Should the public wear face masks? Experts weigh new advice

Update: On Friday, April 3, President Trump announced that the CDC now recommends Americans wear a "basic cloth or fabric mask" in public.

As public health officials learn more about the novel coronavirus and how it spreads, some are taking another look at whether healthy people should consider wearing face masks when they go out in public. Since the outbreak began, the World Health Organization and U.S. Centers for Disease Control and Prevention have recommended that masks be reserved for medical workers, sick people and their caregivers — not worn by the general public. But differences of opinion are starting to emerge.

The mayors of Los Angeles and New York City now recommend that residents wear homemade masks or scarves over their nose and mouth when they leave their homes.

Dr. Anthony Fauci, head of National Institute of Allergy and Infectious Diseases, said on CNN Tuesday that the issue is currently being discussed by the White House Coronavirus Task Force.

"The idea of getting a much more broad, community-wide use of masks, outside of the health care setting, is under very active discussion at the task force. The CDC group is looking at that very carefully," Fauci said.

In an interview with "CBS Evening News" anchor Norah O'Donnell, Fauci stressed that "the primary people who need masks are the health care providers who are putting themselves in harm's way when they are taking care of someone with a highly contagious disease." Masks also need to be worn by COVID-19 patients to prevent them from infecting others.

But since the CDC says as many as 25% of people infected with the virus don't have any symptoms themselves, but can still spread it, would asking everyone to wear masks in public offer some protection? Fauci cautioned that such a recommendation will be contingent on having an adequate supply.

"One thing you don't want to do is, by recommending that people in the community generally wear masks, is if it takes it away from the people who really need it," Fauci said.

"But in a perfect world, if you had an unlimited supply of masks — which we don't — if those individuals could possibly be spreading infection and not even knowing it, [masks are] a potentially good way of preventing that. It's not 100% for sure, we know from studies that masks are not 100%, but we don't want the perfect to be the enemy of the good in doing something that you could have an impact in preventing transmission."

The consideration marks a stark change in federal messaging. In February, about a month after the first case of the coronavirus was reported in the United States, Surgeon General Jerome Adams pleaded with the public to stop buying masks for personal use.

"Seriously people — STOP BUYING MASKS," Adams wrote on Twitter. "They are NOT effective in preventing the general public from catching coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!"

On Wednesday, however, he too said that the government is reconsidering its early advice, in order to "clear the air" over the the nation's mask confusion.

"Initially, the CDC, the World Health Organization, and my office recommended against the general public wearing masks based on the best available science at the time, in terms of whether or not it prevented the wearer from catching coronavirus," Adams said on "Good Morning America." "Now, we've learned about this disease... and we've learned that there's a fair amount of asymptomatic spread."

With that new knowledge, Adams said that the CDC has been asked "to take another look at whether or not having more people wearing masks will prevent transmission of the disease."

On "CBS This Morning" Thursday, CBS News medical contributor Dr. David Agus explained why it might be a good idea.

"You know, when you put a mask on, it's not so much to protect you from somebody else, it's so the droplets in your mouth don't get out. When you stand in front of a mirror and breathe, that fog are droplets. You put a mask in front of you, you can block the droplets. So the whole notion of wearing masks when you go out ... it's to protect others, and I think it's fantastic," Agus said.

Former FDA commissioner Dr. Scott Gottlieb said on CBS' "Face the Nation" Sunday that asking people without symptoms to wear masks "could be an interim step" for local governments to use after lifting more restrictive stay-at-home orders. But before those orders are lifted, Adams emphasized that masks cannot replace social distancing and diligent hand-washing.

"We don't want people thinking, 'Hey, I'm going to wear a face covering so it's appropriate for me to go out around other people,'" Adams said. "The most important thing right now to do is for people to stay at home."

Gottlieb explained that by asking everyone to wear a mask, authorities would be operating under the assumption that anyone could be a carrier — whether or not they know it.

"The value of the mask isn't necessarily to protect you from getting sick, although it may offer some protection," he said. Instead, "when someone who's infected is wearing a mask, they're much less likely to transmit infection."

According to Gottlieb, studies on the transmissibility of other respiratory viruses, like the flu, have shown that even wearing a rudimentary mask can reduce a person's ability to spread the virus by up to 50%.

"I think people should be contemplating wearing masks," he said. "A cotton mask — we should be putting out guidelines from the CDC on how you can develop a mask on your own."

He and the surgeon general both made clear that any recommendations for the public would involve simple fabric surgical-style masks, which could even be homemade — not the higher-grade N95 respirator masks used by health care workers on the front lines.

"If you are going to wear face covering when you go out, please understand you still don't need an N95 mask," Adams said. "And if you take one of those N95 masks, you could be taking it out of the hands of a health care worker who desperately needs it to care for patients."