COMMENTARY

Unmasking Mask Misinformation and Myths

Mark A. Lewis, MD

Disclosures

August 19, 2020

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This transcript has been edited for clarity.

Hello. This is Dr Mark Lewis, recording for Medscape. At the risk of sounding hackneyed, I'd like to speak about masks. I realize that this topic has been saturating the news in both the medical and the lay press of late. But I still want to add my voice to the chorus, because I think it's clear at this point in the pandemic that the virus is not abating. Until we have very effective antiviral therapies and ideally a vaccine that confers lasting immunity, I think this is going to continue to be a public health crisis that we have to meet head-on. This is really a case where an ounce of prevention is worth a pound of cure. Hence the mask.

I have seen a lot of misinformation — and even disinformation — about masks, and I've found a few talking points to be helpful. Of course, I'm not guaranteeing that these will sway everybody; I think some people are fairly entrenched in their beliefs at this point.

Misinformation and Talking Points

1. Efficacy. I grant you that the mask is not 100% effective, but there are very few things in medicine that are. The best analogy I can use is the seat belt. It does not protect you, unfortunately, from being harmed or even killed in a car accident. But we know that it does offer some protection, and hence most of us will buckle up every time we get in the car.

2. Mixed messages. I know we have sent some mixed messages here during the pandemic. Back in March, there was a real concern that we as healthcare professionals would suffer from a dearth of personal protective equipment (PPE) and we didn't want the public hoarding PPE in the same way that we saw panic-buying of toilet paper. Our messaging has now swung to where we believe that everybody, when out in public, should wear a face covering if possible.

3. Behavioral aspects of mask wearing. At some point we were concerned that mask wearers were likely to be more cavalier in their behavior and less likely to socially distance, for instance. But we now have seen that wearing a mask in public is more advantageous than not.

4. "Schrodinger's mask." Critics of the mask can't have it both ways. It can't be both porous enough to let the virus in but impermeable enough to keep oxygen out. As a physical barrier, I think we need to make the point that largely what it's doing for the wearer is catching droplets that we expel — certainly when we breathe, but especially when we cough or sneeze. Yes, the virus itself is so tiny that it can potentially pass through the pores in a mask like the one I'm wearing. We also have to remember that the particles are not traveling in a straight line. They experience Brownian motion. They also might be affected by the electrostatic charge of some mass, particularly N95s.

5. Portals of entry. Again, it's a two-way street. You're protecting others around you by wearing the mask, and you're also lowering the chances that you would receive droplets from another person. As Dr Anthony Fauci recently pointed out, there are three main portals of entry in the face in terms of mucosa: the mouth, nose, and eyes. Wearing a mask like mine is covering at least two out of the three of those, and typically I'm also wearing a clear face covering that provides eye protection when I'm in clinic.

6. Gas exchange. I'm in Salt Lake City, at an elevation of 4400 feet. I'm a cancer patient myself. I recently had a pulmonary embolism, and I put on my own personal box of 30 masks and used a pulse oximeter to prove that my saturation did not drop. We need to reassure our patients and the public that while there is a certain discomfort to the mask, in a sense that gas exchange is being impaired, there is really more psychology to that than physiology. We have practiced knowing germ theory and medicine now for over a century and a half (ie, Semmelweis, Lister). And we know that our surgical colleagues wear these masks for hours on end in the operating room with no appreciable drop in oxygen or elevation of carbon dioxide.

At the risk of preaching to the choir, I think it's so important that we continue to message to the public that these very simple things — wearing a mask, washing hands, social distancing — are the best preventive measures that, frankly, are not just personal protection but increasingly a civic responsibility. I hope that everybody can stay safe out there. For Medscape, this is Mark Lewis, signing off.

Mark A. Lewis, MD, is director of gastrointestinal oncology at Intermountain Healthcare in Salt Lake City, Utah. He has an interest in neuroendocrine tumors, hereditary cancer syndromes, and patient-physician communication.

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