The two hair stylists in Springfield, Mo., broke the cardinal rule of infection control: Despite having respiratory symptoms, one went to work and saw clients for eight days, when she learned she had tested positive for Covid-19. Her colleague also developed symptoms, three days after her co-worker, and also kept working until she tested positive, two days after the first stylist. Together, they saw 139 clients, with appointments for haircuts, shaves, and perms lasting 15 to 45 minutes.

Yet when the local health department identified and contacted the 139 clients, asking them to self-quarantine for 14 days and checking in daily about whether they had developed Covid-19 symptoms, not a single one (of the 104 who agreed to be interviewed) did. Of the 67 who consented to a swab test, every one tested negative. There was one other notable fact about the case: Both stylists and every client had worn a face covering.

The stark case, described on Tuesday in Morbidity and Mortality Weekly Report, adds to the near-universal scientific consensus that, more than any of single action short of everyone entering solitary confinement, face coverings can prevent the transmission of the coronavirus that causes Covid-19.

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“Like herd immunity with vaccines, the more individuals wear cloth face coverings in public places where they may be close together, the more the entire community is protected,” Robert Redfield, director of the Centers for Disease Control and Prevention, and two colleagues wrote in an editorial in the Journal of the American Medical Association, also published on Tuesday. Because cloth face coverings can also allow states to more safely ease stay-at-home orders and business closings, Redfield told a JAMA Live webcast Tuesday, “If we could get everybody to wear a mask right now, I really think in the next four, six, eight weeks, we could bring this epidemic under control.”

The “if,” of course, has been the problem. Because masking or refusing to mask has become a political statement, only 62% of Americans said in April that they did so (the CDC recommended the practice on April 3); in May, 76% said they did, according to another MMWR study. The CDC advice followed weeks of mixed and contradictory messaging, and even after it was issued, President Trump and other national leaders fell well short of endorsing face coverings.

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Although mask wearing does not differ by gender, it does vary by region of the country. In May, 87% of people surveyed in the Northeast said they wore masks when going out in public; it was 80% in the West, 74% in the Midwest, and 71% in the South, where cases are skyrocketing.

Face coverings almost certainly explain why the Springfield hair stylists did not transmit the virus to a single client. Of the 104 clients surveyed, 102 said they wore a face covering (usually cloth coverings or surgical masks) during their entire appointment; two said they did for part of it. Both stylists were always masked.

The benefits of masking in reducing viral transmission are clear from much more than the unusual case of a Springfield hair salon, of course. In an unpublished analysis of 194 countries, those that did not recommend face masks saw per-capita Covid-19 mortality increase 54% every week after the first case appeared; in countries with masking policies, the weekly increase was only 8%.

And at the largest health care system in Massachusetts, Mass General Brigham, before administrators adopted a policy of universal masking for health care workers in late March, new Covid-19 infections in that population were increasing exponentially, from 0% to 21%, or 1.16% per day, on average, researchers reported in another JAMA paper published Tuesday. With everyone masked, the rate of Covid-19 in health care workers fell to 11.5% by late April, dropping 0.49% per day, on average.

In his editorial, Redfield made not only a public health case for face coverings but also an economic one. Citing an analysis by Goldman Sachs Research, he and his colleagues noted that if masking increased 15%, it “could prevent the need to bring back stay-at-home orders that would otherwise cost an estimated 5% of gross domestic product, or a projected cost of $1 trillion.”

“Broad adoption of cloth face coverings is a civic duty,” Redfield and his co-authors wrote in their editorial.

  • During WWII the Fed commandeered all business and industry for war production. Why isn’t it forcing production of enough N95 masks for everybody to be safe? NOBODY disputes the ability of an N95 to stop virus.
    The masks you are wearing were NOT designed for it. And don’t hand me that horse-radish about droplets and particles. Anything small enough will pass through under the right circumstances. COVA19 is 11 billionths of a meter in diameter; a water molecule is 3 atoms in size.
    Your mask gives you such a false sense of protection that you are ignoring the prime directive of all agencies: DISTANCE. Look around you; I see it all the time.
    Mitch McConnell just announced that “The single most important thing to do is wear a mask “. This is blatent misinformation. Distance is the surest way to stop spread. Perhaps he’s changing the order of priority because businesses can’t operate under distancing. Senator McConnell will reopen them….and at our expense. Or possibly he just doesn’t know any better.
    Please don’t put faith in surgical masks or less. They weren’t designed to protect anybody from virus. Push your representative for a mass supply of appropriate protective material

