Biden wants Americans to wear masks for 100 days — do they protect against COVID-19 or merely promote healthy behavior?

President-elect Joe Biden wants Americans to mask up.

He will ask Americans to wear a mask for the first 100 days after he takes office and issue a standing order that masks be worn in places where he has jurisdiction, including federal buildings and interstate transportation, he said Thursday. “Just 100 days to mask, not forever: 100 days, and I think we’ll see a significant reduction,” he told CNN’s Jake Tapper.

Biden has also asked Dr. Anthony Fauci, the nation’s top infectious disease expert, to be a chief medical advisor and part of his coronavirus response team when his administration begins on Jan. 20, 2021.

‘Just 100 days to mask, not forever: 100 days, and I think we’ll see a significant reduction.’

— President-elect Joe Biden

Biden’s push for masks was well-flagged on the campaign trail. Speaking in his home town of Wilmington, Del. in October, Biden vowed to push for more Americans to wear masks. “First, I’ll go to every governor and urge them to mandate mask wearing in their states, and, if they refuse, I’ll go to the mayors and county executives and get local mask requirements in place nationwide,” he said. President Trump, for his part, has described mask wearing as both “patriotic” and “politically correct.”

Amanda Jezek, senior vice president of public policy and government relations at the Infectious Diseases Society of America, supports Biden’s plans. “In August, IDSA began calling for a national mask mandate, as compelling scientific data indicate that masks significantly reduce the risk of COVID-19 transmission,” she told MarketWatch.

“Further, modeling suggests that near universal masking could prevent 180,000 COVID-19 deaths. We continue to support a national mask mandate,” she added.

Biden will have to persuade state governors to mandate their own mask-wearing policies, some political analysts say, and even then it will be a tough ask to get everyone to wear masks, particularly those in Republican states and areas loyal to President Trump, who himself has made a point of appearing in public more often than not without a mask.

And yet people remain divided on their effectiveness, even if the actual studies are far more conclusive. Do double-cloth face coverings help stop coronavirus transmission, members of the public often wonder, or do they simply promote healthy behaviors?

Previous studies have concluded that face masks have helped reduce the transmission of influenza by reducing droplets being sprayed into the air during flu season; another Japanese-based study from June says this works when paired with a flu vaccination, which is not an option in the case of the coronavirus.

This study says N95 medical-grade masks do help filter viruses that are larger than 0.1 micrometers (One micrometer, um, is one millionth of a meter). The coronavirus is 0.125 um. “These products can help block large droplets expelled by the wearer, but also have been shown to have efficacy at filtering smaller particles and are designed to fit tightly to the face,” it said.

Previous studies have concluded that face masks have helped reduce contagion by reducing droplets being sprayed into the air during flu season.

N95 masks are tighter-fitting than surgical masks and protect against small particles and large droplets, according to the CDC. In April, New York Gov. Andrew Cuomo ordered all New Yorkers to cover their faces in public when they can’t maintain a proper social distance.

According to this article by Seattle-based science jouranlist Lynne Peeples in the October edition of the journal Nature: “To be clear, the science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease.”

She cited the case of two hair stylists in Missouri who tested positive for COVID-19, but wore a double-layered cotton face covering or surgical mask in their salon. “Although they passed on the infection to members of their households, their clients seem to have been spared,” she wrote. “At Black Lives Matter protests in U.S. cities, most attendees wore masks. The events did not seem to trigger spikes in infections, yet the virus ran rampant in late June at a Georgia summer camp, where children who attended were not required to wear face coverings.”

It has been a long road to mask wearing in Americas. After two months of obfuscation over the efficacy of face masks and New York City becoming the epicenter of the pandemic in the U.S., the Trump administration, the Centers for Disease Control and Prevention, the World Health Organization and Cuomo, a Democrat, finally agreed on one thing in April: All Americans should wear face coverings in public settings.

