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How to decide if you should always wear a mask

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As masking mandates rise and new coronavirus infections fall in the United States, there is much confusion about whether and when to wear a mask.

“It’s the hardest thing of all, because it’s not just the risks and the benefits to you,” said Dr. Robert Wachter, professor and chair of the department of medicine at the University of California, San Francisco. Francisco. “It’s the risks and the benefits to the people around you.”

A good way to frame the problem is to ask yourself: who is the most vulnerable person in your immediate circle?

If you have compromised immunity, for example, or live with someone who does, it’s a good idea to continue wearing a mask and maintain social distancing from strangers, especially in indoor areas. with stagnant air where the virus can accumulate. Masks are also important if you are unvaccinated or hanging out with other unvaccinated people. Unvaccinated people are at extremely high risk of hospitalization and death from Covid-19. Masks are also essential in hospitals, where there are many vulnerable people.

But if you are otherwise healthy and have had your vaccine and booster shots, your risk of becoming seriously ill with Covid is extraordinarily low. This corresponds to other risks that people take every day, such as driving a car.

Many people are “weighing that they would like to get back to normal and might be willing to accept a little risk in order to achieve a level of simplicity they last experienced in 2019,” Dr Wachter said. . “It’s not irrational.”

There is also always the risk that a person will develop long Covid, even if vaccinated, although much about the disease remains unknown.

If infection rates where you live are high, which was just about everywhere during the last Omicron wave, the Centers for Disease Control and Prevention continues to recommend masks in most indoor spaces. But in many situations, the decision to wear a mask becomes a personal decision.

We spoke to experts to give you a guide to where and when it’s good to cover your face.

There is little scientific evidence showing that face coverings provide additional protection in many outdoor spaces such as sidewalks or parks. Things get a little hairier with crowds, like at a concert or gym.

“If you don’t feel the wind on your cheeks, you’re probably not in an area of ​​high outdoor ventilation,” said Dr. Asaf Bitton, primary care physician and executive director of Ariadne Labs, a center for innovation in public health. at Brigham and Women’s Hospital and Harvard TH Chan School of Public Health. “If you’re really neck and neck with people, it could be a case of wearing a mask outside, at least for now.”

Erin Bromage, an associate professor of biology who studies infectious diseases at the University of Massachusetts at Dartmouth, has helped touring music groups assess Covid risks throughout the pandemic. The main place he has seen a risk of transmission at concerts is in the standing room area near the stage.

“Where the risk is mostly concentrated are the pits at the very top of the stage where people are on top of each other singing, exercising,” Dr Bromage said.

Most outdoor concerts, however, are generally safe, he said. “If you’re standing on a lawn watching a show, there’s really no data to prove that a mask does anything to protect you that Mother Nature doesn’t care about.”

And if the venue requires vaccines or a recent negative Covid test, you’re in even better shape.

First and foremost, follow the standards and rules of the company you are entering. If the sign at the door says “Mask Required,” you don’t want to force retail employees to enforce policies over which they have no control. Their job is hard enough, and anyone can wear a mask with little to no sacrifice.

If the business is optionally screened, consider space, crowds, and airflow.

Dr. Bromage offers a cigarette analogy: If someone smoked, would the smell and taste of cigarettes quickly fill the air? If so, the virus too. You would be smart to wear a mask. Otherwise, you are unlikely to be infected.

“When I walk into a space, I always do,” Dr. Bromage said. “How high are the ceilings? Does the air move? Can I create my own small buffer space? »

Take a big box store with high ceilings. “These tend to have good ventilation and because of the high ceilings there’s a lot of dilution,” said Linsey Marr, a Virginia Tech engineering professor who studies airborne virus transmission. “The risks are pretty low unless you’re in a crowded queue waiting to check out.”

“If it’s a smaller, crowded space, like Trader Joe’s, or a New York market with tiny aisles and people really packed in, the risk is higher,” he said. – she continued. “You might want to wear a mask.”

A hair salon may be a small space, Dr Bromage said, but there will usually not be many people in the business, so the risk of someone infected passing by will usually be low, d especially as the number of cases decreases.

In a restaurant, cigarette smoke from someone at the next table wouldn’t fill the air above yours. But you would smell someone smoking at your own table, so your direct meal companions pose the highest risk, Dr. Bromage said.

The gym can seem particularly scary. Heavier breathing can expel more virus particles, but most gyms have excellent ventilation systems. (“If gyms didn’t have good air circulation, they would stink,” Dr. Bromage said.) That means any virus particles that might be floating around are also sucked in along with the sweat smell.

Dr. Bromage uses the cigarette analogy again. He had run on the treadmill without a mask, but he had put an extra treadmill between him and another runner. But a spinning class, in a small room with “people screaming, screaming, huffing huffing”? Probably not yet, he said.

Public transit is exempt from local mandates: you must always wear a mask, per federal requirements.

It’s also a good idea – on buses and subways there are a lot of strangers going in and out of a tight, enclosed space.

“It’s a place where I would probably still wear a mask,” Dr Marr said.

In planes, you must absolutely wear a mask. There is no national mandate requiring airline passengers to be vaccinated, so even if you are vaccinated, you don’t know the status of those around you.

Also, you don’t want to ruin your vacation or business trip by getting infected and quarantining, even if your risk of getting seriously ill remains low.

Public health experts agree that school mask mandates shouldn’t last forever, but they differ on whether now is the time to end them. For parents, changing the rules can be confusing.

Here are some things to consider when choosing your own family.

Children almost never suffer from severe symptoms, whether they are vaccinated or not. Many pupils have gone to school without a mask during the pandemic – such as in Britain, parts of Europe and many US states – and very few children have become seriously ill.

“The risk for children has always been lower than for adults,” said Dr. David Rubin, professor of pediatrics at the University of Pennsylvania’s Perelman School of Medicine.

The jury is still out on whether masks hinder social development. But several studies suggest that a mask makes communication difficult, inhibiting children’s ability to recognize themselves or each other’s emotions.

“Children and their schools have had to shoulder a collective burden, in large part to protect the adults in their lives,” said Dr. Rubin, who is also director of PolicyLab at Children’s Hospital of Philadelphia.

And as much of the world opens up, consider all the ways kids are hanging out with each other. Masks can stop transmission in the classroom itself, but children interact outside of school hours.

“Masks don’t work when people wear them in one circumstance, but later in the day they take them off,” said Dr. Bromage, who has consulted with schools on different mask policies. “All we’re doing is transferring the infection from school to after school.”

Also know that the United States is an exception in its devotion to pediatric masks. The World Health Organization does not recommend them for children under 5 and the European Center for Disease Prevention and Control does not recommend them for children under 12.

Covid is not the only bug floating around, nor the only one that can harm vulnerable people. The flu, for example, kills more than 30,000 Americans in a typical season, most of whom are elderly or immunocompromised.

“The flu and the common cold are probably transmitted the same way as Covid,” Dr Marr said. “If you feel a little sick, you could spread the virus through the air and pass it on to other people. You must stay home or, if you must go out, wear a mask.

A well-fitting, high-quality mask will protect you, experts say, even if other people aren’t covering their airways.

KN95, N95 and KF94 Masks are the best protection there is, just make sure they are not counterfeit. Cloth masks offer limited protection — especially if you don’t add a filter or second mask — and surgical masks are often gaping.

Here’s a Wirecutter guide to buying N95 and KN95 masks, and here’s how to spot a fake.