FACT OR FICTION: Local medical and legal experts weigh in on masks

IDAHO FALLS — If you’ve spent anytime on social media lately, most of you know that wearing masks have become one of the more controversial parts of the COVID-19 pandemic in Idaho.

The Gem State was recently ranked fourth in a national survey for anti-mask sentiment among states in the union. As cities across the state have discussed implementing mask ordinances, Idaho has seen protests, threats of lawsuits or recall elections, and mountains of conflicting information about the effectiveness of masks in traditional and on social media.

RELATED: Health board unanimously passes order mandating masks in Bonneville County

This all came to a head in eastern Idaho this month, as Teton and Bonneville counties have had temporary mandatory mask orders put in place by Eastern Idaho Public Health. During the Tuesday EIPH board meeting to implement mandatory masks in Bonneville County, there was consensus among the medical professionals about the effectiveness of masks to reduce the spread of COVID-19.

But that consensus doesn’t extend to the public. On Thursday, despite the order, many people are still without masks, and it appears to attract significant opposition and apathy.

Part of the reason for that is because there is so much conflicting information about the effectiveness of masks, the legality of the orders and whether these mandates are even enforceable.

EastIdahoNews.com spoke to local legal and medical experts to get answers about masks, debunk some of the myths surrounding them, and discuss the legalities of requiring citizens to wear them.

The legal side of masks

“Those charged with enforcement of the order (police) should exercise a level of restraint to encourage education and compliance with the (mask) order.”

Bonneville County Prosecuting Attorney Daniel Clark talked to EastIdahoNews.com about the legal side of Eastern Idaho Public Health’s mask order.

EIN: Will you be prosecuting people who don’t wear masks?

Clark: Enforcement of the health district’s order ultimately rests on law enforcement, where they are members of the executive branch of government. A prosecutor is a member of the judicial branch, and as such holds and may exercise discretionary power to prosecute (or not) those cases when presented to us by law enforcement and determine whether it is in the public’s interest to do so.

At this time, I do not see this as being any different than the governor’s previous orders where law enforcement efforts were simply to advise, encourage and help facilitate compliance with the health district’s order.

In my conversations with our law enforcement partners, education and encouraging compliance with the health district’s order will be our paramount effort at this time, similar to the quarantine and essential business requirements earlier this year.

Our public officials are good men and women trying to do their best in a very difficult time. No doubt their conduct will be the subject of much public fodder in the months and years to come. But one thing is certain – they care about each of us and are trying their best to help our community thrive during this difficult period.

Likewise, Bonneville County residents are good citizens with a genuine care and concern for one another. I believe these attributes will translate into an appropriate level of compliance with this order as with any other laws currently in place. We live in the best place in the country, and that is because we respect the rule of law and the rights and responsibilities we have to one another.

EIN: Explain the legalities of the health district’s order. Is this something that can really be enforced?

Clark: There is no question the health district’s order is legal. While there are many, and understandably so, questions about any potential overreach or government intrusion, the fact of the matter is the governor and the constitutional powers given to him and his subordinates — namely the director of public health and regional health districts — hold this authority under the current laws. The question that I have heard time and again isn’t so much the legality of the order, but rather the efficacy or appropriateness of the order, which has been the subject of much debate.

The beauty of our system of government is that there are checks and balances on each branch of government ultimately responsible to the public as a whole. The general concern among the public is the overreach by the government. This is now, and always should be, a concern by the public in general to be a check on government intrusion.

But within the framework itself, those charged with enforcement of the order (police) should exercise a level of restraint to encourage education and compliance with the order. If or when a prosecutor is presented a case where there is noncompliance with the order, that prosecutor should likewise exercise restraint to ensure that those prosecuted for this offense, if any, are truly guilty of the crime and ought to have the government intervene in their conduct. Once all of those checks are done, finally it is the judge or jury who may determine whether someone is truly guilty of any conduct alleged.

On Wednesday, Idaho Falls Police Chief Bryce Johnson told City Council members that the police department will enforce the mask mandate similar to how it enforced the state’s stay-home order during the beginning of the pandemic — largely educating people over enforcing it on people, while reserving the right to cite people for “egregious” violations, according to the Post Register.

Johnson says he prefers that people self-enforce the order.

The laws that allow the health district to initiate mandates are Idaho Code 39-414, 39-415 and 39-419.

