From 2005 to 2008, I was heavily involved in pandemic preparedness with the military, Hawaii state officials and the Centers for Disease Control and Prevention, and worked internationally across the Pacific with nations and territories at risk.
I even gave a presentation to Chinese military health officials in Wuhan in 2007. At that time, the 2002-03 SARS outbreak in Hong Kong had ended (another coronavirus) and health experts were worrying that a severe form of influenza carried by birds, the so-called “Bird Flu,” Influenza A H5N1, could become a pandemic.
Like today’s scare with the new coronavirus, COVID-19, we didn’t have a vaccine against this new and deadly bird flu. As public health physicians, we had to plan what we would do to slow down the virus when vaccines were months away. The medical literature showed us that the combination of good hand hygiene and facial masks worked in reducing the people infected with influenza and was also used in the SARS coronavirus outbreak.
I’ve watched over and over as public health experts across the country have been saying that healthy, uninfected people shouldn’t wear masks as a part of the fight against the new coronavirus.
Yes, washing your hands correctly is the most important thing you can do. Always wash your hands for 20 seconds with soap and water and use hand sanitizer if soap and water are unavailable. The experts dismiss masks because they point out that many masks, especially the normal paper surgical masks, are inefficient at stopping the small droplets and suspended viral particles that cause the disease. And they are absolutely correct; they are not efficient in this way.
What the experts ignore is the role of masks in two other important ways: as a barrier from touching your nose and mouth and as a visible reminder that a virus is on the loose to raise awareness of better hand hygiene.
Anyone who has been in a traffic jam has seen one of our worst habits, and I’m not talking about smoking or playing with an electronic device. People will, when bored, inevitably put their fingers in their noses. In my travels around the world, I can tell you firsthand this is a global sport. Without proper hand washing, these contaminated fingers spread viruses and bacteria to other people’s hands through handshakes and deposit these pathogens on inanimate objects we call fomites: a doorknob, a telephone and just about anything else that can be a platform where a clean hand can acquire the virus or bacteria.
The cycle is completed when the unsuspecting, uninfected person touches their nose or mouth, transmitting the disease.
A mask is a barrier that can help interrupt this nose-to-fingers-to-nose means of transmission and slow the spread of viruses. Moreover, if many people are wearing masks, it is a constant and visible reminder of what viral respiratory diseases are about and that hand washing is critical.
I lived in Japan for five years. There, mask wear is socially acceptable for everything from the common cold to allergies. I wish it were the same here. If you work alone and away from other people, a mask isn’t helpful. If you work among people in a crowded office or in service industries, they can help. But they aren’t effective if not combined with proper hand hygiene.
Right now, you can’t find masks in stores or online because of the COVID-19 scare. Don’t panic. The advice about hand washing is correct and will help protect you from respiratory viruses of all types. But remember that, if you have masks, the evidence from the medical literature shows they work together with hand hygiene.
To steal from John Lennon: All I am saying is give masks a chance.