Debunking Mask Myths

With the CDC’s guidance on masks for the general public changing from not recommending public use early on in the pandemic, to its current guidance that public mask wearing can indeed help prevent the spread of COVID-19, there has been confusion about the efficacy of masks, with many myths circulating online. Today, we speak to two Children’s pediatric experts, Dr. Shannon Godsil and Dr. Alice Sato, to help us debunk the myths and determine fact from fiction.

Topic Breakdown

1:49 – Wearing a mask helps protect both yourself and the people around you
4:49 – Masks can provide a false sense of security
6:55 – Best types of masks
11:11 – Almost everyone over age 2 should wear a mask — with extremely limited exceptions
14:29 – Keeping masks clean
17:23 – Masks do not cause breathing problems
17:53 – Healthy people still need to wear masks
18:54 – Masks will not make you sick
20:00: Masks with filters, valves, and vents
22:47 – How to protect children under age 2 who cannot wear masks


Transcript

Here at Children’s Hospital & Medical Center in Omaha, Nebraska, it’s all kids — all day, every day. Our pediatric experts are here to answer your questions and weigh in on hot topics, helping you keep your child healthy, safe, and strong. We’re here for you. Listen in.

With the CDC’s guidance on masks for the general public changing from not recommending public use early on in the pandemic, to its current guidance that public mask-wearing can indeed help prevent the spread of COVID-19, there has been confusion about the efficacy of masks, with many myths circulating online. Today, we speak to two Children’s pediatric experts to help us debunk the myths and determine fact from fiction.

Dr. Godsil: Hi, I’m Dr. Shannon Godsil and I am a general pediatrician at Children’s Physicians Val Verde, and I am so excited to talk about masks and mask myth-busting with you, Dr. Sato.

Dr. Sato: Hi, I’m Dr. Alice Sato. I am a pediatric infectious disease physician at Children’s and the hospital’s epidemiologist.

So we’ve been given a list of questions that people have about mask-wearing out in the community, which is a little bit different from the masks we wear here as doctors and nurses and other healthcare providers in the hospital and in patient care settings. But we want to tell you that mask-wearing is really, really important to keeping yourself safe and those around you, and keeping the rates of infection really as low as we can get them in our community.

Wearing a mask helps protect both yourself and the people around you

So the first question we’ve been asked is, “Who benefits the most from wearing a mask? Does wearing a mask protect the wearer or the people around them?”

Dr. Godsil: It protects those around us, so it’s really, really important that we are protecting everybody, especially in those scenarios where you can’t socially distance. And so the CDC recommends that if you’re around somebody who’s not in your household, you should be wearing a mask. There are especially some populations that are more at risk and should be, not only themselves wearing masks, but around others who are wearing a mask. But I have been telling my families that if you are outside of your house, with other groups of people — especially if you’re in an area like a grocery store or any kind of shopping situation — you really should be wearing a mask.

Dr. Sato: right. The idea behind wearing a mask to protect other people is that you’re catching those droplets, those mists that are coming out of your nose and mouth — both, so both need to be covered — in order to protect people around you. In medical terms, we call that “source control,” where we’re limiting or catching the stuff coming out of a person that could be infectious. But the good news is that we are learning more and more, that wearing a mask also protects the person wearing it. So it seems like the amount of virus that you are exposed to at the time you get infected — if you get a big cloud of someone else’s droplets, you get lots and lots of virus all at once — you’re much more likely to get sick. And if you think about that barrier, that piece of cloth over your nose and mouth keeping you more safe, fewer viruses get in. So even if you do get infected, it seems like you’re much less likely to be severely ill. And in some cases, like even in a meat processing plant or the seafood packing plant in Oregon, where they had their workers in masks — even though hundreds of infections were seen in those environments, almost all of the infections were asymptomatic, where people didn’t feel sick at all. So we’re learning that not only does it protect the people around you, it protects you.

Dr. Godsil: Dr. Sato, that’s so good to know, because I have had a lot of families ask me about what it does for them, as well, not about just protecting others around them, but what that means if you wear a mask — how it can protect you, potentially. And so I think — I’ve been trying to push a lot, exactly what you’re saying with — there’s so many people with COVID-19 who are showing no symptoms at all, or who have spread prior to showing symptoms, and so I think it’s so important that everyone is wearing them at all times.

Masks can provide a false sense of security

Dr. Sato: Another question that’s come up is, “Do masks provide a false sense of security?” In other words, are people not doing the other things they need to do to stay safe because they’re wearing a mask? Do they feel more bold?

Dr. Godsil: I have had some families, honestly, that have told me that when everyone’s wearing a mask, they feel more likely to be in larger groups. And I really want to encourage families to still practice good hand-washing, disinfecting all those surfaces that we’re touching, and social distancing as much as possible. There are certain situations where you can’t socially distance — you’re out in the grocery store and needing those items for home — but I really think it is important that we don’t use masks as a way to be in larger group settings or putting ourselves at risk.

