June 9, 2020
For Immediate Release
Thomas Locke, MD, MPH, Jefferson County Health Officer
Jefferson County Public Health
Why should people wear masks to prevent coronavirus infection?
SARS CoV-2, the virus responsible for COVID-19 infection, has been spreading in the United States for 4-5 months. There is still much that is uncertain about this pandemic infection but it is known that the main way it is spread is through respiratory droplets and aerosols. Masks provide an effective form of “source control,” catching respiratory secretions before they can spread to other people. We have also learned that many people who have COVID-19 do not have symptoms (asymptomatic cases) or are infectious for several days before they develop symptoms (presymptomatic cases). This means that people can carry and spread the virus without knowing they are infected. This does not appear to be a rare occurrence and may, in fact, be the major way the virus is spread. Masking (to prevent spread of infectious respiratory particles) and physical distancing (to lessen risk of exposure to airborne particles) are the best currently available strategies for controlling asymptomatic and presymptomatic spread of coronavirus. Until we have something better, we have to rely on these basic strategies to prevent as many cases of COVID-19 as we can.
Do face masks protect the person wearing the mask?
Different types of masks provide different levels of protection to their users. Simple cloth masks are the least effective at filtering the air that is inhaled. Depending on their fit and the fabric type used in their construction, they do provide some filtering effect. Their greatest value is to trap respiratory droplets and aerosols that are exhaled, preventing the exposure of others to any potentially infectious particles we might breathe or cough out. Medical masks (surgical and N-95) provide more filtration and user protection from inhaled aerosols. Fit tested N-95 masks (used in high risk health care settings) offer the highest level of protection. Unfortunately, medical masks are in short supply, especially N-95 masks, and their use for health care workers and first responders is prioritized.
Why should I wear a mask that protects someone else but not me?
The coronavirus pandemic presents many unprecedented challenges. Health care workers and first responders have been asked to put their health on the line, often with inadequate supplies of personal protective equipment like medical masks. They have done this heroically and at great personal cost. More than 60,000 health care workers have been infected with COVID-19 and almost 300 have died. Essential workers have been on duty since the beginning of the pandemic, also taking risks for the benefit of others. Non-medical personnel have their part to play in controlling this pandemic as well. One thing we can all do is wear masks in indoor public places and outdoor settings, where physical distancing cannot be maintained. Some people want to look at mask wearing solely as a matter of personal risk – if a person wants to go mask free, they willingly take the risk. But it’s not that simple. If they are unwittingly infected with COVID-19, they are putting other people at risk as well. In an infectious disease pandemic, our personal choices have public health consequences.
What scientific evidence supports the use of masks to prevent COVID-19?
We are in the early stages of the coronavirus pandemic. It will likely be another year or longer before it is under control. Most scientific research on masks as a communicable disease control strategy were done for the control of influenza, including the 4 influenza pandemics which have occurred over the last 100 years. Scientific studies support the value of masks as both a source control strategy (i.e. worn by people with acute influenza infection) and for worker protection (for health care workers taking care of hospitalized influenza patients). Not all studies have shown benefit and there is ongoing uncertainty. Several recent U.S. studies have indicated that simple cloth masks are an effective source control strategy and this has led the Centers for Disease Control, the World Health Organization, and a growing number of state and local health officials to recommend masks as part of a comprehensive pandemic coronavirus control strategy.
What good is a mask directive if there are not strict criminal penalties for violation of the directive?
A community masking policy that depends on criminal penalties and punitive enforcement is doomed to failure. If we cannot come together as a community and accept the mild inconvenience of having to wear masks in public places, then we are unlikely to successfully rise to the challenge that this public health emergency presents. Masking does not have to be 100%. Some people cannot wear masks due to age or an underlying medical condition. Some people will refuse to wear masks as a political statement or to show their opposition to public health authority. Not everyone is a responsible member of society. For those who are concerned about the welfare of others and who accept the concept that the choices we make effect the health and safety of others, use of cloth masks in public is a way to protect fellow community members. When they do the same, they are protecting us. The more people who wear masks in situations where airborne spread of coronavirus can occur, the safer those places become. Even those individuals not wearing masks benefit from the inconvenience others have accepted on their behalf.
On May 28, 2020, I issued a masking directive for the citizens of Jefferson County. It gives business owners the authority to exclude unmasked individuals from publicly accessible places unless they meet one of the directive’s exemptions. I am not requiring businesses or community members to enforce this directive. I am giving them the opportunity to use this public health authority to protect themselves, their employees, and their customers. We need to give ourselves a chance to act like responsible adults and engaged citizens. Some community members cannot wear masks due to medical or psychological conditions. They should not be stigmatized or made to feel unwelcome. It is reasonable to ask an unmasked individual to put on a face covering while in an indoor environment or outdoors in close proximity to others. If they state they have a medical exemption, this should be accepted in good faith. If they refuse on ideological grounds, they can be asked to leave the private business. If they become belligerent or threatening, they are creating a nuisance and law enforcement can be called to assist. Increasingly, indoor masking will become the social norm.