  • If you look back to the Beijing Olympics the Chinese have been wearing masks for various reasons for a long time so getting used to them is not an issue anymore then getting used to seatbelts. I owned some major performance cars in my last some without seatbelts and yet today I wouldn’t think even once of jumping in a car without one
    I totally agree about the quality of masks and proper wearing but even a poorly fit poorly made one worn poorly is better then open transmission of viral load
    We need as a society start to accept things as they are or will be and not look to find righteous indignation why we shouldn’t be made to comply
    No one is forcing anyone to do anything in their own home but to live outside amongst others in a community we ALL must accept some loss of choice and freedom for the better good of everyone the options are death or find an island with folks who assimilate your ideals and move there. As I have said since the first bombing of the World trade center no one is forcing anyone to stay here but if you do then you agree to live in accord.
    Dr. Dave

  • Masks are a tool, and just like any tool they can be well made and suited to the task at hand or not. They can also be well fitting and worn properly or not.

    Some of the masks being worn are HORRIBLY thin which limits their protection. Others are worn in ways that leave large gaps, noses exposed, etc…

    And then there are those who refuse to wear them. We have had impromptu street parties in some areas of our inner city with 200-400 people partying at a time. Care to guess where the majority of the cases in our County are located? People are their own worst enemy and the enemy of the rest of us. That is never going to change.

    Now, how would any such mask order be enforced? In reality they cannot even be enforced now where they already exist because there is no legislation / no ordinances that make not wearing one a crime. And, given all of the protection we give to people regarding their medical history even if there WAS legislation in place all one has to do is to say that they have a medical condition and all is forgiven. No proof required because that goes against privacy laws.

    We are also already seeing violence against people who try to even politely correct someone who is not wearing a mask or not wearing one properly. That is only going to get worse, not better.

    Do I, as someone who serves as a volunteer in the EMS community, always wear one? In places where they are required yes. In some locations within my professional work environment no. It is hot, humid and dirty. The glasses fog up, it is uncomfortable, and it can be hard to breathe. Do I wear them outside? No. I keep my distance.

    Long story short yes, I agree that masks help. To what extent….I believe it is HIGHLY variable, and people are still doing foolish things when they can which circumvents anything they do right. People are also going to tire of wearing masks. Does anyone really thinks wearing them will be tolerated for another 6 months or for even longer terms if the vaccines fail to provide protection? Not likely. It just isn’t human nature….

  • I would like to also say -this may sound backwards, hear me out – maybe one lesson of this Wuhan epidemic is, we need strong public health voices, people who can not be squelched by any elected official or anyone else- but maybe even more important – strong CONTRARIAN public health voices.

    I understand medical doctors try to apply “Standard of Care”, where best practices are identified and then clinicians implement them, which is a complex task considering all the factors which must be considered.

    All the public health people come from medicine – well, you got Masters of Public Health but they are never the top boss- maybe we need some people who will not wait for consensus, and not stick to their own baliwick.

    So, for example, when New York resisted face masks and shelter in place and such- suppose the Top Doc – the head of public health – in say Connecticut – felt no political inhibition, stood nothign to lose, by piping up and saying “Cuomo and deBlasio are wrong, they need a lockdown last month” ??

    It could add to chaos with public health people disagreeing, but I think we saw Dr. Fauci, a great and brave man, risking his life to fight this epidemic, but not making all the right decisions early on, maybe too conservative, being an advisor but not really an independent voice- we can not depend on one person – and we can’t leave ourselves so vulnerable to people doing the wrong things, as we did, or so it appears.

    The failure of the mass media should also be mentioned – running around the country searching for grievance stories, with no investigational of educational journalism, which would have enabled, as the least, intelligent people to prepare on an individual basis, being done.

  • Pretty interesting thread here. The two most common arguments are either that a medical issue is somehow a political issue and that a scientific issue should be directed not to the majority but to the outlier group.
    For over 30 years I have gone a lecture to all incoming residents at one of the largest multi-hospital universities in the Northeast and the title is ”There is no Yeah, but only an occasional No, because”
    American people prefer to attach to the outlier groups than to the typical meaning we look for zebras not horses. Ready g the thread more of you prefer the one-off publication of ”masks don’t work” as opposed to the plethora of publications that say absolutely they do. Why is that? I can’t actually tell you because it is unique to our nation. When we teach foreign grads they usually accept the typical and look for the most obvious whereas the American students prefer to look for all the reasons that something can’t be the cause or won’t work.
    The Southeast Asians pretty much said from day one ”we don’t want this disease in our country how do we keep it out and under control?” They implemented mandatory masks isolation protocols and even connected mobile apps to track people’s movements so if someone was tested positive they could track back to the people who came in contact. Americans went ballistic when Apple and Google suggested this later options as being viable.
    Time we stop looking for reasons to not be personally responsible for everything and stop blaming others included elected officials for our situation
    If the WH or Congress had gone in any other direction the news would still report they screwed it all up, when in reality this is biology 101 viruses move about thru human contact don’t contact, don’t spread period!