That, however, happened more than a month after the WHO declared the COVID-19 outbreak a pandemic. The public was understandably frustrated and confused, and some people were upset over the lack of clear messaging, given the number of lives that could have been saved. On Jan. 29, for instance, The New England Journal of Medicine said: “There’s evidence that human-to-human transmission has occurred among close contacts since the middle of December.”

Related: Want to make your own mask? Here’s a simple DIY approach.

Yet authorities prevaricated on the efficacy of masks. “The virus is not spreading in the general community,” Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said on Jan. 30. “We don’t routinely recommend the use of face masks by the public to prevent respiratory illness. And we certainly are not recommending that at this time for this new virus.”

President Trump resisted the recommendation by public-health officials to wear a mask when he was in public. “You don’t have to do it. I’m choosing not to do it, but some people may want to do it and that’s OK,” he said in April. He eventually said that wearing a mask was “patriotic,” but the president, who tested positive for and recovered from coronavirus in October, has rarely worn one in public.

The WHO estimates that 16% of people are asymptomatic and can transmit the coronavirus and advises wearing masks. As of Saturday, 66 million people worldwide had contracted COVID-19, with 1,519,883 deaths, with 14.4 million cases in the U.S. and 278,996 fatalities, according to Johns Hopkins University.

Joe Biden: ‘I’ll go to every governor and urge them to mandate mask-wearing in their states.’

MarketWatch photo illustration/Getty Images, iStockphoto

Do face shields work?

Face shields do not suffice, health professionals say. That’s according to an experiment on the subject showing how respiratory droplets that could carry the virus spread while people wore a face shield and a face mask with exhale valves compared to how droplets spread from a traditional mask. Some college and high-school students and children in elementary schools have returned to classrooms this year wearing face shields with a cloth mask, and sometimes without one.

In California, for instance, the Orange County Health Care Agency, the Orange County Department of Education and school districts across that county developed a guide to returning to school before last fall’s school year started. It said face coverings were required for third-graders through high school-level students, and “strongly encouraged” for children between two years old and second grade. “A face shield is an acceptable alternative for children in this cohort who cannot wear them properly,” the guide stated.

‘No burden of 100% efficacy should be placed on face shields or any containment policy because this level of control is both impossible to achieve.’

— A commentary published by JAMA Network, an open-access medical journal published by the American Medical Association

Vanderbilt University in Nashville, Tenn., among some other colleges, said in a post on the school’s website that it was comfortable allowing faculty members inside classrooms to wear a face shield without a mask. But research suggests that may not be enough to prevent a teacher from spreading coronavirus, especially if he/she is asymptomatic or pre-symptomatic. (Vanderbilt did not return requests for comment.)

To reduce the risk of spreading COVID-19, the disease caused by SARS-CoV-2, it may be preferable to use high-quality cloth or surgical masks that are of a plain design instead of face shields and masks equipped with exhale valves, according to this July 2020 experiment and video published in September 2020 by Physics of Fluids, a monthly peer-reviewed scientific journal covering fluid dynamics.

The journal, which was first established by the American Institute of Physics in 1958, published the study, “Visualizing droplet dispersal for face shields and masks with exhalation valves,” to illustrate how a shield or mask with a valve affected the movement of droplets compared to wearing a face mask without valves. Their conclusion: It may be preferable to use high-quality cloth or surgical masks with plain design without valves. That’s in line with what the U.S. Centers for Disease Control and Prevention has said: it recommends against using masks with valves or vents, because they can “allow virus particles to escape.”

“We focused on the smaller droplets, since they can stay suspended for very long times and might contain enough virus particles to transmit COVID-19,” said Siddhartha Verma, one of the paper’s authors and an assistant professor at the Department of Ocean and Mechanical Engineering at Florida Atlantic University in Boca Raton, Fla. “Even the very best masks have some degree of leakage.”

“As students return to schools and universities, some have wondered if it is better to use face shields, as they are more comfortable and easier to wear for longer periods of time,” Verma said in September. “But what if these shields are not as effective? You would be essentially putting everyone in a tight space with droplets accumulating over time, which could potentially lead to infections.”

