Face masks: Amid confusion and political turmoil, people are not getting ‘the right stuff’

A nurse practitioner wears a medical-grade mask and a respirator to block transmission of coronavirus between her and her patients. Infectious disease experts say widespread use of face coverings, even non-medical grade masks, reduce transmission of coronavirus. Credit: Laura Cassels

Face coverings. Who knew they would become a vital part of discussions around the world about survival and our way of life? Much less a signal of one’s political views?

This will be the year in history when billions of people started learning about face coverings — and there is a lot to learn. Scientists say the masks people wear and how they use them, if they mask up at all, are important as COVID-19 infections and deaths continue to surge while economies reopen.

Florida topped 114,000 infections Thursday and reported 3,327 deaths, according to the Florida Department of Health — which advocates the wearing of masks in public, on a voluntary basis.

Health experts are in accord about the benefits to society of wearing face masks, but some people perceive mask mandates and even mask recommendations by the Centers for Disease Control and Prevention as infringements on their individual rights.

In Florida’s state capital, Leon County on Thursday enacted a requirement to wear masks in indoor public places. Meanwhile, Leon Republican Party Chair Evan Power is going to court over the mandate, according to court records.  He contends non-maskers may be wrongfully required to disclose private health information in order to claim the only exemption to the mandate, a medical one.

At a Palm Beach County Commission meeting Tuesday, commissioners unanimously adopted a mask mandate despite raucous protests. During public comments recorded on video, the majority of speakers accused the commissioners of being evil, militaristic, communistic and acting contrary to God’s will.

Several alleged that wearing masks could kill people by preventing them from breathing.

Clearly, masks have become a thorny issue.

Meanwhile, health experts generally agree on several things:

1) The top job of wearing face coverings is not to protect the wearer from others; it is to protect others – and ultimately everyone – from the coronavirus particles that wearers may be carrying around, often without knowing it.

2) The fabric of a face covering fine enough to filter out dust and bacteria so that the wearer does not inhale it is not fine enough to filter out tiny particles of novel coronavirus, SARS-CoV2.

3) The likelihood of an uninfected person contracting COVID-19 from an infected person, even those who exhibit no symptoms, depends on how close they are and for how long. The closer and longer, the more likely. If all parties wear masks, stay 6 feet apart, and don’t stay near each other for hours, the risk drops dramatically.

4) Masks not covering one’s face from nose to throat offer little protection to the wearer or others.

5) People with elevated vulnerability and people who know they are infected should isolate, and they should be exceptionally diligent about distancing and wearing the best masks available if they must venture out.

6) When in public, any kind of covering over the nose and mouth is better than none.

Those are key messages from experts such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and an adviser to President Trump on coronavirus, and the infectious disease team at the U.S Food and Drug Administration (FDA).

Societal duty and personal liberty

“Everybody should wear a mask out in public,” Fauci said Wednesday in a videoconference interview on CapRadio, a public broadcasting station based in Sacramento. “It really does not only protect you, but it protects others in case you might have an infection that you don’t even know about.”

Elected officials in Orlando, Tampa, Tallahassee, Palm Beach County and the Florida Keys are among the Florida municipalities hoping their newly adopted mandates will increase mask usage in public places, especially in high traffic areas such as workplaces, restaurants, bars, gyms, sports event and, yes, political rallies.

California, Connecticut, Delaware, Illinois, Kentucky, Maine, Michigan, New Jersey, New Mexico, New York, Rhode Island and Washington are among states that have taken the strongest stances, ordering statewide masking mandates with various levels of specificity and enforcement.

Florida Gov. Ron DeSantis has declined to issue a statewide mask order.

Alex Chan of Franklin, Tennessee, said he didn’t feel safe leaving home when the virus hit the United States and he set his mind to finding masks that would protect him and his family. An entrepreneur, he turned his mission into a business and says he now sells approximately 1 million FDA-worthy masks and KN-95 respirators to the general public in the U.S.

Chan told the Florida Phoenix he got a headstart on the mask situation in October while he was in Seoul, South Korea, a nation well acquainted with the use of face masks. With a common “haze” of pollution reportedly heading toward the city, he said, he bought masks at a convenience store to protect himself and his party. He brought the leftovers home and was glad of it in January when coronavirus started blowing up.

“In Asian cultures, they expect the masks to be good. They’ve been through this kind of experience before,” Chan said, citing the SARS pandemic of 2002 that ravaged the Asian continent. “So in January, we had some. But when the pandemic happened, we realized people were not getting the right stuff.”

