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14 Face Mask Questions Answered by Texas Virus Experts

Public health experts recommend wearing protective face coverings in public in order to limit the spread of COVID-19.
Public health experts recommend wearing protective face coverings in public in order to limit the spread of COVID-19.
Photo by Schaefer Edwards

The coronavirus pandemic isn’t ending any time soon, if recent spikes in COVID-19 cases across Texas and throughout the Houston area are any indication.

Over the past few weeks, hospitalizations for COVID-19 have continued to climb to record highs both in Texas and in the greater Houston area. Harris County Judge Lina Hidalgo cited these trends as key factors in her decision to order all county businesses to require their customers to wear protective face masks starting today.

Now more than ever, it’s important to know the facts about how to best protect yourself, your loved ones and your community from this deadly disease. That includes learning the ins and outs of face masks: how they work, why they’re important and what to tell friends and family who don’t see the point of masking-up.

To that end, the Houston Press spoke about the finer points of face masks with two Texan infectious disease experts: Dr. Jill Weatherhead, an assistant professor of infectious disease at Houston’s Baylor College of Medicine, and Dr. Joseph B. McCormick, founder of the Brownsville campus of the UT Health School of Public Health where he’s also a professor of epidemiology.

Below are the 14 questions we asked Dr. Weatherhead and Dr. McCormick along with their answers, which have been lightly edited for concision and clarity.

1. Does wearing a mask help slow the spread of COVID-19?

Weatherhead:
There’s certainly a reduction in risk if you’re wearing a face mask. The purpose of wearing a mask is to prevent transmission of the virus from someone who’s not displaying any symptoms, who’s feeling well, who is going out into public and that has the risk of infecting other individuals.

McCormick:
It looks like it could decrease it by anywhere from three to five-fold. This is something we don’t have absolute concrete evidence of, but the evidence is certainly mounting.

2. How exactly do masks help protect people from the coronavirus?

Weatherhead:
We know that the virus is most commonly spread through respiratory droplets. Any time we are talking, laughing, singing, coughing, sneezing, we’re releasing these respiratory droplets,so as you’re talking, you could spread the virus to someone who is within six feet of you. The mask is to contain those respiratory droplets so that the amount of virus that is spreading out into the public space is reduced significantly.

McCormick:
I like to compare this to if you’re a non-smoker and you walk by somebody who is a smoker. Even if they’re not smoking, you can detect smoke particles in the air. This is a similar kind of a concept where when you’re talking, or certainly when you’re coughing, you’re projecting virus out in the air. The mask certainly helps to mitigate that. If you are infected, it will help to reduce or mitigate the spread of the virus, and if you are not infected but wearing a mask near someone who is infected, then that’s going to help to prevent the virus from getting into
your respiratory tract.

3. What is the best type of mask for everyday Houstonians to wear?

Weatherhead:
Any form of facial covering is better than nothing. We tend to recommend material that is more tightly-woven to prevent larger particles from getting through, but it also needs to be breathable. Any of the surgical masks will work or any sort of cotton mask will work, you just need to make sure that it’s not so tight that you can’t breathe through it.

McCormick:
I think the cloth masks that you have control over, that you can have two or three of and wash them periodically, I think those are fine for everyday use.

4. I’ve heard N95 masks are the most effective. Are those worth seeking out, or do those need to be reserved for hospitals and first responders?

Weatherhead:
The N95 masks are needed for high-risk individuals working in close contact with infected individuals and patients, so those masks specifically should be saved for healthcare workers and first responders.

McCormick:
I think they should be probably used primarily by people who are at high risk. Certainly you can clearly see that hospital personnel who are taking care of COVID-19 patients or are in a high-risk area are wearing those, and I think first responders definitely should too. So yes, they are more efficient than cloth masks, and are going to add a dimension of protection in high-risk situations.

