The events of the last few weeks have often drawn comparisons to the Spanish Flu of 1918. Then, as now, social distancing was humanity’s only real tool to slow the virus’ spread, so the measures to contain it were much the same: Travel bans, restaurant closures, government orders for everyone to keep at least three feet from everyone else.  

But take a look at some photos from that era, and you’ll notice one major difference: Everyone back then was wearing face masks. During the COVID-19 pandemic, not only are masks a rare sight in public, but health authorities in North America have often been telling people not to wear them.

Below, The Capital presents the evidence for why, given what we now know about COVID-19, we should all be covering our faces in public.   

Yes, masking isn’t a magical shield against disease

Masks obviously do something to prevent the spread of COVID-19, otherwise health authorities wouldn’t be scrambling to find enough of them to equip their staff. However, throughout the spread of COVID-19 the World Health Organization, the Public Health Agency of Canada and the BC Centre for Disease Control have all explicitly warned against civilian wearing of masks. As the BC CDC writes on its dedicated COVID-19 page “masks may give a person a false sense of security and are likely to increase the number of times a person will touch their own face.” Basically, they don’t want people slapping on a mask and thinking it’s some kind of talisman against infection; if you wander into a room full of coughing COVID-19 patients, even with a top-of-the-line respirator you will absolutely contract the disease absent other precautions such as handwashing or social distancing.

During the aforementioned Spanish Flu, US data showed that municipal masking orders often had little effect on how hard a city was hit by the pandemic, and even seemed to correlate with a higher death rate. The handmade gauze masks of the era were particularly bad at guarding against infection and it’s entirely possible that misguided wearers made the fatal mistake of using them as an excuse to go about their lives as normal.

Masks need to be used in combination with other measures

Masks may not be an infallible shield against COVID-19, but limited effectiveness hasn’t stopped health authorities from recommending all manner of other public health measures. The widely recommended flu shot, for instance, was only 58% effective in Canada for 2020, and 45% effective in the United States. Condoms are the bedrock of most Canadian sexual health programs, yet if they’re a woman’s only form of birth control she still has a 1 in 50 chance of getting pregnant in an average year. Rather than advise against these two technologies, however, health authorities have simply learned to educate people on their shortfalls: A flu shot isn’t an excuse not to wash your hands and a condom isn’t always going to stop you from getting pregnant or contracting an STI.

This is something that is done routinely in the more mask-friendly countries of Asia. Here, for instance, are the mask wearing guidelines published by Hong Kong’s Centre for Health Protection. Pamphlets published by the agency show how to properly don and doff a mask, while warning that masks have to be used in combination with other preventive measures such as hand washing, coughing etiquette and staying home where possible.  

Masking is absolutely better than nothing

In 2013, a small team of UK researchers set out to answer the question that is now roiling much of the planet: In an infectious disease pandemic, is an improvised mask a good idea? They fitted volunteers with shoddy masks made out of cotton t-shirts, had them cough and then measured what came out. Their conclusion? You shouldn’t perform surgery in a t-shirt mask but “it would be better than no protection.” A 2008 Dutch-led study that tested various face mask types determined that even if face masks were homemade and ill-fitting, in a pandemic situation they were "likely to decrease viral exposure and infection risk on a population level."

The numbers get even better if the populace is equipped with proper masks and know how to use them. A 2009 study out of Los Alamos National Laboratory found that if only 10% of the population donned a face mask during a flu pandemic, total cases would drop by 20%.

The same thing that makes COVID-19 so deadly also makes it a great candidate for universal masking

There is one singular reason that COVID-19 is proving to be way, way deadlier than SARS, Ebola or any other recent pandemics: It spreads invisibly. The virus spawns an invisible trail of asymptomatic cases who become carriers of the disease without even knowing that they’re sick. This is why we’re all effectively locked down in our homes right now: Regardless of how healthy we feel, any one of us could conceivably be the one who spews out a virus-saturated cough on the bus that ends up spawning a trail of infection that eventually erupts inside a care home or hospital.

One of the most comprehensive profiles of COVID-19 thus far was conducted aboard the Diamond Princess cruise ship. After a former passenger was found to be a carrier of COVID-19, 3,063 passengers were tested for the virus. Of the 634 that tested positive, an incredible 51.7% weren’t exhibiting any symptoms.

The BC Centre for Disease Control advises that “masks should be used by sick people to prevent transmission to other people,” but they fail to note that “sick” has a very different meaning when it comes to COVID-19. Then, this week, the World Health Organization released the stunningly reckless advice that for anybody without a fever, cough or runny nose “you do not need to wear a medical mask.” This advice might hold for earlier pandemics, but it’s wholly ignorant of the unique characteristics of COVID-19.

Among those reading this article are dozens, hundreds or even thousands of people who are “sick” with COVID-19, but have experienced symptoms no more serious than a sore throat – if they’ve experienced any symptoms at all. Without a face mask and other preventive measures, those people are just as dangerous to public health as someone running a fever of 104.

The “masking” countries are all weathering the pandemic relatively well

Some version of the chart below is near-ubiquitous on social media lately; it shows the infection curves for various countries. As pro-masking advocates note, all the places that flattened their curves (Japan, Singapore, Hong Kong) also happen to be ones where the public wearing of masks is a cultural touchstone. This oversimplifies the situation somewhat, since those places also implemented measures such as travel bans and contact tracing that was well above the levels pursued by Western governments.

However, it’s true that health authorities in the likes of Hong Kong, Taiwan and others treated public masking as a key tool in fighting COVID-19, rather than something to be resisted. One of the first public health actions by the Taiwanese government, in fact, was to ramp up mask production to ensure that every citizen could obtain at least three per week.

Supplies are indeed tight, so you’re going to have to make your own

With rare exceptions, a medical-grade face mask is going to do much more good on the face of a frontline healthcare worker than on a civilian going to the liquor store. Every nurse or doctor felled by infection is a nurse or doctor who can’t be manning the barricades as the greatest health crisis in a generation smashes full force into BC’s hospitals. If you’re a drywaller, lab technician or artist sitting on a stack of unused N95s, The Capital encourages you to immediately donate it to healthcare workers fighting against COVID-19.

However, the COVID-19 pandemic has spurred a grassroots wave of people sewing their own face masks. Indiana’s Deaconess Health System, in particular, launched a dedicated website with detailed directions on how to sew a CDC-compliant face mask to be used both by the public and by healthcare workers.

Nothing says “pandemic” like a mask

In a pro-masking column for the New York Times, techno-sociologist Zeynep Tufekci made a point that is not directly backed up by any known evidence, but is compelling nonetheless: “Masks are an important signal that it’s not business as usual.” Tufefci essentially argued that in addition to whatever biological protections it can provide, a face mask can also function similar to an “I Voted” sticker; a signal to fellow citizens that this is not a normal day and that there are civic duties they are expected to perform.

We don’t know for sure if the sight of face masks will make cause people to be more cautious about social distancing, but there is plenty of evidence to show that humans can have their behaviour dramatically altered by subtle visual cues. Posting pictures of eyes in urban areas can reduce crime by upwards of 35%. Similarly, a “we are watching you” sign placed above a bike rack can reduce cycle thefts by more than 60%. Marketers employ an entire toolkit of colour cues to make customers hungry, calm them down or reduce perceptions of waiting time.

If, like in Taiwan or Japan, every dogwalker or police officer on a North American street was suddenly wearing a face mask, it’s reasonable to assume that a lot more people would be taking COVID-19 with the seriousness it deserves.