Disagreement Over Mask Types Strains Friendship

Helen is an old and dear friend and I urged her since March to not leave her house without this kind of a of a suit up

-by Helen Klein

This started over the weekend. On Saturday, I was on the phone with Howie and the topic of masks came up. As DWT readers are aware, Howie has been following the details of the corona virus since the very beginning and he is the most knowledgeable person I know in this regard; a semi expert, one might say. He asked me whether I had purchased the mask he has been recommending since the beginning of the pandemic – an N99 mask such as those from Base Camp. Embarrassed, I said no. Some of our other college friends had followed through right away and when he asked why I had not, I could only shrug. Needless to say, I felt rather chastised. Months ago, my husband had downloaded a pattern for cloth masks and I had made them for myself and my family, which we all have been wearing.

So I followed through. I went on line and purchased four N99 Base Camp masks, which should arrive in a couple of weeks (slow Post Office mail not withstanding). I shared this information with a close friend and neighbor, who is very well informed about many virus related issues and was interested in my purchase. She asked me about the specifics of the mask and then looked it up on line.

Woah. This started a back and forth that wound up disrupting our friendship, at least for the time being.

My friend responded that the mask has valves and that they spread the virus. Articles to this effect followed. She said to wear everything BUT that mask (with vents), and one that goes around your neck is better. “Did you read the articles? The vent releases viral particles which might not hurt you but could hurt someone else. If the CDC felt that it needed to send out a warning, don’t you think that might mean something?”

I responded that I was upset that she was putting down the masks I ordered. “The CDC is warning against them. Maybe ignore me, but read the articles.” She reiterated that the CDC recommends cloth masks.

Upset, I called Howie. He walked me back. He assured me that to protect oneself from the virus, the N99 mask is the best and much better than cloth masks. He cautioned that if the mask wearer has the virus, some particles may be released through the vents but went on to say that other types of homemade masks, such as cloth masks, do not fit well and would also release virus particles, likely much more so. Naturally, someone who is infected should be quarantined and has no business walking around with any mask.

I did not want to get into a back and forth with my friend and my husband suggested I wait and let it go for a while. Always good advice.

Much to my surprise on Sunday, Salon had a lengthy article on this very issue: CDC warned the public against wearing valved face masks-- while recommending them to health care workers.

It turns out the issue of vented masks has become a political tool. Apparently, the airline industry lobbyists have been hard at work. What a surprise!

It is a long piece, and readers are encouraged to read it in its entirety. For DWT, I will highlight some of the pertinent parts here (italics mine).

The politicization of science in the Trump era-- from the manipulation of the National Weather Service to the suppression of information on climate change at the Environmental Protection Agency-- has been as spectacular as it has been horrific. The latest and most peculiar example comes from the Centers for Disease Control and Prevention (CDC), once the standard for science that informs and shapes health policy in the US and around the world.

In a recent update to its recommendation regarding facemasks, which made national news, the CDC recommended that Americans not wear valved masks. These types of facemasks have a piece of plastic embedded in the fabric with a one-way valve that opens when you exhale and closes when you inhale.

Certainly amid the pandemic there is a great deal of confusion about masks. Yet the agency's latest guidance adds to the confusion rather than clarifying it. In fact, the agency's updated guidance contradicts years of their own safety advice to health care workers; indeed, the CDC's website features a database that includes more than 600 models of valved facemasks recommended for health care settings.

Moreover, the agency admits that it updated the policy without any new data. Peculiarly, the new CDC guidance in early August aligns with a Delta Airline company policy issued in July. Like the CDC guidance update that followed, Delta's earlier policy rejects valved N95 respirators while accepting the wearing of bandannas and neck gaiters-- which offer far less protection to the wearer and to those around them.

On its surface, the agency's logic for this appears to make sense. Valved masks release a small amount of exhaled air, which, if a person has coronavirus, could be virus-ridden air-- thus possibly putting those immediately nearby at risk.