Is a public health directive to wear a mask in public a violation of an individual’s right to enjoy their personal freedom?
Neither public health authority nor individual rights are absolute; they must be in balance. Public health codes exist to protect everyone (including the person who feels their rights are being violated). They balance the rights of individuals against the right of everyone to be free from a preventable health threat. A person with a contagious disease might feel aggrieved by a public health order that keeps them in isolation for the duration of their illness, but that order protects other people from being exposed and infected with that disease. In the case of masking, people are being required to protect each other. If it were solely a matter of personal risk, it would be much simpler – everyone could take whatever risk they want without effecting anyone else (like mountain climbing or downhill skiing). Public health is seldom simple. The “personal” risk you take can also affect the risk you are imposing on others. In the case of pandemic coronavirus, these risks can be substantial. A healthy young adult may feel that they can weather a case of COVID-19 without difficulty. If they spread it to an elderly relative with chronic health issues the outcome could be tragically different. For those who want to see wearing masks in public during this pandemic as yet another front in the bitter and divisive “culture war” that is engulfing America, I urge them to satisfy their need for political conflict elsewhere. COVID-19 is real, not a hoax. People are getting sick and dying. It will get worse before it gets better. Accepting the minor inconvenience of wearing a cloth mask is not too much to ask to protect community health. Refusing to wear a mask (if you otherwise don’t have a legitimate age or medical reason) is not a bold political statement. It’s selfish and self-centered.
What is the specific requirement for masking in Jefferson County?
There are three different directives that compel use of masks to prevent coronavirus transmission that effect Jefferson County residents:
1) Governor Inslee’s proclamation that covers employers and employees,
2) the Jefferson County Health Officer’s directive on mask use, and
3) the requirements of individual businesses for public access to their private business (“No shirt, no shoes, no mask, no service”).
The Governor’s proclamation requires that employers and employees wear cloth masks in indoor settings (unless alone in a separate room) and in outdoor settings where a 6-foot physical distance cannot be maintained. Enforcement is through Labor and Industries occupational health regulations and penalties are strict.
The Health Officer’s directive of May 28, 2020 requires individuals who do not meet one of its 5 exemptions to wear a face covering when in indoor public settings or outdoor public locations when a 6-foot physical separation cannot be maintained. Additionally, businesses are directed to not allow non-employees to enter or remain inside a building without a mask, except under certain circumstances.
And finally, businesses are free to set reasonable health criteria for people entering their buildings. Costco and Goodwill require customers to wear masks as a matter of corporate policy. Hospitals and clinics require patient and visitors to wear facial masks. This is a growing trend.
How do masking initiatives relate to Phase 2 and Phase 3 of the Safe Start WA plan?
The coronavirus pandemic of 2020 is still in its early stages. Outbreaks, hospitalizations, and deaths will continue until a vaccine is developed or effective antiviral medications are discovered. Washington State is attempting a phased reopening of businesses and community activities in what is known as the Safe Start Washington Plan. This reopening will inevitably increase the risk of coronavirus transmission. Jefferson County is currently in Phase 2 of this reopening plan, allowing restaurants and other businesses to partially reopen. If we are able to prevent surges of COVID-19 during this phase, Jefferson County will be eligible for further reopening of businesses, movie theatres, museums, libraries, and other community functions. Successful reopening is by no means guaranteed. The public health and medical systems have spent the last 10 weeks preparing for the increase in COVID-19 that will occur when community life resumes and summer travelers flock to the area. These systems can only react to new infections – treating disease complications and trying to limit the community spread of infection. The only thing that can PREVENT new cases of COVID-19 is widespread community implementation of the things we have learned are effective control strategies – physical distancing, masking, hand hygiene, disinfection of surfaces, cough etiquette, and staying home (and getting tested) at the earliest signs of COVID-like illness. These actions are the “make it or break it” activities that will determine whether we move forward to a reopened community or we succumb to the outbreaks and hospital surges we have tried so hard to prevent.
Those who see masking as a burdensome nuisance and something they just “don’t believe in” fail to see the severity of the situation we are in. Those who insist on seeing this pandemic through the “us against them” lens of partisan politics fail to see that there is no “them.” It’s only “us.” The pandemic coronavirus is indifferent to political ideology or social status. It sickens and kills whether we believe in it or not. Communities have come together and paid a heavy economic cost to “flatten the curve” and buy ourselves more time to respond to the pandemic. Now we are called to action and must see if we can come together as a community and successfully deal with the worst public health threat of the last century. Masking is a small but crucial part of this pandemic response plan.
Jefferson County Public Health
Always Working for a Safer and Healthier Community