Are face masks forever?
Face masks became part of our "new normal" this past year. They became such a part of our culture that companies began offering them in various shapes and sizes, and even in fun, fashionable patterns for both kids and adults. But as more people get vaccinated—and it seems like life could eventually go back to normal—one question remains: Is it really time to get rid of our masks?
Some experts say not so fast.
"I wouldn't throw masks away just yet," says Carlos Oliveira, MD, Ph.D., a Yale Medicine infectious diseases specialist. "There could be spikes in [coronavirus] transmission for a variety of reasons. And there is still a lot we don't know, especially as the new variants continue to emerge and enter the U.S. It's still unclear whether these variants will cause more breakthrough infections." (In this case, "breakthrough" refers to COVID-19 infections occurring in people who are vaccinated against the disease.)
Sheela Shenoi, MD, MPH, a Yale Medicine infectious diseases specialist, adds that even as COVID-19 cases are declining in the U.S., rates of infections and deaths are still high in other parts of the world. "I hesitate to say that we are approaching a post-COVID world when so many are still being ravaged by this virus," she says. "If there is anything we should have learned in the past 16 months, it is that we are all interconnected; what happens in one part of the world affects everybody."
Even if COVID-19 numbers start to plummet everywhere, doctors say it might be a good idea to consider wearing the masks that offered protection from SARS-CoV-2 to reduce transmission of other viruses, like seasonal flu and the common cold. Masks can also be used as a barrier against the pollen that causes those miserable seasonal allergies.
Should you keep wearing a mask to protect against COVID-19?
Many people were confused when the Centers for Disease Control and Prevention (CDC) said vaccinated people can resume most activities without wearing masks both indoors and out (while following local business and workplace guidelines). The new guidelines also opened things up for those who are not vaccinated—it's now OK for them to go without masks outdoors when they bike, walk, or run alone or with other members of their household.
The update doesn't mean the CDC has given anyone the right to insist on living mask-free—there are still guidelines in place, especially for those who are unvaccinated. What it did was give many grocery stores, employers, and others the ability to make their own rules. "A lot of people were caught off guard," says Dr. Shenoi. "I tend to be on the cautious side. I'm still wearing my mask inside at stores and at work because I'm interacting with people, and I'm not sure if they are vaccinated."
Research done this past year shows that masks offer some level of protection. For example, one study from the CDC showed that, within 20 days of the implementation of mask mandates, there were significant declines in COVID-19 case counts and deaths in the areas that made the ruling.
Both doctors say they are wearing masks alongside their children when out of the house, since they are too young to be eligible for a vaccine. Dr. Oliveira says his greatest concern is for children exposed to adults who could be infected, since the majority of infected children got COVID-19 after exposure to an infected parent or other adult. Also, he suggests doing whatever you can to limit a child's exposure to unvaccinated people. "My advice—if your children can't get the vaccine by the time school starts—is to make sure they are with immunized people outside of school," he says. "Try to get everyone in the family who can get the vaccine to get it."
Karen Jubanyik, MD, a Yale Medicine emergency medicine specialist, is also careful to wear a mask around people who have compromised immune systems, whether they are elderly, or taking immuno-suppression medications, or if they are an organ transplant recipient or have a condition such as cancer that affects the immune system.
"The vaccinations weren't well tested in those populations, and we remain concerned that the vaccines might not be as effective in them," Dr. Jubanyik says.
Anyone trying to decide whether or not to wear a mask might also consider two other factors: the potential for breakthrough infections and geographic location, Dr. Jubanyik says.
"Even the best vaccinations are 95% effective, and that's good news for any given person, but across 350 million people in the U.S., that's still a lot of potential infections," she says. "That means you have to know the status of where you are and where you're going. There are pockets in this country and entire other countries where there aren't many people who are fully vaccinated and infection rates are high. I think it is important to realize it could be potentially dangerous to you, as well as other people, to not wear a mask."
Can your mask protect you from colds and flu?
