Avoid these situations or go during “off” hours to limit contact with others. Look for restaurants with outside seating for dining when weather permits, which is safer, and wear a mask until the food or drink is served.
If you are outside and there are no other individuals within 15+ feet, you do not need to wear a mask since heated breath rises. Also, avoid walking behind a person or group since you may walk into an infected cloud of heated breath. While you want to protect your physical health, remember that it’s important to protect your mental health, too. Avoid staying at home all the time, and limit the amount of time you spend watching television. Make it a point to go outside every day (weather permitting) to do things like enjoying the sunshine, exercise, visit with neighbors (outdoors and at a distance), and/or drive somewhere. (Speaking of driving: if someone who does not live with you is riding in your car, be sure to wear a mask; turn on the outside air; lower the windows a small amount for ventilation, if possible; and have the person sit in the rear seat opposite the driver.). The car is a very tight, enclosed, and unsafe environment, so try to avoid giving outsiders a ride or riding with others.
Unless you are disinfecting them daily, do not wear the same mask each day. Cheap surgical masks should be thrown away after each use. If you have a cloth mask, wash the mask in detergent and then use the dryer. Don’t use harsh chemicals like bleach, Lysol, or alcohol since you will breathe in the dangerous residual fumes. Some N95 and KN95 masks also have electrostatic processes that can be harmed by washing, so be sure to read the instructions for recommended cleaning methods.
Some research indicates that the virus can survive on the outside of a KN95 or N95 mask for five days or more! We suggest that you purchase seven N95 or KN95 masks, place them in individual paper bags (paper is breathable, unlike plastic), and rotate them during the week since the virus will die off by the seventh day. Yes, it seems neurotic, but if you want a failsafe system, follow the science!
Another option is to regularly sanitize your masks using ultraviolet (UV) rays. UV light boxes that kill COVID-19 and other viruses can be purchased on Amazon for $60-$100. They can usually sanitize three masks at a time (in addition to other items like cell phones, etc.); the process takes about 10 minutes. Although initial research suggested they could, recent studies have shown that the sun’s UV rays cannot kill the COVID-19 virus since the ozone prevents most of the UVC light from entering our atmosphere.
Even after you receive the COVID-19 vaccine, which is currently administered in two doses spread about three weeks apart, you will only be protected from the virus about 95% of the time. So, there is a 5% possibility that you may be infected even after being administered the vaccine. There will still be others who have the virus and don’t know it (or those who refuse to wear masks) with whom you may come into contact, so there will still be risks. Therefore, you should continue wearing a mask when in public even after being vaccinated for COVID-19. The extra protection afforded by wearing a mask will help ensure that you avoid contracting this potentially devastating illness. In addition, some scientists believe that vaccinated individuals may still be able to shed the virus and infect others, so wearing a mask remains the considerate thing to do.
The bottom line: Dealing with COVID-19 has been a long and difficult struggle for many people throughout the world. With a vaccine coming our way, we can see the light at the end of the tunnel, but it is important to continue precautions like wearing masks, social distancing, avoiding high-traffic surfaces (such as public door handles, shopping carts, etc.) since the virus can live on them for 72 hours, and frequently sanitizing or washing our hands for 20 seconds.
Don’t fear the virus; rather, respect its dangers and know the reasonable preventions we can implement to avoid unnecessarily getting sick and/or spreading it to others. Let’s all work together, as one, to get our lives back to normal!
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About the Author: Mike DuBose has been a staff member for the University of Social Carolina’s graduate school since 1985, when he began his family of companies, and is the author of The Art of Building a Great Business. Visit his nonprofit website www.mikedubose.com for a free copy of his book and additional published business, travel, and personal articles, as well as health articles written with Surb Guram, MD.
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