5. How should a mask be worn to be most effective? Can I keep my nose free?

Weatherhead:
It is critical that the mask is worn correctly in order for it to be effective. It needs to cover your nose and your mouth and come down around your chin in order to prevent and to trap those particles from escaping from the mask. If it’s not covering your mouth or if it’s not covering your nose, it won’t be effective.

McCormick:
No. You need to cover your mouth and your nose. And there is a little risk of virus getting into the eyes because the eyes have mucosa just like the nose and mouth. But it’s definitely the breathing in and out that’s the most important, so you want to cover your mouth and nose because the virus can get in or go out either way.

6. If I’m wearing a mask correctly, does that mean I don’t need to worry about things like washing my hands or social distancing when going out in public?

Weatherhead:
A mask should not be used in lieu of other practices. The mask is an extra step that should be taken, not instead of those other practices, but in addition to them.

McCormick:
Not at all. You still need to practice all of those things. The mask does not eliminate risk, but it certainly reduces it.

7. How often should masks be changed out or washed?

Weatherhead:
Most people will be wearing cloth masks, which can be washed. If you have several, you can wash them after each use, as soap and water in a washing machine will be effective in killing the virus. If you need to reuse, then you can place your cloth mask in a breathable bag like a paper bag that will contain the mask and allow for decay of the virus over time. That duration of time is still being determined, so it’s important not to touch the inside or the outside of the mask when you’re taking it off or putting it on.

McCormick:
If you’re in a situation where you’re wearing them for a good bit of the day, I think they should probably be washed at the end of the day. If you’re wearing them for an hour or so when you go out to the grocery store, or to a specific place and you come back, then you could wear them multiple times over several days without that being a risk, I think.

8. If I wear a mask while talking face-to-face with someone who has COVID-19, how much would that help keep me safe?

Weatherhead:
The exact percentage is unclear. It’s certainly more effective if the infected person is wearing the mask, but it will still provide some protection if only the uninfected person is wearing it, but how much so we don’t know.

McCormick:
The evidence is mounting that it will help reduce the risk of infection. Now, in that scenario, it depends on how easily the person who is infected can spread the virus. We have super spreaders who apparently have a lot of virus and can spread it pretty easily, but you don’t have any way to know that. This all depends on how much virus they are projecting, and how close you come to them. So that is a variable, but wearing a mask will definitely reduce your risk.

9. Should people wear masks when they’re outdoors exercising?

Weatherhead:
If you’re able to maintain social distance while exercising, you have to weigh the risks and benefits. If you’re not able to keep that distance, it’s more likely beneficial to wear a mask. Any time you’re outdoors, or any time you’re in public, you still need to maintain that social distance, greater than six-feet, even when exercising. The mask is just an additional step to that.

McCormick:
My view is if you are outdoors exercising, and you’re not close to someone, you don’t need to wear your mask. It’s true that outside, where you have more air circulation, that virus gets diluted fairly quickly by the amount of air, which also reduces your risk. You don’t need to wear your mask if you’re walking by yourself or with your spouse, or with somebody in your family who you’re there with every day, but take it with you in the event that you meet other people or get in a situation where you’re going to have more close contact with people.

10. If I’m eating indoors at a restaurant, should I keep my mask on when I’m not in the middle of eating or drinking?

Weatherhead:
Yes. You should keep the mask on any time you’re in public and close to other individuals. Obviously, when you’re needing to eat and drink, then you have to take the mask off. But any time you can have it on, it should be on. And again, as you’re taking it on and off, make sure not to touch the exterior or the interior of the mask.

McCormick:

If you’re going to a restaurant—which by the way, I’m not doing—wear your mask. Wear it unless you’re eating, because talking definitely can spread the virus. We saw that that occurred in China in a very classic story of one person at one table spreading the virus to nine other people. The virus spreads more easily indoors, where there’s less air circulation, and when you’re in a restaurant situation, that puts you in close proximity with people, so I strongly recommend you wear your mask unless you’re eating.