Experts believe mask-wearing—along with social distancing, handwashing, and other preventive measures—made the 2020-21 flu season one of the mildest ones in memory. While the numbers are still being finalized, records thus far show that only one child died in the 2020-21 flu season compared to 195 the previous year.
In addition to getting a flu shot, masks provide useful protection against colds and flu, which could soar as people return to their normal activities, doctors say. "More typical viral infections have already started re-emerging," says Dr. Shenoi. Cases of respiratory syncytial virus (RSV), a common respiratory virus that can be serious in children, immuno-compromised, and older adults, is already ticking upwards in some places in the U.S. "It's problematic because we are still in the COVID-19 mindset, so anyone who is sneezing or has a runny nose may think they need to get tested for COVID-19," she says. "It's particularly hard for parents. Under normal circumstances—before COVID-19—kids would have a sniffle going on from November to March, and we knew to expect that."
Dr. Jubanyik also urges adults to consider wearing masks during flu season this year if they are at risk for or interact with people who are vulnerable to complications from the flu. "Because the flu hits you all of a sudden—you may feel fine even though you are potentially contagious, then all of a sudden you have a fever of 102," she says. In fact, Dr. Jubanyik has long worn surgical masks on airplanes during flu season and carried extras to offer people sitting around her. "Usually about half the people take me up on my offer," she says.
If the flu is circulating in your community—and your community is allowing people to gather—she recommends wearing a mask in the grocery store, and at concerts, movies, sporting events, and other busy venues. "While you might not need one on a hiking trail, you might consider it in any situation where people are crowded indoors," she says.
Can a mask help cut down on allergy misery?
Prior to COVID-19, few would consider wearing a mask to limit allergy symptoms. But, "Masks provide significant protection from airborne pollens in people who suffer from allergies," says Florence Ida Hsu, MD, a Yale Medicine allergist. She says that her patients have found wearing masks while outdoors to be helpful in decreasing seasonal allergy symptoms such as sneezing, runny nose, and nasal congestion, even though the CDC has relaxed its mask guidelines for people who have been vaccinated.
"I absolutely recommend considering face masks when spending time outdoors, particularly on windy days—as well as wraparound sunglasses to decrease the chances of getting pollen in your eyes," Dr. Hsu says. "As a side note, pollen in the eyes can lead to nasal symptoms—not just ocular symptoms—since tears carrying allergens can get into the nose through the tear ducts."
Dr. Jubanyik specifically advises wearing a face mask when you or a neighbor are using a lawnmower or leaf blower. "My husband has significant allergy problems and he finds that wearing a mask when he's doing yard work is very protective," she says.
Making a personal choice about masks
If COVID-19 cases continue to decline, it's unclear whether mask-wearing will continue as a public health strategy in the U.S. Some doctors point out that masks are now part of the culture in some Asian countries. There the habit took hold after the region was hit hard by severe acute respiratory syndrome (SARS), which led to more than 8,000 infections and almost 800 deaths in 2002-2003.
But Dr. Shenoi is not sure if that will happen here in the U.S., where individualism prevails, as a way to better manage diseases like the flu. "I'm not sure it has sunk in how interconnected we are—that what one person does affects the next person, affects the neighborhood, affects two people down the chain—and all that can have consequences," she says.
At the same time, maybe COVID-19 has led some Americans to think about masks in a new way, Dr. Shenoi adds. "Now that we've lived through this, I think masks are much more familiar to us. We know how easy it is—how straightforward it is—to wear a mask. We've learned that this is doable."
However there are still unknowns surrounding COVID-19. Unanswered questions include: What is the potential for outbreaks and new variants of the virus? Could masks help in those cases? Should people worry about the rare infections in people who have been vaccinated or partially vaccinated? How long will the vaccines protect us? What will happen in the fall when children go back to school and families gather for the holidays?
"There's nothing that's 'safe'—it's always 'safer." If you are fully vaccinated, it is safer than it was a year ago to be around people without a mask," Dr. Oliviera says. "Maybe after another full winter, we can say with more confidence that for COVID-19, the mask can probably go away—it we want it to."