Back to Basics: Why We All Should Still Be Wearing Masks to Protect Against COVID-19

Two years after it first appeared, we are still learning how to treat and prevent COVID-19. Currently, though there is no cure, we have found that social distancing, wearing masks and frequent handwashing can reduce the risk of transmission. The newly created vaccines have been a step in the right direction as they help our immune system create protective antibodies. Though they are effective at preventing severe illness or hospitalization, they still cannot completely prevent infections.

Even those who have been vaccinated can further spread the virus, though up until recently that possibility was very low. Unfortunately, the new variant has changed all that. That is why, in order to prevent further spread of this more deadly strain, it is time to go back to the basics.

The virus that causes COVID-19 spreads by way of respiratory droplets and aerosols most commonly caused by coughing or sneezing, but also through talking, singing, yelling or even breathing. A cough can release up to 3,000 droplets traveling 50 mph. A sneeze releases about 30,000 droplets at a rate of 200 mph. The largest droplets then can travel within 6 feet, with even smaller particles or aerosols able to travel even further.

The spread of COVID-19 occurs because infected individuals have the virus in the nasal passages, the amount of which is known as the viral load. Each variant of COVID, such as the Delta variant, may have different abilities to cause a higher or lower viral load in an infected individual based on its ability to use our cells to reproduce itself. The problem is that even though we can determine the viral load through a polymerase chain reaction (PCR) test, it is not a correct indicator of an individual’s ability to spread the virus. This is why the CDC has brought back its recommendation for masking, even for the vaccinated.

We believe that as few as 1,000 viral particles of SARS-CoV-2 may be able to infect someone. However, the ability of a virus to cause infection is based on several factors. How well that virus attaches to our airway passages and once it attaches, how easily does it get into our cells and start duplicating itself. We are seeing that this ability can change based on mutations, which is why some variants, such as the Delta variant, are more worrisome. We also know that certain people are more likely to be infected because of their immune systems, the presence of chronic diseases or because of the use of medications that compromise the immune system.

It is with all this in mind that we need to consider putting the masks back on. Wearing a mask is the best way to minimize the number of droplets or aerosols you inhale and decrease your risk infection. If you are infected, either mildly or without any symptoms at all, wearing a mask can decrease the number of droplets that you expel into the air that will reach and infect others.

Other important considerations for masking and transmission have to do with your location. Outdoor settings allow more dilution of the viral particles in the air and decreases chances of transmission. Indoors, the presence of improved ventilation and a larger space also decreases the risk of transmission. With this reasoning, indoor spaces, poorly ventilated and crowded, especially with individuals not wearing masks, can increase likelihood of transmission.

When enough people are vaccinated and we reach that elusive "herd immunity", the virus will have less people to infect and eventually, and hopefully, become only an annoying backdrop in our lives like colds (endemic) and no longer surging, creating hot spots or taxing our health care system (epidemic). Higher vaccination rates mean that day comes sooner than later.