The KN-95 mask Alex Chan sells is manufactured by a Chinese company the FDA lists as an approved manufacturer of non-medical-grade masks. The FDA warns that many masks look legitimate but are counterfeits. Credit: AEA Group LLC

Chan researched face coverings in countries such as South Korea and Hong Kong, and in the United States, finding the countries to be worlds apart.

“There is no mask culture in the U.S.,” Chan observed. “We don’t like to do what people tell us to.”

Chan, who identifies as a conservative, said he understands general resistance to government mandates but not resistance to wearing face masks. Asked what he thought about President Trump’s political rally in Tulsa, Oklahoma, Chan said he was “kind of ashamed” that so few people were seen wearing face masks.

Chan said he would like to see the president conspicuously wear face masks as an apolitical example of how to help the economy reopen safely.

“To me, to reopen the economy, we have to wear masks. Masks alone is not the solution, but it is critical,” Chan said.

Which masks work best?

As understanding of the disease has increased, public interest in adopting a mask culture while waiting for a vaccine or cure has grown. People who wear face coverings are donning bandannas, homemade cloth masks, fixed-shape polyurethane masks, disposable surgical-style flat masks, and buffs or gaiters, which are tube scarves for your neck and lower face.

Disposable masks that lie flat but expand to cover the face should be blue on the outside, with pleats pointing downward. Check if the manufacturer is FDA approved. Credit: AEA Group LLC

Chan scouted out a manufacturer in China who could produce FDA-worthy masks, including KN-95 respirators (a step or two down from medical-grade N-95s that are set aside for health-care workers) and Level 2 disposable, surgical-style flat masks. He said he found no specifications required for producing masks for the general public.

“That’s what drove me nuts. There is no requirement for masks except for healthcare workers. But at this point, the public needs it too,” Chan said.

Chan’s masks are manufactured for his company, AEA Group LLC, by Guangzhou Harley Commodity Company Limited, listed as authorized by the FDA because they meet standards for filtration of viral particulate matter, which is a higher standard than for bacterial filtration. They have no vents, as recommended by the CDC and the FDA. Health experts say vents release virus in the very exhalations that masks are supposed to restrict. And the vents accumulate moisture, which is the key way coronavirus particles travel between people.

Chan and the FDA stress that millions of substandard, ineffective, even deliberately counterfeit manufactured masks are flooding markets around the world, driving down prices and misleading consumers.

The FDA reports that loose-fitting masks do little to protect wearers from prolonged exposure to infected people, but they help. They do their best work when wearers keep them extended fully, from below the eyes to below the chin. Wearers are advised to handle them only by the ear loops, not to touch the surface of the masks, and to wash them after each exposure, especially if they become moist.

Fixed-shape polyurethane masks also serve to keep an infected person – notably an asymptomatic person who is unaware he or she is infected – from exhaling the virus to others. It does little to filter out virus particles from air inhaled by the wearer.

The FDA’s take on disposable masks that lie flat but expand over the face, referred to as surgical masks or medical masks, is that the most effective ones have metal strips that bend to seal against the bridge of the nose and which include a layer of plastic to serve as a moisture barrier.

KN-95s produced by manufacturers listed on the FDA website are probably the most effective the public can buy because they score high on filtration from the inside out and from the outside in, giving the wearer some protection from others and giving others some protection from an infected wearer.

Some governors, mayors and other local authorities are mandating that masks be worn in public – any kind of a mask – most importantly when in close proximity to other people, such as in workplaces, restaurants and bars, theaters, sports events and political rallies. Enforcement plans vary from issuing warnings to issuing fines to forfeiting business licenses.

‘Get past it’

As for the politicization of face masks, Fauci said people’s choices on whether to wear masks and avoid crowds as much as possible should be about helping society as a whole rid itself of coronavirus.

“There’s no secret formula for that except to say, get past it. It should not be a political issue. It’s purely a public health issue,” he said. “Forget the politics. Look at the data.”

He explained: “When you get infected, even if you’re without symptoms, even if you have mild symptoms, the chances are strong that you’re going to infect somebody else who’ll infect somebody else who then will infect the vulnerable person: a grandmother, a grandfather, an uncle or a cousin who has leukemia and is on chemotherapy.

“That’s how your responsibility is not just individual. There really is a societal responsibility here.”