The medical side of masks

“It’s not so much about protecting the individual who’s wearing the mask, but it’s protecting other people around you by wearing the mask.”

EastIdahoNews.com spoke with Eastern Idaho Regional Medical Center Infectious Disease Medical Director John Bagwell and Idaho Falls Community Hospital Medical Director of the Hospitalist Program Jared Morton to debunk myths about masks.

EIN: I’m not sick. Why do I need to wear a mask?

Bagwell: With COVID, at least 40% of patients don’t have any symptoms ever, and you can spread the virus when you’re without symptoms easily. That’s thought to be a big driver of this whole pandemic. The other thing is you can be completely asymptomatic and spread it and never develop any symptoms.

You can also be what’s called presymptomatic, where you’re actually developing the infection before you get symptoms, and you’re intensely shedding (the) virus. Then, of course, you can be symptomatic when you move to the phase where you’re actually having a cough, sore throat and fever.

All those phases, you could shed the virus and be infectious. You may not know that you got the virus and you could be spreading it all over the place, and that’s why masking is thought to be really beneficial.

If we all wore masks, we could all protect each other. It’s not so much about protecting the individual who’s wearing the mask, but it’s protecting other people around you by wearing the mask.

Morton: Most folks think masks help them more than others, and COVID is a case where the exact opposite is true. By wearing a mask, (it) helps others more than yourself. Masks are a critical tool in preventing the spread of COVID. They help you not get COVID, but they really do a better job of preventing asymptomatic and presymptomatic viral shedding to others because they prevent their primary mode of viral transmission by droplets.

I think the key is, it (masks) keeps others from getting the virus that you don’t even know you have, or you may never have symptoms of, and that’s a different part of this virus compared to other diseases. Initially, we didn’t do it (wear masks) because we had no idea that the virus could be shed early on before symptoms appeared.

So both groups unknowingly could spread the virus very effectively. Masks tremendously impact that transmission, and that’s why you should wear a mask even if you’re not sick because up to 35% to 40% of people will be asymptomatic, and yet they can still transmit it to other people.

Morton encourages people to read about a real-life scenario where two infected hair stylists wore masks and treated 139 different clients from the time they developed COVID-19 symptoms until they took leave from work. After public health contact tracings and two weeks of follow-up, no COVID-19 symptoms were identified among the 139 exposed clients. Read more on how face masks played a role by clicking here.

EIN: Does wearing a simple cloth mask really help? People say it’s equivalent to using a chain-link fence to stop mosquitos.

Bagwell: Once again, the intent is not so much to protect the mask wearer. The intention is to prevent the spread of the virus (with) the person wearing the mask when they don’t know (they have the virus).

When we go into an operating room and a surgeon makes a big cut in you to take out your appendix or whatever it is, we’ve known for a long time that if you do not wear a mask, that there’s a potential to spread whatever’s in the surgeon’s mouth or breath into that surgical wound and cause an infection. Now, would anybody in their right mind want a surgeon to not wear a mask when they take out your appendix? I mean, it’s crazy.

The same sort of thing is applicable here. We’re talking about source control. We’re trying to talk about stopping the infection by this mouth covering.

Morton: The ideal mask is the one that you can wear consistently and you can wear comfortably as long as you can — cloth or surgical — anything that completely covers the nose and mouth will suffice in terms of just wearing it. There is no downside for most people to wear masks, and cloth masks can be very, very effective at preventing droplet transmission of this virus to other people.

Masks are all about risk reduction, not 100% prevention. You don’t take the cholesterol pill or aspirin or something like that knowing that 100% of the time you’re going to prevent your next stroke or heart attack, you do it to try to reduce the risk. That’s what any mask does. You’re trying to prevent the transmission to other people and trying to a little bit less, but still just as important, prevent you from getting it from someone else. Any mask will help us do that.

Brigham Young University conducted a study on respiratory droplets being ejected into the air while speaking without and with a mask. They found a significant decrease in droplets in those wearing a mask. For more information on how face coverings reduce the spray of droplets, click here.

EIN: Has the science on masks changed?

Bagwell: Yeah, I think when we first were talking about this, I don’t think anybody thought that the mask would be a big player in this. I think Dr. (Anthony) Fauci (the director of the National Institute of Allergy and Infectious Diseases) and that others are an example of that. I mean, these guys know what they’re doing, but the thing that’s sort of different about this is that it’s this asymptomatic spread that seems to be so common and the presymptomatic spread that’s what seems to be really a problem with COVID that hasn’t really been encountered that much in the past.

