Initially, individuals were told not to wear face masks. This was intended to preserve personal protective equipment for health professionals on the front lines of COVID-19 care. But now it is more important than ever that everyone do their part and #MaskUp to stop the transmission of COVID-19. As the U.S. continues to grapple this new normal of wearing masks as part of their daily attire, patients might have questions.
With “understandable confusion about masks because the recommendation changed,” JAMA Associate Editor Preeti Malani, MD, sat down with us to discuss some questions patients might have about managing risk and wearing masks during the COVID-19 pandemic.
“This is a simple way to prevent respiratory droplets from going into the air and landing on other people,” said Dr. Malani, the chief health officer and professor of medicine in the Division of Infectious Diseases at the University of Michigan in Ann Arbor. “When we talk or cough, we create droplets, and so the cloth-based covering can help keep the droplets from traveling.”
“There’s an increasing body of evidence that suggests this is a really important way to reduce spread,” she said.
For example, at a hair salon in Missouri, two hairstylists who had COVID-19 saw 139 clients. However, both hairstylists and all clients wore face masks. As a result, no symptomatic secondary cases were reported. Adherence to the face-covering policy likely mitigated the spread of the virus, according to the Centers for Disease Control and Prevention (CDC).
“Anytime you’re out and about that you’re not in your own backyard or by yourself walking, you could end up in a situation where you’re really close to people,” said Dr. Malani. “Even outdoors, it’s helpful and what I suggest is just carrying the mask with you.”
Additionally, “it’s a respectful, empathetic, kind gesture that says, ‘I care about everyone around me and about the health system not being overwhelmed and I believe in science and evidence,’” she said.
CDC Director Robert R. Redfield, MD, explained the protective value of face masks during a recent episode of “Conversations With Dr. Bauchner.”
Patients might be unsure of how often they can use the same mask. But “if the mask is visibly soiled,” it is a sign that it is time to get a new one, said Dr. Malani.
However, “it’s OK to wear the mask for a day or two, depending on how much you’re out and about,” she said. “If you’ve been out in the heat walking around, it’ll probably be time to remove it and wash it, so having a few masks on hand makes sense.”
The CDC offers advice on using cloth face coverings to help slow the spread of COVID-19, as well as how to make and wash masks.
“For little kids two and under, there would be a safety issue, and kids up to age five would have a hard time wearing a mask,” said Dr. Malani, adding that this also includes “anyone who is otherwise unable to remove the cloth face covering without assistance.”
For example, “the frail elderly would also be a population where you wouldn’t want to necessarily put a face covering on them,” she said. “It’s a case by case basis.”
Many people have been connecting with their family through FaceTime, Zoom or other platforms. However, if a person can visit their family, it raises the question of if a mask is needed.
“It depends on the situation, but it is probably a good idea if you are visiting family—particularly those with high risk—to wear a mask,” said Dr. Malani. “It’s better to be safe.”
“Gyms are difficult to make completely safe,” said Dr. Malani, adding that while they are opening in some states, they remain closed in most.
“It’s really difficult to distance everyone enough there and also to prevent droplet formation because in some of the vigorous exercise that happens in a gym, you can’t safely wear a mask,” she said. “For people that have high risk, I would continue to advise that individuals exercise at home or outdoors and wait on the gym.”
While “a lot of people can’t wait to get back,” it is vital that everyone “pays attention to the preparation that’s been done in the gym,” said Dr. Malani. “Have they moved the equipment to where it’s far away? Are there barriers? Are people wearing masks? Is there adequate hand hygiene?”
Additionally, “it really has to be in a setting where there’s not a lot of community spread,” she said.
“Children need to be with other children,” said Dr. Malani. “My advice is to allow your child to play outside with other children—preferably just one child at a time.”
It is also important that parents make sure to “ask about the child’s exposure and the family’s practices,” she said. “It’s important for their well-being to have connection with other kids, but it’s also important to make sure that the other families are following guidelines very carefully.”
The children should also “be instructed to wash their hands and to not get too close to each other as much as they can avoid it,” said Dr. Malani.
People are vying for time with their families and friends. When asked about outdoor gatherings, Dr. Malani recommends that people “limit the size and make sure people can truly physically distance.”
“There have been a large number of outbreaks that have been linked to family barbecues and picnics,” she said, adding that while “it is safer outdoors than indoors,” proper preventive measures are key.
Stay current on the AMA’s COVID-19 advocacy efforts and track the pandemic with the AMA's COVID-19 resource center, which offers resources from JAMA Network™, the CDC, and the World Health Organization.