RALEIGH — Compounding the questions of how North Carolina’s public schools will open this August is the concept of mandating the use of masks or face coverings. Parents concerned about whether their child will be forced to wear a mask won’t find any answers soon.
In both March and April, the World Health Organization said that face masks were unnecessary for healthy people. In May, a video on the WHO website titled “when and how to use masks” repeated that “there is no evidence that they protect people who are not sick.”
Videos and graphics on the WHO website advise that wearing a mask “cannot stop the new coronavirus when used alone,” and that they should be accompanied by before and after-use handwashing. This advice applies to schools, daycares and caretaker and education-related settings.
Likewise, the Centers for Disease Control and Prevention guidance for schools and childcare says that “cloth face coverings are meant to protect other people in case the wearer is unknowingly infected but does not have symptoms.” This CDC statement was echoed by N.C. Department of Health and Human Services Secretary Mandy Cohen.
During an April 2 briefing, Cohen said, “Face masks are really protecting the world from the person wearing the mask, not the other way around.” She also said people should just wash their hands and stay home.
Cohen has since reversed course, stating in several briefings that the public should be wearing masks. The NCDHHS website says now that “Covering your face is about helping others” and showing that “you are being a good neighbor and community member.”
The CDC’s most recent guidance for schools says that states’ health and school officials should “teach and reinforce use of cloth face coverings” that can be worn as feasible in “all-day settings” by students and staff. Face coverings are “most essential” when social distancing is difficult or impossible.
The guidance from the CDC also says that cloth face coverings should not be worn by children 2 years old and under or by persons with trouble breathing, or who are unconscious, incapacitated or otherwise unable to remove the cloth face covering without assistance.
If top level guidance wasn’t confusing enough, advice on masks at the state level in North Carolina is of little help to parents at this point.
In an April 30 press release, State Superintendent Mark Johnson announced that a Schools Reopening Task Force had been formed with specific goals, one of which tackles social distancing in schools.
“The need for greater social distancing is likely unavoidable until there is a vaccine,” the N.C. Department of Public Instruction said in the release. “The SRTF will help develop guidelines in partnership with NC DHHS with the goals of getting as many teachers and students back in schools as safely as possible and determining best paths forward for extracurricular activities.”
On May 14, NCDHHS Chief Deputy Secretary Susan Perry told members of the House Select Committee on COVID-19’s education working group that NCDHHS has “very high sense of urgency” about providing clarity on when schools will reopen.
When asked about a specific timeline, Perry told lawmakers, “That’s the million-dollar question.”
And it’s still the million-dollar question as the agency has yet to deliver any guidance and the SRTF has yet to meet.
When asked if Supt. Mark Johnson’s School Reopening Taskforce had met yet, Graham Wilson, director of Communication and Information Services for DPI replied in an email that, “No task force meetings have been scheduled. The group is still waiting on NCDHHS to release school health guidance.”
Guidance on the NCDHHS website is not much help to parents either, as it only echoes the CDC cloth face coverings guidance. Additionally, NCDHHS refers to Gov. Cooper’s Executive Order 138, which recommends that people wear a cloth face covering when they leave their house and might come closer than six feet to someone else.
Near the end of May, the governor added to the confusion by tweeting “A face covering signifies strength and compassion for others. Wearing one shows that you actually care about other people’s health.”
Droplets and the six feet rule
Whether to wear a mask or not is tied to the kind of mask and how effective it may be against transmission of COVID-19.
The Mayo Clinic’s website says cloth face coverings do not protect a person from becoming infected with COVID-19. The porous, breathable nature of cloth coverings inherently will not block a person from breathing in particles and air that could contain the virus. These types of masks are effective for slowing the spread of COVID-19, but only when used in conjunction with hand washing and social distancing.
The Mayo Clinic’s information lines up with both the CDC and NCDHHS, which says that cloth coverings “can play a part in controlling the spread if they are used properly” and are worn accompanied by preventive measures like washing hands and wiping down surfaces.
The point of masks and face coverings goes back to the idea purported by both the WHO and CDC that the main spread of COVID-19 from person to person is by “respiratory droplets” from an infected person coughing, sneezing, or talking. These “respiratory droplets” may land in the mouth or nose of those in close proximity.
The CDC claims that “studies and evidence” on infection control claim that these droplets “usually travel around six feet.” This is where the social distancing “six feet away” rule comes in.
This is drawn from a single report on isolation guidelines that is 13 years old, dating back to 2007. The 2007 study is in turn based on an experiment from 2003. The study clearly says that the distance of transmission is “unresolved” and that experimental studies “with smallpox and investigations during the global SARS outbreaks of 2003 suggest that droplets from patients with these two infections could reach persons located 6 feet or more from their source.”
Additionally, the study says the six feet away rule is also based on the likelihood of a host of other criteria such as velocity, mechanism by which respiratory droplets are propelled from the source, the density of respiratory secretions, environmental factors such as temperature and humidity, and the ability of the pathogen to maintain infectivity over that distance.
A 2015 study of the penetration rates of various masks showed that the penetration rate of particles through cloth masks was almost 97% and medical masks had only 44%. That study also found that, “Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection.”
A 2020 study looking at N95 masks, medical masks and “homemade” masks, currently being cited as showing cloth masks can block 95% of virus in aerosols, is only true if the homemade masks are created out of ” one‐layer polyester cloth plus four‐layer kitchen paper.” It’s also worth noting that study was published with no peer review by individuals at the “Qingdao Agricultural University” in China.
The right mask is not for the public
The WHO says that “the wide use of masks by healthy people in the community setting is not supported by current evidence and carries uncertainties and critical risks.” The WHO goes a step farther and says that only “surgical masks and respirator masks” offer the right protection.
Medical masks, also known as surgical masks, are made from a minimum of three layers of synthetic nonwoven materials configured with filtration layers in between. Respirators come in different performance levels (FFP2, FFP3, N95, N99). Respirators are specifically designed for healthcare workers who provide care to those with infectious diseases, like COVID-19 patients.
The CDC has also said it does not want the public using surgical masks or respirators: “The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.” In North Carolina, the DHHS’ website repeats this CDC guidance.