Dr. Sato: I think the actual study data on this is a little bit mixed, because people who are good at wearing masks tend to be good at doing the other things, right? So, sure, if I wear a bicycle helmet, will I maybe go a little bit faster sometimes? Maybe. But also — maybe I’m someone who’s more aware of what’s around me and paying attention for cars. It’s a little bit like that.

A mask is a layer of protection. It’s like having a seatbelt, but you also want to not speed too crazy, and have good tires on your car, and you want to have airbags. So each thing is helpful. Just because I’m wearing a mask doesn’t mean I shouldn’t try to socially distance as much as possible. Just because I’m wearing a mask doesn’t mean I don’t need to clean my hands.

Dr. Godsil: Right.

Dr. Sato: So, it is a great thing to do. You hear people say, “Well if masks work, why do I need to do this?” It’s because each is cutting down your risk by some amount, and so the lower we get our risk, and the lower we get that amount of virus coming into our eyes, nose, and mouth, then the safer we are.

Best types of masks

Dr. Godsil: We’ve been asked about specific types of masks that people can wear, right? What is the kind of mask that people should be wearing or looking to wear?

Dr. Sato: We don’t recommend N95s for people in the community. They need to be fit — that’s a very trained thing to use. People need to be able to wear them, and frankly, they’re not very comfortable. So they are not as useful as you would think in most normal situations, where you’re not taking care very closely to someone who’s sick.

Dr. Godsil: The CDC continues to say that those surgical masks and those N95s are still critical for healthcare workers and in dire need — so we are recommending, and I’m telling my families that, those are hopefully just saved for us. And really to utilize the cloth masks — especially at school and out in public.

Dr. Sato: People have done studies now, looking at different types of masks, and you may have seen some of this go around on social media and such. The good news is that a double-layer cotton mask really seems to keep the spread of droplets — there was one study that looked, remember, we talked about source control — how much virus is spewing out of the mouth and nose of somebody who might be infected. Without a mask, you can see stuff going feet away from them. A really good cough or sneeze actually goes even further than those 6 feet. It can go 8 feet.

If you put on a bandana, which I do not recommend, if you think about wearing a bandana like you’re a cowboy or an old-fashioned bank robber or something — that flapping of the bottom of it does not keep it well-fit to cover stuff spewing out of your mouth while you’re talking, coughing, sneezing. While it catches a teeny bit, it doesn’t keep that wave of — causing the bottom of the bandana to fly out in the breeze and stuff can still travel out a couple feet. But if you wear a two-layer cotton mask, and that can be with ear loops or that can be with ties that go around your head, as long as you get a really good fit — that can decrease the spread of droplets coming out of someone’s mouth to two and a half inches. It’s really, really good.

Dr. Godsil: Yeah. I think what’s great is, like you said, Dr. Sato, there’s been so many new studies that — they’ve been really trying to post on social media so that you’re getting the visual of what those respiratory droplets look like. I think that’s so important to know, that there are certain covers that aren’t doing the job in order to keep us safe and not spread those droplets.

Dr. Sato: At the same time — if you think about, if I made one out of lace, that probably wouldn’t work very well, right? Even if it’s fit closely over my face, if it’s a wide crochet, that’s not helping.

There was one test of concept paper that got pushed out into the media that suggested that neck gaiters were not a good idea. That particular neck gaiter, according to the description, was made out of a fleece material, so it was maybe not the best material to make it out of. Unlike a bandana, the bottom of that neck gaiter comes all the way down, and would do a better job of catching stuff coming out from your nose or mouth if you were to cough or sneeze.

So I think that a neck gaiter is not necessarily a bad idea. Some kids find them easier to keep track of because they’re around their neck and they won’t lose them. And so I wouldn’t write off neck gaiters all together based on one test on one fleece neck gaiter.

Dr. Godsil: That’s great to know, because I was trying to read a little bit, because I have had some patients ask me about that. Because they said that their kids feel a little more comfortable with the neck gaiter and feel like they’re holding onto it a little bit more, since it’s wrapped around them, almost like a scarf.

Almost everyone over age 2 should wear a mask — with extremely limited exceptions

Dr. Sato: We have also been asked — mask mandates are currently in effect in Omaha. Those are always changing on a day-to-day basis. I would argue that you should wear a mask when you’re not at home as much as you can, and that’s what I do, that’s what my kids do and their dad who teaches does. We recommend them whether or not there is a mandate in place.

The current Omaha mandate is for people ages 5 and above. But the American Academy of Pediatrics supports masking for children who can tolerate them above age 2.

