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Life is Now a Masquerade: Everything You Wanted to Know About Face Masks in the Time of COVID

Eligible for CME Credit

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by Stuart M. Caplen, MD

Medical mask use dates back to the 1600s when doctors wore bird-like head and face coverings during plague epidemics. The beak of the mask was filled with straw and aromatic herbs, in an attempt to prevent “bad air” miasma from infecting the wearer. [1]

An Italian Plague doctor and one from France
An Italian Plague doctor (left) and one from France (right).[2]

Masks played a prominent role in trying to decrease the infection rate in the 1918 influenza pandemic. Then, just as now, mask wearing was politicalized. In San Francisco, in just one day, 1,000 people were arrested for not wearing masks. A health inspector shot a “mask slacker” after a fight ensued about mask wearing. An organization called the Anti-Mask League was formed and their objections to mask wearing included a lack of scientific evidence that masks worked, and the belief that forcing people to wear them was unconstitutional.[3]

Why Did the CDC and the WHO Flip-Flop on Mask Use?

At the beginning of the COVID-19 outbreak, the Centers for Disease Control and Prevention(CDC) and prominent health officials were saying that masks should be reserved for health care workers. In February, U.S. Surgeon General Jerome M. Adams tweeted "Seriously people - STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!"[4] After evidence came out that asymptomatic people could spread the disease, the CDC in April recommended that all Americans over the age of two wear masks when out in public. The recommended masks are cloth facial coverings, or homemade masks, and the CDC still recommends that medical-grade masks be reserved for health care professionals. The World Health Organization similarly flip-flopped on mask usage.[5] Dr. Anthony Fauci has said that his initial reservations were in part a fear that if everyone wore masks, it would exacerbate the mask shortage occurring in hospitals at the beginning of the pandemic.[6]

Medical Masks and Nanofiber Masks

Medical masks such as N95 respirator masks (also called N95 masks), when fit tested, do provide the wearer significant protection against COVID-19 infection. Surgical masks provide droplet protection, but not as much as an N95 mask. Surgical masks are also not...

Read the conclusion on medical masks and nanofiber masks, N95, N99, and N100 masks, reactions to masks, do they work, and protection rates. Plus details on removing, reusing, and cleaning masks.

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Stuart M. Caplen, MD, FACEP, MSM

Dr. Caplen is a former emergency physician and emergency department medical director, now retired from clinical practice. His current interests include how quality is produced and maintained in health care, and he recently achieved greenbelt certification in lean/six sigma.


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