Face Masks and the Risk Continuum - In the Age of COVID-19

Like most things in life, managing risk is not a binary proposition—100% dangerous vs. 100% safe. Instead, risk exists on a continuum. As individuals, we make decisions along our personal risk continuum every day. We consider past experiences, potential future consequences and the benefit of a good outcome versus the negative impact of a bad one. Decisions both large and small are part of our personal risk management considerations - should I jump off this porch step, stay up late knowing I have an early morning conference call, invest in this stock, get married? These decisions are all part of our personal risk/reward continuums. 

However, when something comes along to disrupt our risk assessment rhythm, we must be more intentional about our decisions. The COVID-19 pandemic is one of those disruptive events. We are making decisions every day that impact both our personal health risk and public health outcomes. These are inextricably intertwined and co-dependent. We can think of the COVID-19 risk/reward continuum as containing all actions that increase risk of exposure and all the mitigating choices we have available to combat exposure. The challenge for the world’s population today is to understand how COVID-19 is spread and to make decisions along the risk continuum that balance the negative impact of acquiring the disease and spreading it to others against the positive impact of regaining our pre-COVID lives and livelihoods.

Key considerations in assessing our personal risk regarding COVID-19 include our age, underlying health conditions, local infection rate, job requirements, the population density of our live/work/play locations, and the needs of family members that we live with. When assessing our public health risk contribution, we consider whether we can work from home, our access to the internet and communication tools, our essential worker status, and our economic health.

At the onset of the COVID-19 pandemic, we felt we had little control over our exposure risk, but, with gains in knowledge, mitigating solutions have emerged. These tools, when used properly, enable a partial return to normalcy while keeping both personal and public risks low. In our previous article, we explored face masks as one of the tools available to mitigate risk. Social distancing and hand washing are two other essential tools available to mitigate COVID-19 exposure and transmission risk.

We prevent the spread of COVID-19 primarily by physically increasing our distance from each other. However, this necessary distance is antithetical to the activities needed to continue our preferred lifestyles and preserve our livelihoods. Thanks to dedicated work by scientists around the globe, we are finding ways to mitigate the risk of virus transmission when we need to be close to each other. Physical barriers, including face masks and respirators, are key tools available to mitigate transmission risk when close proximity is required. Knowing when to use masks and which face masks to use for which activities helps us manage both our personal and shared public risks. More information can be found in our first article.

Face masks primarily serve to reduce the wearer’s likelihood of spreading the virus to others, but they also protect the mask wearer from virus exposure. Recently published study results indicate that the protective benefits of face masks for the wearer were initially under-reported/evaluated. (Chu, MD., Derek,Lancet)  A cloth or 3-ply face mask containing a non-woven layer is recommended in community-based situations where a physical distance of 6 ft is not possible or when inside buildings and structures where we gather. Our healthcare heroes and first responders have a fully regulated set of conditions for the use of medical grade face masks, respirators, face shields, and other critical PPE (personal protective equipment) and operate at the high end of the risk continuum.

Knowing where your daily activities fall on the COVID-19 exposure risk continuum is critical when selecting face masks and assessing when to wear a face mask. We recommend doing the following so you are prepared for a variety of risk scenarios:

·       Keep a supply of face masks ready and accessible at home and work

·       Keep a supply of clean cloth or 3-ply disposable masks at the ready in your bag or vehicle, as well as a receptacle for used masks

·       Understand any face mask mandates/guidance from your local government, as well as the masking requirements at any businesses or institutions that you may visit in your day

Assessing your activities from lowest risk to highest risk and having a plan to mitigate risk by wearing a face mask will allow you to assert positive control over both your personal risk exposure and your public health risk contribution. By using face masks and other tools at our disposal, we can increase our benefits, reduce our risks, and put ourselves and our communities in a more favorable position on the COVID-19 risk continuum.