Dr. Godsil: I’ve been saying the same thing, Dr. Sato. I have been telling my patients that although Omaha has a recommendation for 5 and above, my recommendation and our recommendation from the American Academy of Pediatrics, is 2 if they can tolerate it. And I have seen a number of my patients — even 18 months and above — who are tolerating it well.

Dr. Sato: Right. So, the worry with the younger kids, is that they would not be able to take their mask off if they needed to. There are situations where you don’t want to necessarily have a mask on, like if you are out in water, you wouldn’t want something that you couldn’t get off easily if it were to get wet. Because obviously a very wet mask would be difficult to breathe through.

There are very, very few health conditions that make it not possible to wear a mask. If you had a facial burn, obviously it would be hard to wear most masks. So a face shield might be an alternative in that situation, to at least give you some protection.

Remember — everything is to decrease your level at risk, so we do as much as we can in any situation. If you think about our cystic fibrosis patients, with their very bad lung diseases, some of them — we actually have them wearing medical masks when they’re out and about on a regular basis. Because it protects them from getting infected. So, even children with very bad lung disease have done great with wearing masks. We have our cancer patients wear masks on a regular basis if they have to go out. If you have really more severe illnesses, then avoiding going out is really obviously your greatest level of protection. But almost everybody can wear a mask and wear a mask safely.

Dr. Godsil: I agree with this as well, in the sense that we have had parents contacting us and asking for letters or exceptions. And just as Dr. Sato had mentioned, there’s very limited populations of children that would need an exception, and so I personally have not written any letters. And I’ve had a lot of my patients practice prior to school starting or just having the option of doing remote learning if there are true concerns. But I do feel that most children can tolerate them very, very well, if not all.

Keeping masks clean

Dr. Sato: So, in terms of mask cleanliness — obviously if you have a child who’s likely to chew on their mask or is coughing a lot — well, if they’re coughing a lot, hopefully they’re staying home. But if their mask was to get dirty, we would want them to change it.

And I think about it like — I had a child — one of my children had trouble learning about using the bathroom at the right time. And so, we always sent at least one extra set of clothes in his backpack every morning until that issue resolved. And I would say it’s kind of the same thing. I would pack an extra mask or two for your child and yourselves when you go out. I always make sure that I have at least two or three masks for myself when I’m going out to the store, because something could happen to the mask that I’m wearing and I might need to change it or want to change it. So I have a bag to throw the dirty one in and I have a new one in a clean supply bag.

I think that with some children — and you will know your children best — some of them are going to need to have a few on hand to be able to change them out during the day if they get soiled, if they get wet, anything like that. My youngest ran around outside a lot this summer doing different things with the mask on, and sometimes we’d get mud on a mask, so we’d change it.

Dr. Godsil: I think it’s great to have multiples, especially when you’re going out, having at least two with you or at least a set of clean ones in your vehicle. Because if you are going anywhere, at least you’ll have a stash in your vehicle.

But I agree that — I talk to most families who say that they have packed several in the children’s school backpacks. There’s definitely some brands out there who even have — even the name of the day on the masks so you have one that you remember for each day. But they do need to be washed at the end of the day. The CDC has great recommendations for washing of your cloth masks, and they do say that you can wash it in your laundry. You just want to make sure that it’s in that warmest temperature and that it’s the warmest dryer temperature, as well. And if you choose to wash it by hand, that you’re using either a third of a cup of bleach — that’s disinfectant bleach — within a gallon of water, letting it soak for five minutes. And then, either letting it air-dry flat — ideally in the sun — or air-dry. But there’s definitely a lot of ways that — you can just throw it in the regular laundry and have it be okay. But it definitely needs to be washed at the end of the day.

Masks do not cause breathing problems

Dr. Sato: So, we have some quicker facts we’re going to try to go through here. Some quick questions we were asked. “Is it true that wearing a mask can introduce new respiratory issues for an otherwise healthy person?”

Dr. Godsil: No.

Dr. Sato: Right, it’s very safe to wear masks. We have some of our more delicate patients wear masks, and we are not worried about them causing problems for people who are otherwise healthy.

Healthy people still need to wear masks

This one’s a bigger question, I think. “Is it true that I only need to wear a mask if I’m sick?”

Dr. Godsil: The answer is no. The answer is no for that, as we were talking earlier, that sometimes you don’t know whether or not you’re carrying COVID-19. So it’s really important that even if you’re having no symptoms at all, that you’re still protecting others around you and yourself by wearing a mask.

Dr. Sato: I think this caused a little confusion early on. We thought this was going to be like the first SARS, back in 2002 and 2003, where people really weren’t shedding the virus until they were feeling sick. We have learned that, unfortunately, with this virus — though it’s very closely related to that first one — that many people can spread this virus before they feel sick or they never feel sick and they can still infect other people. Which is why masking has become really a focus in terms of protecting others and protecting ourselves.

