Julie Vomund started wearing a mask before most of her friends did. She’s a 15-year survivor of Hodgkin lymphoma, and the cancer left her with lingering heart and lung issues.
Vomund knows if she contracts the coronavirus, she could die. That’s why she’s been locked inside her house since spring.
But seeing people wear masks to protect themselves and others in recent weeks has made her more confident about leaving her home.
“Now that the city is really starting to wear masks, I see it everywhere,” she said. "It made me feel safe."
Face masks are hot, itchy and awkward. But wearing one is among the best ways to help keep the coronavirus from spreading. Doctors and public officials have been pleading for people to wear them in public for months, and in early July, St. Louis and St. Louis County began requiring people to wear them in public in indoor spaces and outdoors when they couldn’t socially distance.
This week, Vomund finally decided to venture out to the Tuesday evening farmers market in Tower Grove Park. After months inside, she was able to pick out the food she wanted — like the perfect, tender summer peach.
“It was just like, ‘I can’t believe this is day 144, and here I am,’” she said. “Peaches are what’s making me happy!”
Dr. Alex Garza, head of the St. Louis Metropolitan Pandemic Task Force, ends every livestreamed public health update with a plea to mask up. But now that the region's hospitals are admitting dozens of people every day with COVID-19, it's more important to wear them, he said.
“If we can get the majority of people to wear masks, then we will continue to see the benefits,” he said. “The evidence supports that, without a doubt, masking is one of the best ways to get transmission down.”
Researchers at the University of Washington estimate that if everyone in Missouri wore a mask, more than 1,500 deaths and thousands of infections could be prevented through the end of October.
A sense of normalcy
As officials have relaxed stay-at-home orders across the region, masks are key to returning to some sense of normalcy, said Dr. Blessy John, an infectious disease physician at Mercy Hospital South.
“We of course cannot keep the whole country shut down for a long period of time, so when we started opening back up again we encouraged people to wear masks,” she said.
In St. Louis, wearing masks has at times become a contentious issue. In late July, footage surfaced of people jammed together in clubs, drinking and not wearing masks. Mayor Lyda Krewson announced the health department would start penalizing bars that broke the rules.
But Jefferson and St. Charles counties have not issued similar mandates.
Jefferson County residents demonstrated outside county health offices to protest a potential mask ordinance. The county council later decided to encourage but not mandate their use.
It’s unfortunate that masks have become a political statement, said Kelley Vollmar, the director of the Jefferson County Health Department.
“There’s more freedom, there’s more space, just kind of the ability to be your independent self” in Jefferson County, Vollmar said. “That’s reflected in a lot of the manner and behaviors we see in our community.”
She said the key to changing minds about the need for masks is education, not shaming.
“The more we can put out to help people understand the why behind why we’re implementing these kinds of restrictions or mandates, I think the better people will understand the impact it will make,” she said. “We’ll see the positive side of it.”
Clarifying what a mask mandate would mean could help, she said. For example, in St Louis, residents don’t have to wear them at all hours in all places, just when you’re in indoor spaces or social distancing can’t happen. People can go without on a solitary hike or alone in the car.
How masks work
While scientists are learning more about the coronavirus every day, they say the main mode of viral transmission is through respiratory droplets. Namely, mucus and spit.
“We know that if someone wears a mask and if these droplets are spread the mask will contain them,” John said. “Without a mask, there’s a chance they’ll spread the virus.”
That’s why people don’t have to wear masks outdoors when they can keep their distance from others. Viral particles can drift through the air, especially indoors in poorly ventilated spaces, but the droplets are the most common way the virus is spread, according to the World Health Organization.
Public health officials didn’t originally support mask wearing in early spring, and that may have eroded trust in public health officials, said Dr. Pearl Philip, an infectious disease physician at St. Luke’s Hospital in Chesterfield.
“I think we need to give people an opportunity to change their behaviors as we get more information,” she said. “We need to give them an out to not be tied so much to their identity as a non-mask wearer.”
Initially, doctors were concerned that promoting masks would diminish protective supplies for health care workers. And there wasn’t yet evidence that cloth masks were effective at preventing the spread of coronavirus.
But as the pandemic has continued, researchers have found scientific and anecdotal proof that cloth masks can prevent virus transmission, Philip said. That’s particularly important as researchers have learned people can spread the virus before they feel sick.
For example, in May, two hairstylists saw around 140 clients at a Springfield, Missouri, salon. Even though the hairstylists tested positive for the coronavirus, none of the clients got sick. The Centers for Disease Control and Prevention has cited the salon as proof masks work.
"The more we can put out to help people understand the why behind why we’re implementing these kinds of restrictions or mandates, I think the better people will understand the impact it will make."Kelley Vollmar, Jefferson County health director
Emerging evidence also suggests that masks could make COVID-19 less severe in people who do get sick.
How to mask
But that’s only if people wear masks correctly, said Dr. Alexis Elward, a pediatric infectious disease doctor at St. Louis Children’s Hospital.
“I do think the orders have helped, it does seem like people have a mask that is on their face,” Elward said. “But what I’m seeing more of now is it might be down below someone’s nose or down below their chin.”
She said a mask worn across the mouth and not across the nose is almost as bad as no mask at all.
And all masks aren’t created equal.
“How tightly is it fitting around your nose and mouth? Is it wet? Wet is going to be less effective, dry is more effective,” she said. “Having several layers is going to be more effective, and the tightness of the weave of the cloth.”
How clean a mask is matters, too. People should wear a newly washed mask every day, just as they put on clean underwear.
Ultimately, the most effective mask is one that someone wears, Elward said.
Since Vomund started wearing masks in spring, she has amassed a colorful closet, including a sparkly, spangled mask and a leopard-print one.
After recovering from cancer, she doesn’t want to get sick again. And unlike her lymphoma, a coronavirus illness is preventable.
“In this case, most of us have resources to prevent a bad thing from happening to us, if we’re being safe in other ways,” Vomund said. “I’m shocked people wouldn’t take advantage of that and really embrace it.”
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