  • “near-universal scientific consensus.”
    Whenever someone plays the ‘scientific consensus’ card, you know they’re FOS. Consensus is the opposite of science. How about we agree that there is a near-universal political consensus (on the left)?

    • Doug,
      Your statement is rude with the “FOS” part, but also totally nonsensical.
      You are aware that if you buy textbooks for college science classes, they all say pretty much the same things about hundreds of questions in science, right?
      You are not going to have disputes about the chemistry of photosynthesis, how genetic mutations occur, that a meteor impact caused a tremendous number of extinctions, and on and on and on – so, there IS consensus among scientists about many things.
      I am not sure about face masks preventing the Wuhan virus, but these scientists, who talk to a lot more scientists than I do, probably know how they feel.

    • Why is it so much more important that you stand behind the poor decisions of the WH even when it’s costing people their lives and ruining our economy? You’re stand makes no sense, and just reiterates how selfish and stupid trump supporters are.

    • I am not sure if you were commenting to me or the OP, but either way, I do not understand your post.
      Anyway, to me, the White House has screwed up very badly – I am not a lawyer and do not know all the legal options, but I would have done what it takes to get better PPE to the public – but maybe they did, I do not know.
      I would have started a White House YouTube account which would teach people how to make masks and hoods – and it is a bad thing that we need that , because if we had good PPE we could buy, obviously, it would not be needed, but i would do that.
      Trump’s overt resistance to mask wearing is terrible. And the shutdown was terrible mismanaged in other ways – done right, we would be where Germany is now, maybe – mostly emerged from the epidemic, though needing to remain very cautious to ensure it does not come back – vastly better than we are now.
      I believe also the vaccine development should have included human challenge testing and much faster approval times.
      I would also radically streamline medicine approvals – antibodies, antivirals, and so on – I would suspend IRB approvals and have a Federal board, slanted towards approvals of everything with a good theoretical basis, to permit studies of all types – medicines, vaccine challenges, etcetera. If a study was approved by my hyper aggressive board, the maximum liabilities for study participants alleged harms would be limited and paid for by the Federal govt.

      I can go on and on – but the point is, Trump screwed this up.

      However, some of the criticisms of his supporters causing the epidemic are flat out wrong:

      1. The mask wearing – NOW, mid July 2020, that is very destructive to efforts to contain the virus- but applying strict rules to place which had very few cases early on was excessive.

      2. The shutdowns – ditto for some of them.

      3. Two wrongs don’t make a right, but New York, City and State, resisted most of the public health measures which clearly made sense from the beginning – they did not shut down- both Cuomo and deBlasio resisted it, and gave, I would say ‘”Selfish and Stupid” reasons for doing so.

      Later studies show very clearly, the epidemic largely spread from the East Coast, with New York as the epicenter, to the rest of the country . Blame Trump for what he did wrong, but recognize there is plenty of blame to go around.

  • Isn’t it also interesting that the two hairstylists wore a mask but still were able to come down with the virus. Why is there no information about how many of the people that test positive, wore face coverings and still were infected.

    • Well, they didn’t catch it from their customers… Which means they probably caught it somewhere else… You know, somewhere else where they weren’t wearing a mask perjaps.?

    • I really, really, really want to believe the story of the two hairdressers will be representative – because that means, if I wear my mask correctly and stay away from anyone who does not, I am very safe – I can have a life – the country can recover – all is beautiful about it – BUT – BUT – how do I know these two people were at all representative? I read about superspreaders, maybe these two were supercontainers? supersupressors?
      I would really like to know. And know their symptoms – maybe they almost never coughed – so I will avoid coughs more than other exposures to people, if that is what spreads it . Precisely what type of mask did they use?
      We need more info.

  • So does that mean that the back-stabbing, two-faced members of the White House staff we’ve all been reading about for the last 3.5 years…ought to be wearing TWO MASKS?

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