Masks will not make you sick

Dr. Godsil: The next question is a question honestly that I have gotten in the office. “Is it true that wearing a face covering prevents the flow of oxygen, or that carbon dioxide gets trapped in the mask, making the wearer sick?”

So, even though those respiratory droplets are very small, the good news is that oxygen and carbon dioxide molecules are even smaller. And so those can pass through the mask safely. And so we’re able to get oxygen moving back and forth, through that mask, safely. So you should not be trapping any of that carbon dioxide once you exhale. Even though we are trapping — hopefully trapping — all of those respiratory droplets within the mask, you are not trapping those molecules that we need in order to breathe safely.

Dr. Sato: It can get a little getting used to, especially if you’re working harder to run around. It can take a little practice to figure out how to be comfortable and what’s the most comfortable mask.

Masks with filters, valves, and vents

“Is it true that investing in a mask with a filter insert can protect my family even better than a regular cloth mask?”

I guess my answer is possibly or probably. It depends on what the rest of the mask is doing for you. Many people have added a layer — so they’ll have a mask that has a pocket and they will add in a layer of paper towel, because that is a non-woven piece of material, so that it maybe has a little bit less in terms of open spaces between the fibers. Or, some people use a coffee filter, the same idea.

The one thing I would really caution against doing is cutting up a vacuum bag because you don’t know what you would be inhaling from the edges where you have cut from a vacuum bag. And really, it’s so thick, some of those bags, that what you are doing is breathing around — and not through — that filtering layer. If I put a piece of plastic inside my mask, I would certainly not breathe anything through the piece of plastic. But all my air would come from around it. So if it gets to be too great a resistance to airflow by adding something inside your mask, then that can cause you to only use the parts of the mask to breathe around it.

Dr. Godsil: And I’ve also had families ask me about exhalation valves or vents. And the CDC does not recommend that you use a mask with a valve or a vent in it.

Dr. Sato: Right. So those are designed to make it easier for you to breathe out through a mask. Like if you were working in a dusty environment, no one’s worried about you breathing out into that dusty environment. But those masks are designed to only avoid stuff coming in and not stuff going out. So it might be appropriate to use something like that in some situations, but in terms of what we’re trying to achieve here with the virus, that’s not doing our source control we want. It’s not keeping your respiratory droplets from getting out into the environment around you. And if you don’t know you’re infected, still potentially infecting someone else.

Some people get around that by putting another mask over it, a thin layer over it, to catch anything coming out of that valve, if that’s the mask you have. Some of them are closeable, but most places don’t want to deal with trying to figure out if you’ve remembered to close yours or not. So you may be asked to use a different style of mask.

Protecting children under age 2 who cannot wear masks

Dr. Godsil: Is it true that children under the age of 2 don’t need to wear a mask?

By the American Academy of Pediatrics’ recommendations, we are saying that it’s children 2 or above who are needing to wear a mask. One of those reasons is kind of what we talked about — that a lot of times, kids under 2 aren’t able to take off or put on the mask themselves. And a lot of times, it’s difficult for them to keep it on because they’re tending to play with it a lot of the time, and that’s what we’re trying to avoid as much as possible, is touching the mask.

So if your child can tolerate it, even if they’re under the age of 2 — say 18 months, 20 months, — great. But, again, the recommendation is 2 and above.

Dr. Sato: I would say that with younger children, you want them supervised while they’re wearing a mask. Even your 2 year olds. Just to make sure it remains safe.

What else can you do?

If you are carrying a child in a baby carrier or seat through a busy area, you might want to drape a light fabric over it while you carry them through a crowd, for instance. So they don’t have to be unprotected. Obviously, you’re going to try to keep social distancing on behalf of your younger children. If they are an older child who can wear — some people have bought hats with almost a piece of shower curtain hanging off the front, or some sort of face mask. Again, I would pay very close attention to whether they can breathe comfortably under that and that it’s not getting too close to their face if they’re using a shield.

But in general, what we try and do is limit their exposure to other people. And work on that social distancing piece — which will be the most important way to keep them safe. And sadly, not handing them off to everybody. A lot of, you know, friendly hugs and snuggles from people outside your family unit-bubble.

Dr. Godsil: Agreed. As hard as it is, I’ve had to tell families that your household, your family bubble, is your new crew. So you’ve got to get the snuggles from them, but you’ve got to wait on everybody else and do a lot of waving and virtual hugs.

Dr. Sato: Thanks for listening. We really appreciate you spending your time with us. We hope you found some of these answers helpful.

Dr. Godsil: And thanks for all that you’re doing to keep us safe, Dr. Sato. And thank you families for keeping us safe, and hopefully, we’ll continue to get through all this together.

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