The WHO estimates that 16% of people are asymptomatic and can transmit the coronavirus.

MarketWatch photo illustration/iStockphoto

Some universities won’t let students on campus without a mask and shield. The U.S. Centers for Disease Control and Prevention does not recommend face shields as a substitute for masks: “It is not known what level of protection a face shield provides to people nearby from the spray of respiratory droplets from the wearer. There is currently not enough evidence to support the effectiveness of face shields.”

The CDC has reminded people to distinguish between masks, and surgical masks. “Currently, those are critical supplies that should continue to be reserved for health-care workers and other medical first responders,” it says. “Masks also are not appropriate substitutes for them in workplaces where surgical masks or respirators are recommended or required and available.”

‘What if these shields are not as effective? You would be essentially putting everyone in a tight space with droplets accumulating over time.’

— Siddhartha Verma, assistant professor at the Department of Ocean and Mechanical Engineering at Florida Atlantic University

While face shields and masks with valves may be more comfortable than cloth masks, the CDC calls for wearing a mask that covers both your nose and your mouth, with the mask secured under your chin. It should fit snugly against your face. There should not be large openings or gaps around your nose, mouth and the sides of your face. Do not touch the mask while wearing it.

Some educational institutions have been more circumspect on the use of face shields. Loma Linda University, a Seventh-day Adventist health-sciences university in California, advised the wearing of face masks as the No. 1 protection against COVID-19. “Prolonged exposure reduces the amount of protection of the shield,” according to this advice posted in July from the university’s health and wellness team.

Vanderbilt University’s Public Health Advisory Task Force, in a statement on the college’s website about its plans for the 2020 academic year, cited a “preliminary study” as offering sufficient evidence for the efficacy of face shields “in the way Vanderbilt intends to use them, which is coupled with other protective measures (social distancing, less density with classrooms, students wearing face masks/coverings, etc.).”

However, that preliminary study is actually “viewpoint” commentary on face shields that cites other pieces of research on face shields and the influenza virus, which is obviously different from coronaviruses. Nor does the commentary in question published by the JAMA Network offer up enough scientific evidence to show face shields are adequate.

Contrary to the logic for Vanderbilt’s policy, the viewpoint concludes: “It is unlikely that a randomized trial of face shields could be completed in time to verify efficacy. No burden of 100% efficacy should be placed on face shields or any containment policy because this level of control is both impossible to achieve and unnecessary to drive SARS-CoV-2 infection levels into a manageable range.”

BioNTech SE BNTX, +1.11% and Pfizer PFE, +0.62% said in November that a final analysis of its vaccine showed 95% rather than 90% efficacy. The U.S. Food and Drug Administration is to meet on Dec. 10 to review the Pfizer–BioNTech vaccine candidate and could also issue an emergency-use authorization.

On Nov. 16, Moderna MRNA, -3.01%  said its vaccine candidate was 94.5% effective.

A third vaccine being developed by AstraZeneca AZN, +1.82%  with Oxford University — a viral vector-based vaccine — recently produced some confusing results, with the vaccine appearing 62% effective when tested as originally planned but 90% effective when a manufacturing error lead to a reduced initial doze for some volunteers.

Johnson & Johnson JNJ, +0.85% ; Merck & Co. MERK, -1.26% ; GlaxoSmithKline GSK, +0.62% ; and Sanofi SAN, +5.92% are also working on fast-track coronavirus vaccines.

The U.K. plans to start inoculating frontline workers as early as next week, but many hurdles remain. The vaccine needs to be stored at minus 94 degrees Fahrenheit and must be transported to the U.K. from a facility in Belgium.

The Dow Jones Industrial Average DJIA, +0.83% recently broke 30,000 on vaccine news and progress in the transition of power to President-elect Joe Biden. The DJIA and the S&P 500 Index SPX, +0.88%  and Nasdaq Composite COMP, +0.70%  closed in positive territory Friday, buoyed by reports of a possible compromise between lawmakers on both sides of the political aisle on a new COVID-related stimulus bill.

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