While it is true that a small amount of unfiltered air escapes through the valves, there is scant scientific evidence studying how much and how high the risk is. One well-publicized paper (by Duke University physicists), released after the CDC mask guidance change, indirectly looked into the matter... It suggested that, in comparison with the "gold standard" of respiratory protection (an N95 respirator without a valve), an N95 with a valve "can decrease protection" for those around the wearer, but is overall far better at stopping viral spread than a bandanna or neck gaiter-- two other types of ersatz masks that the CDC does recommend. Indeed, the Duke scientists found that bandannas and neck gaiters "offer very little protection." In any case, since scientific research doesn't seem to have influenced the CDC's guidance, the question remains as to why the CDC suddenly recommended against valved masks. The answer may have something to do with the work of airline industry lobbyists. But the media coverage of the CDC's guidance has largely eclipsed the connection.

The media comes for valves

After the CDC’s recommendation against valved masks, the media hyped the news as if the science were settled. One headline at Fox News read: "Avoid wearing coronavirus face masks with vents, valves, CDC says in updated guidance." CNN writes: "Do Not Wear Masks With One Way Valves or Vents"; the Washington Post concludes: "Face masks with valves or vents do not prevent spread of the coronavirus, CDC says."

To be fair, no face covering, short of a properly-fitted N95 respirator, can claim to completely prevent coronavirus' spread. Surgical masks are not designed to create a perfect seal, or to filter out 95 percent of virus particles, and they cannot be fit-tested. Those masks, as well as loose-fitting cotton masks, leave gaps that leak air. They could also leak virus particles, as people breathe in and out. It doesn't take scientists in a lab to see this. Look at just about any random group of mask-wearing people in a store or on the street and observe that large gaps beside the nose or under the ears are visible, and that these are obviously far larger and probably of far greater consequence than the tiny vents on an exhale valve. The zealous focus on valves seems to be a case of missing the forest for a few trees.

Thus it may not be a surprise that the CDC guidance, revised August 7, aligns with the aforementioned Delta Airlines facemask policy dated July 25 that banned valved N95 respirators and any other masks with valves from flights. Delta based its policy on the fear that valves may leak virus particles through a tiny vent. Fair enough. But surgical masks, cotton masks, bandannas, and gaiters all allow particles to get directly through their material, as well as through gaps and leaks around the sides. The updated CDC guidance, which is not based on any new data, contradicts advice the agency has been giving to health care workers for years – and the advice it continues to give them on its own website.

In any case, the extensive media coverage about valved masks ignored that CDC documents published in February-- reviewed by the CDC's National Institute for Occupational Safety and Health (NIOSH) on April 9, and updated by the CDC's National Personal Protective Laboratory on August 3-- contradict its new guidance, issued on August 7. That new guidance followed a lobbying campaign by the airline industry.

The CDC's contradictory advice

3M, the principal manufacturer of N95 respirators, stated in June that they were "not aware of any studies on whether airborne germs exit a respirator through the exhalation valve." They added that as of June, the CDC, NIOSH, and WHO had issued "no guidance on this issue." But 3M noted that the valve does not open far, and that some particles would stick to the valve's membrane rather than exit.

In this same FAQ updated August 8, the CDC stated that because N95s without exhalation valves make it "more difficult to breathe" and may be "hot and uncomfortable," hospitals may want to "consider having employees who are not doing surgery, not working in a sterile field, or not potentially exposed to high velocity streams of body fluids wear a standard N95 with an exhalation valve."

Deconstructing malarkey around valved N95s

The CDC's current recommendation regarding valves that regulate outward flow of air notwithstanding, the agency previously recognized the benefits to valves, stating, "An exhalation valve reduces excessive dampness and warmth in the mask from exhaled breath." Damp or wet masks are not merely uncomfortable, but they are dangerous-- as they can increase the transmissibility of airborne viruses to the user.

Further, the CDC admits that N95 respirators (with or without valves) are safer than surgical masks when the user inhales...

"Surgical masks are not designed for use as particulate respirators and do not provide as much protection as an N-95 respirator. Most surgical masks do not effectively filter small particles from air and do not prevent leakage around the edge of the mask when the user inhales."

Incongruously, the CDC guidance now suggests that a coarsely woven and loosely fitted bandanna or neck gaiter is somehow safer than one of the 624 valved N95 respirators that the CDC recommends to health care workers. What might fly in the industry-friendly, science-averse Trump CDC might be seen as malarkey in another administration.