That’s why the role of masks are coming to the forefront here, and there are multiple studies that are coming out that are supportive of this notion. It’s not like there’s no science behind it. People have mentioned that too. I’ve heard that rumor, and that’s not the case. Just recently, there were several studies that have shown the benefit by wearing masks with COVID specifically.

Morton: I don’t think the science on masks has changed. I think like I mentioned earlier, we didn’t recommend them initially because we had no idea that the virus could be spread so significantly, early on.

There was a Chinese study published a month ago or so … and they talked about that nearly 80% of the documented cases of COVID actually came from undocumented known infections — so from asymptomatic and presymptomatic viral shedding. That wasn’t known early on.

The more we’ve learned about it, the more we’ve said there’s a lot of presymptomatic and asymptomatic viral shedding. In fact, that might be the primary mode of rapid geographic spread of COVID. Therefore, we should try to contain it however we can, and masks have become, along with, social distancing (and) washing your hands, part of those three “W’s” (wear a mask, watch your distance and wash your hands) to really try to keep people as safe as we can and stop the transmission as quick as we can.

The science really hasn’t changed. It’s been discovered, if that makes sense. We’ve changed our opinions on how we should treat the virus, but the science didn’t exist before. So it didn’t change, just now we’re learning more about it almost every day, which is a big, big deal.

To learn more about the changing science of masks, click here.

EIN: There are certain medical conditions that prohibit people from wearing a mask. Are masks actually harmful?

Bagwell: They’re few and far between. I suppose if you have some sort of underlying lung condition like asthma or you’re claustrophobic, that might be something. They do get a little uncomfortable if you’re wearing it for a long time. There’s no doubt about that.

You wear it when you’re around other people. You don’t need to wear it when you work in the yard or the garage or something. It’s just when you go to the store or you do something around other people that you need to wear it.

Morton: Absolutely there are certain medical conditions that can preclude wearing the mask, like certain skin conditions, facial anomalies, anxiety, claustrophobia (and) very specific lung conditions, like pulmonary disorders that can make it difficult.

I think everyone needs to speak to their doctor or health professional about those things if they think they shouldn’t wear a mask or that masks might adversely affect their health. There are a few, but they’re very, very few and far between.

EIN: I’ve heard that if you wear a mask for too long, your oxygen levels will go down, and you’ll breathe too much carbon dioxide.

Bagwell: That’s a myth. That’s totally not true. There’s free air exchange. No one has ever been documented for that to happen. If you feel like you’re short of breath, you’re either claustrophobic or there’s some other reason for it but it’s not because you’re retaining CO2 or not getting enough oxygen.

Morton: No. There’s no data for masks causing low oxygen levels. I mean, we’ve worn them for years in the hospital for hours on end, without issues in the operating room (and) for us on the floors.

However, N95 masks, in very specific patients with various underlying lung diseases that are really severe, can cause higher carbon dioxide levels in their blood. Those patients should absolutely talk to their doctor about wearing masks. (Aside from) those pre-existing lung problems, wearing a mask will not affect your oxygen or bicarb levels to any clinically significant degree at all.

For more information on how much protection face masks offer, Morton recommends reading an article from the Mayo Clinic that can be found here.

EIN: So if I wear a mask, I don’t need to social distance?

Bagwell: That’s not true. Social distancing is probably still the best thing to do, but it’s (wearing masks is) certainly an adjunct to social distancing. I think that’s what we’re all looking at. It’s not a replacement for it. So we probably should still avoid going into a concert with a couple thousand people and feel like you’re going to be safe by wearing a mask there or at a football game.

There’s a lot of things we still don’t know what’s going to happen here in the next few months. But certainly, it’s better to wear a mask than not do anything, if you can’t social distance. It clearly is a form of social distancing, that’s the way I like to look at it.

Morton: No, it’s a tool. It’s a piece of the puzzle from an epidemiological standpoint in trying to decrease the transmission of the virus. It is a very important one, but that’s why doctors, we’ve tried to be fairly consistent in the last month or two, at least as more data has come out, to focus on those three W’s — wear a mask, wash your hands and watch your distance. You need to do all of them.

