Muddled mask messaging may be haunting coronavirus reopenings

©The San Diego Union-Tribune

Geovani Droege, bar manager at Bleu Boheme, speaks to customers Marguerite Elicone and Ray Elicone as the restaurant prepares to reopen in the Kensington neighborhood on May 21, 2020, in San Diego. - Sam Hodgson/San Diego Union-Tribune/TNS

SAN DIEGO — Like the novel coronavirus itself, official guidelines about wearing face masks in public have been a moving target.

Until California Gov. Gavin Newsom issued a statewide order Thursday requiring masks, counties had different rules. Some, including San Diego, mandated them. Others, like neighboring Orange and Riverside counties, didn’t.

Officials with the Centers for Disease Control and Prevention initially downplayed the efficacy of masks; now they recommend them. Same with the World Health Organization.

While President Donald Trump doesn’t wear a mask, his surgeon general, Dr. Jerome Adams, gives media interviews urging Americans to cover their faces.

Public-health officials fear the mixed-messaging may be contributing to outbreaks of COVID-19 cases as San Diego and other communities ease the monthslong restrictions designed to slow the spread of the pandemic. County officials said Thursday they make have to pull back on r-openings after several new clusters were reported.

“We are seeing too many people with faces uncovered,” Newsom said in issuing his order, which came one day after the state set a record for new coronavirus cases. More than 160,000 have been recorded in the state, including about 10,000 in San Diego County.

The order also came as researchers here and around the world are gaining a better understanding of the respiratory disease and how it spreads. Their studies all point toward the same conclusion: Masks matter.

“Wearing a mask is not absolute protection against infection — there is no such thing,” said Dr. Francesca Torriani, an infectious disease specialist at UC San Diego Health. “But masks have proven surprisingly effective in reducing the person-to-person spread of this virus. Not so much in terms of preventing the wearer from acquiring an infection, but rather from the wearer perhaps unknowingly infecting others.”

One new study by a team of scientists at UCSD, Caltech and Texas A&M examined infection trends and mitigation measures in three of the world’s coronavirus epicenters — Wuhan, China; New York City; and Italy — and determined that face masks are “the most effective means” of preventing person-to-person transmission of the virus.

Another paper looked at the data from 172 observational studies across 16 countries and six continents and said the results indicate that mask-wearing “could result in a large reduction in risk of infection.”

And researchers in England recently published a model that shows the widespread use of masks could help prevent additional waves of COVID-19.

“Our analyses support the immediate and universal adoption of face masks by the public,” Richard Stutt, a Cambridge University researcher, told Reuters.

Even as masks have become weaponized in the nation’s ongoing political and cultural wars — Trump said last week he thinks some people wear them to signal their opposition to him — public-opinion polling shows most Americans support their use.

The Democracy Fund + UCLA Nationscape, for example, reported Thursday that 85% of the respondents in its survey had worn a mask in public during the previous week.

So how to explain the photos of revelers in the Gaslamp Quarter last weekend, most of them mask-less, standing shoulder-to-shoulder or face-to-face as they waited outside restaurants and bars? Similar scenes played out in other cities where restrictions have been eased.

The Democracy Fund survey offers some clues. It has been tracking American perspectives on the pandemic weekly since mid-March.

It reported an uptick in the number of people who are leaving the house for non-essential goods and services (from 49% to 53 percent) and in the number of people who are socializing with others outside their household while ignoring guidelines that recommend staying at least six feet apart (from 29% to 32 percent).

Some of the moving away from mitigation measures is probably due to coronavirus fatigue, and to excitement about finally being able to leave the house, said Hala Madanat, director of San Diego State University’s School of Public Health.

“Another thing we know is that some people don’t see this as impacting their lives,” she added. “They don’t know anyone who’s had it. They’re young, they’re healthy, they may be asymptomatic, and they think even if they get it, they’re not going to be very sick. That’s who you see out in the Gaslamp without masks on.”

The mixed-messaging early on, especially from the CDC, didn’t help, public health experts said.

First the agency said no, masks aren’t needed because they don’t provide any benefit. Then it said yes, wear them. They can save lives.

“Any time you do that, there’s going to be mass confusion,” Madanat said. “Some people hear the first message, but not the second. Other people hear them both but now they are less trusting, and so they are less likely to get on board with what you need them to do.”

San Diego County ordered people to wear masks in public in early May, when there were about 3,700 confirmed COVID-19 cases here and about 130 deaths.

“In general, you must wear face coverings anywhere you come within six feet of others,” according to the order. That includes while visiting stores and other businesses. While waiting in lines or riding on buses. While working jobs that interact with the public.

Masks aren’t required while in your own home or car, or while walking, running or bicycling by yourself, although you’re supposed to have one with you and use it if you come within six feet of someone who is not part of your household.

Children under 2 and residents with a health condition that prevents wearing a mask are exempt.

The order recommends cloth coverings — homemade masks, bandanas, gaiters, scarves — and says medical-grade masks, commonly known as N95s, “should be saved for healthcare workers.”

Public health experts said what many people don’t realize is that wearing a mask is more about protecting others than protecting yourself.

Jorge Flores, a server at Bleu Boheme, cleans the bar as they prepare to reopen the restaurant in the Kensington neighborhood on May 21, 2020 in San Diego, California. Restaurants began reopening for dine-in patrons on Thursday as the state and county began easing restrictions imposed during the coronavirus pandemic.

“A mask provides a physical barrier that stops infectious droplets from being generated when we talk, laugh, cough or sneeze,” said Torriani, who is medical director of Infection Prevention and Clinical Epidemiology at UC San Diego Health. “If we control the source, then transmission to others is substantially minimized.”

Madanat said she doubts most people mean it this way, but “what you are saying when you don’t wear a mask is that you don’t care,” she said. “You don’t care about other people, especially those who are most vulnerable to this disease.”

She said getting people to buy into public health directives is always a challenge, because they are about prevention, and when they are successful — when they stop something from happening, or from getting worse — the results aren’t always obvious.

“But I’m hopeful,” she said. “I’m hopeful people will see the value in wearing masks, and not see them as overly restrictive or infringing somehow on their rights.”

And people might want to get ready for a longer haul. When the New York Times recently surveyed more than 500 epidemiologists and infectious-disease specialists, more than half of them said they expect it will be at least a year before they stop routinely wearing a mask.

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©2020 The San Diego Union-Tribune

People enjoy a night out in San Diego's Gaslamp Quarter on June 13, 2020. - Abby Hamblin/San Diego Union-Tribune/TNS