Mask-Wearing Guidance: A Timeline of Slow-to-Shift Messaging
Preliminary research published this week suggests widespread mask wearing in public could substantially reduce the spread of COVID-19. Yet it was not until April 3 that the Centers for Disease Control formally recommended that Americans wear masks in public, after two months of stating precisely the opposite. As elected officials try to understand resistance to their mask-wearing orders among some segments of the population, it is worth looking back on the CDC’s evolving guidance on the topic.
The rapidly evolving scientific knowledge about COVID-19 has largely forced fact-checking organizations to simply refer to the public statements of health officials, pointing to recommendations that would later be reversed.
For example, PolitiFact’s Jan. 31 “reader’s guide to misinformation about the coronavirus” offers that “the likelihood of people in the United States catching the virus is minimal, at least for now” and does not include mask wearing among World Health Organization recommendations.
The fact-checker’s Feb. 28 piece, “Separating fact from fiction on the coronavirus,” points out that “on the topic of masks, NPR reported that some infectious disease experts are hesitant to suggest that people wear masks as a preventive measure because they can provide a false sense of security. What they do agree on is that wearing a mask is a good idea if you are sick, so you can reduce the chances that you'll infect others.”
Its March 5 article, “Stop sharing myths about preventing the coronavirus. Here are 4 real ways to protect yourself,” concludes that “according to the WHO, only people who are infected with the coronavirus or caring for someone who is need to wear a mask.”
Similarly, FactCheck.org concluded on Jan. 30 that “[t]here is no need for people in the U.S. to wear face masks unless someone is infected with 2019-nCoV, or a health care worker is treating someone who is infected.”
The same day, Snopes pointed its readers to an Associated Press story headlined “Do Masks Offer Protection from New Virus? It Depends.”
When did the CDC first begin actively recommending against public wearing of masks?
In a Jan. 29 story about national shortages of face masks due to panic buying by the public, the New York Times cites a CDC spokesperson as saying that the organization would be issuing a statement regarding public mask use at its next briefing. The following day, in its coronavirus briefing for media outlets, Dr. Nancy Messonnier noted that the “CDC does not currently recommend the use of face masks for the general public. … We don’t routinely recommend the use of face masks by the public to prevent respiratory illness and certainly are not recommending that at this time for this new virus.” This advice was repeated in the agency’s Jan. 31, Feb. 5, Feb. 12 and March 10 briefings.
A Time magazine reporter pressed Messonnier on the point at the Jan. 30 briefing, to which she repeated that the CDC’s advice to the public was to “wash your hands, cover your cough.”
Time’s subsequent report, “Can Face Masks Prevent Coronavirus? Experts Say That Depends,” repeated this information. The article was subsequently removed on April 3, replaced with an editor’s note saying that a “previous version of this article was based on expert guidance at the time of publication, but as the COVID-19 pandemic has grown in the U.S. in recent weeks, public health thinking around wearing face masks has changed” and citing updated CDC guidance. A number of other news outlets similarly removed their reporting of the CDC’s original guidance with the release of the new recommendations.
In the CDC’s Feb. 5 briefing, Dr. Messonnier again offered that “we do not think that the American public should be going out and buying masks; we don’t think that normal U.S. citizens going about their day-to-day lives in the U.S. right now are at risk.” Yet this time she went a step further to note that a key consideration in this recommendation was the need to preserve masks for health care workers.
The CDC’s Feb. 12 media briefing appears to be the first in the series to modify its previous advice by offering that while the “CDC does not currently recommend the use of face masks for the general public,” anyone who is “sick or a patient under investigation and not hospitalized, CDC recommends wearing a face mask when around other people and before entering a health care provider’s office.”
At the CDC’s March 9 briefing, Fox News referenced panic buying and members of the public wearing gas masks, asking if the CDC could “provide some sobriety here because the last thing I think we all need is a panic but we want to be people vigilant and make the right decisions.” Dr. Messonnier responded, “I think that’s a really great point, and really important thing for the media to try to communicate.” She went on to emphasize: “We really do not think this is the time for Americans to be going out and getting masks. Masks are really important for those at highest risk in the health care setting and we want to make sure that we save enough masks for our health care workers on the front lines. … I ask people to please fight the urge to buy a mask and make sure we save them for the people that really need them.”
The CDC repeated this advice on its COVID-19 website, recommending that while sick individuals should wear masks, “If you are not sick you do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.”
Two months after the CDC referenced mask shortages for health care providers as a primary rationale for recommending that the public not wear masks, Dr. Anthony Fauci confirmed this consideration: “When we get in a situation where we have enough masks, I believe there will be some very serious consideration about more broadening this recommendation of using masks. … Because if, in fact, a person who may or may not be infected wants to prevent infecting someone else, one of the best ways to do that is with a mask, so perhaps that's the way to go.”
It was not until April 3 that the CDC’s public guidance was changed to “Everyone should wear a cloth face cover when they have to go out in public.”
Similarly, Canada’s chief public health officer, Dr. Theresa Tam, offered in January that “there's no recommendation to wear a mask when you're going about your regular daily activities” and that mask wearing by seemingly healthy individuals “can actually present some risk as you're putting your fingers up and down your face, removing your mask, putting them next to your eyes, that sort of thing.” She subsequently shifted her guidance on April 4 and on May 20 officially recommended mask wearing.
The end result has been a public told for two months not to wear masks, not because they don’t work but because those masks were needed for health care workers. For a public saturated with this “don’t wear” messaging from news outlets and fact checkers, it is not surprising that there has been resistance to current mandatory mask orders. The episode reinforces the critical need for officials to consider the impact of contradictory public health messaging, and reminds us of the limitations of fact-checking sites during a crisis when so much is unknown and guidance changes often.