11. Is it safe to let someone inside my home if they’re wearing a mask?

Weatherhead:
The mask-wearing will reduce the risk of transmission, but it doesn’t eliminate the risk. Continuing to have that social distance, continuing to practice hand hygiene and cleaning and disinfecting is still going to be very important. It certainly will help, but it won’t bring the risk down to zero.

McCormick:
That is an interesting question. Theoretically, it probably is reasonably safe. Now, no one should come into your house if they’re not wearing a mask. If it’s someone who is coming in to say, clean your house, and they’re going to spend three or four hours, you want to make sure that you maintain social distance from them and that they’re wearing their mask all the time. If they’re coming in for a repair that may last for half an hour or 45 minutes, then that’s a different situation, almost certainly a lower risk. Still, maintain your distance, wear a mask yourself, and make sure they wear a mask.

12. If more Texans had worn masks in public over the past few weeks, would that have prevented the big increase in cases we’ve seen since Memorial Day?

Weatherhead:
It would have made a difference in terms of the volume of cases. We’ve seen cases of what happens when masks have been worn and when masks haven’t been worn. In Springfield, Missouri, there were two hairstylists that had contact with 140 clients. All of them were wearing masks, and there were zero cases that occurred. In comparison, there was a more recent outbreak of 16 people who went to a bar in Florida. None of them were wearing masks, and all 16 of those people tested positive. Because people have been out and in such concentrated areas and haven’t always been social distancing since Memorial Day, there still would have been an increase in cases, but widespread mask use most likely would have reduced how many of those cases there were.

McCormick:
Yes. And let me give you some information from our area. The age distribution of our cases in South Texas has changed, and the cases are much more likely to be younger. In fact, on one of our days, 60 percent of the cases were between the ages of 20 and 30. That tells me that the younger people are not wearing masks. They’re not social distancing. We’ve seen it from many pictures on beaches and in bars and elsewhere, and they are the ones who are driving the transmission. And that transmission ultimately means it’s going to spread more in the community. We’re seeing more cases. We’ve had a tremendous spike, a six-fold spike per day in South Texas, and we’ve seen that elsewhere in Texas and in many other states.

13. What would you say to people who refuse to wear masks because they think doing so is a sign of fear or weakness, or that they’ll look silly?

Weatherhead:
As the restrictions are lifted and the economy is opening up, it’s imperative that people understand that we’re not going back to normal. If you don’t need to go out, you should still stay home, even if things are open. If you do have to go out, you need to wear a mask. The reason is not just to protect you and your family and friends that you live with, but also to protect your entire community. We need to be thinking about others within the community who are at risk, and wearing masks needs to be part of this new normal lifestyle.

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McCormick:
We all have a responsibility to each other in this country. If we think that our behavior is our own business, and we don’t have to worry about other people, then that’s pretty selfish in my opinion. It means that you’re going to drive the spread of the virus. To put it bluntly, if you continue to do that, you may kill some people.

14. What should I tell my friends or family members who don’t want to wear a mask?

Weatherhead:
You can tell them that they are risking the lives of their community members in addition to their family and friends. And it’s important to protect yourself, so if they’re coming around you without a mask, it’s okay to say “You can’t come into my home,” or “We can’t go out and do any certain activities unless everyone is wearing a mask.” That needs to be our approach moving forward to help reduce this huge uptick in cases.

McCormick:
I confront people. I was in a bicycle shop with my wife, and nobody was wearing a mask except for us. I asked a young man if he thought this might be irresponsible. He said “It’s a matter of opinion.” I said “Well, I don’t think that people dying of COVID disease is a matter of opinion, and you’re helping to spread it.” So I confront people with this, because that is the reality. If you believe in science, you know that the virus is spreading, and you can see that it’s spread much more dramatically after we opened the economy. The other point I make to people who don’t wear a mask is if you don’t want to keep your job, just keep transmitting the virus, because eventually it’s going to close down businesses.

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