An example of the CDC's use of false and loaded language is its claim that valves "allow air to be exhaled through a hole in the material." (This claim also belies OSHA's study.) An actual valve is a secure plastic fixture with a membrane that opens when you breathe out and closes when you breathe in. It is not by any reasonable definition, a "hole."

Two-way protection

Another red flag in the CDC guidance is that it suggests that masks are intended only to protect others, when in fact they protect in both directions. While their stated concern is "source control," the CDC has no warning against leaky unfitted masks, including those better-than-nothing cloth face coverings and other homemade masks of any quality.

3M states: "Note that surgical masks, procedural masks and face coverings-- which are often worn to control the spread of infectious diseases-- are not designed to fit tightly to the face and have gaps around the face through which air will leak both inward when the wearer inhales and outward when the wearer exhales, potentially including expelled particles."

3M added that procedure masks and homemade cotton masks do not fully prevent the spread of virus particles either because in addition to gaps between the mask and face, "air and particles will also travel through the mask material at different rates depending on their construction."

So what could have propelled the CDC's recommendation to ditch valved masks?

It may have something to do with the Trump administration's accommodation of the airline industry, and the struggle of the airlines to cope with the pandemic.

The airline industry connection

On April 24, United became the first airline to require employees to wear masks. Three days later, based on the CDC's voluntary guidance to wear facemasks outside the house as a best practice, JetBlue announced that it would require passengers to wear masks, too, effective May 4, 2020. On April 30, Delta Airlines announced that passengers would be required to wear masks, also effective May 4. Frontier Airlines and Lufthansa announced the same day that they would require passengers to wear masks on planes and in terminals by May 8.

On July 27, Delta banned "any mask with an exhaust valve" on its flights, while allowing any basic "cloth face covering over their nose and mouth." This would include a neck gaiter or loosely woven, loosely fitted bandanna with gaps around the nose, beside the ears, and under the chin big enough to poke fingers through. A sleeping passenger with a cloth napkin over his face might arguably pass muster by Delta's standard.

After the CDC updated its guidance on valved masks on August 7, Delta claimed that it was "aligning with best practice guidelines from the CDC"-- although Delta had actually banned valved masks nearly two weeks earlier. That suggests that the CDC was following Delta's lead. It may not be coincidental that both the CDC and Delta are headquartered in Atlanta.

The Hill reported on June 21 that airports had begged the Trump administration to set a facemask policy for passengers. The airports and the unions not only did not get the regulation that they had fought for, but the CDC guidance on valved masks achieved a key aim for the industry without appearing to be just for them.

Unfortunately, this is not the first time that government agencies and a compliant, conveyor-belt media have spread misinformation about masks in the name of (faulty) science.

Early in the pandemic, Americans were told not only that they don't need to wear masks, but that they don't work. It is possible that this was a lie intended to try to discourage consumers from buying up protective masks that were desperately needed by health workers, and were in short supply at the time.

But by lying and telling the public that they don't need masks, as University of North Carolina sociologist Zeynep Tufekci wrote in the New York Times, "the authorities sent a message that made them untrustworthy." And the CDC is repeating their error in scolding the public not to wear valved N95 respirators because they are allegedly dangerous, while recommending them to health care workers because they are safe.

The subtle scapegoating of valved masks notwithstanding, the exponential spread of the coronavirus in 2020 is not due to the relatively small number of people wearing valved masks, but rather a major factor is the overwhelming number of people who refuse to wear masks of any kind, those who wear inadequate masks or who do not wear masks properly, and who do not socially distance and who engage in large group events without adequate or even any protection.

The one obvious question not explicitly dealt with in the Salon article is WHY. Why did Delta prohibit vented masks? What was the motivation? Well, the most obvious possibility is MONEY. Vented masks are far more expensive. Airlines staff might well prefer to wear them, as they offer far better protection for the user compared to typical surgical masks. It may be that airlines would not want to absorb this cost, increased virus risk to their employees be damned. Other possibilities? Legal aspects? Perhaps DWT readers could offer other ideas.

So, where does this leave me with my friend? Clearly, it is inadvisable to rehash any discussion of masks. Different opinions are always present in any friendship, as are occasional disagreements. We have been friends for thirty years and surely this is a minor hiccup. A mask is like a piece of lint compared to the fabric of Trump horror, of which we strongly concur. Our friendship will survive. Serenity Now!

The Hone Ranger