If I had my wish, (let’s) just wear a mask, but that’s not good enough or isolate yourself inside your house forever, but you can’t do that. You have to work in this world. We have to have our economy working. And in the end, yeah, wearing a mask, watching your distance and washing your hands, those three things together are the best. But if I get someone to do one of them, that’s better than none. But it’s better if they did all of them.

EIN:Is it true you don’t need to wear a mask outside?

Bagwell: That’s generally true unless like you’re going to a state fair and it’s outside for example. A couple of thousand people, and they’re fairly close, you probably need to wear a mask. That doesn’t mean you shouldn’t wear a mask just because you’re outside. It just depends on how many people you’re planning on being around and what kind of gathering you’re at.

Morton: It’s probably likely less important to wear a mask in your backyard, outside in a park or somewhere where you are less likely to come in close contact with others, less than 6 feet. But in crowded places, like the beach or somewhere else where you can’t socially distance, you should probably wear a mask.

We’re trying to help other people more than ourselves. And that’s very different about this virus. So yes, they should absolutely wear them in the right spot if you can’t socially distance outside.

EIN: Do N95 masks blow the virus into the air from a contaminated person?

Bagwell: N95 masks are a very tightly sealed mask to your face around the edges. The air exchange all occurs through this membrane. You have to be what’s called fit-tested when you get an N95 mask to get the exact right size, and you make sure you get a seal around the edges. Now I do see a lot of people wearing N95 masks that are very loose, and they’re not on their face correctly. And those masks will leak around. You’re going to have air and droplets leak around the mask if it’s not fitted tightly to your face. They’re not wearing it properly, so I guess that is perhaps true if it’s not fitted properly.

However, if it’s fitted properly, there should not be any exchange.

Morton: Certain ones, the ones that have the valves that you see, those ones can absolutely spread droplets through those valves, and we don’t really recommend those. But any other N95’s, you should be fine.

EIN: What about herd immunity? Isn’t it better for community members to not wear a mask and for us all to catch COVID-19?

Bagwell: That would mean that we’d have a bunch of people that would get really sick and be in an ICU and perhaps die. Granted though, the great majority of people will be fine, but then we have to take the chances that we can’t predict who’s going to get really sick and who’s going to not get sick.

Morton: Vaccines have absolutely had success and control of deadly infections by the concept of herd immunity like diphtheria, smallpox (and) polio, that kind of stuff. Sometimes you can do herd immunity with infection, and we initially hoped we could do that with COVID, early on. Remember we thought it would be seasonal and it’d go away? It’s not like that.

Our immune responses to COVID are different than that of other infectious diseases. We don’t sustain the antibody responses like we had initially hoped for. That’s sad, but it’s a characteristic we’ve known about for years with other coronaviruses. We all have waning antibody responses to those, and that’s why we get reinfected with them every year and sometimes multiple times in the same year by the same coronavirus.

There was a recent (study) done in Spain, and there was a recent Chinese one, (and) you’re looking at roughly 3% to 10% or so of folks that are making a sustained antibody response and so in the end, we’re just having more and more studies done now showing rapid declines in our antibody production from primary infection over a period of months. And so the concept of herd immunity outside of a vaccine, it’s not possible.

To read more about antibody responses, click here.

EIN: Why have masks become political?

“I think masks have become political because people want to make it about something it isn’t.”

Bagwell: I don’t know why other than there’s resistance by some people for governmental control. There’s always going to be a group of people that are resistant to having somebody tell them what to do. I think that’s real. I think that’s a lot of it, and yeah, maybe our President hasn’t been that helpful in that regard too. I don’t know.

It’s not a political thing, and it shouldn’t be, but it has become that. Our leaders who we have elected are asked to make public health decisions, so therefore, this masking decision will always have a political component.

Morton: I think masks have become political because people want to make it about something it isn’t. For the foreseeable future, the risk of transmitting and acquiring COVID is not going to be zero. We try and minimize the risk with everything we do. We try to wear our seat belts, and we try not to drive while using the phone, and some people made those political back in the day.

Whenever you have some kind of uncontrollable and frightening issue like COVID that’s invisible and even more scary with all the confusing information, people look for other reasons, and they attack it for reasons they don’t need to. They attach things to it, stigmas, political viewpoints and all that, and they don’t need to.

In the end, this is one of those that masks make good sense. They make scientific sense now that we know more about this virus and this case. It really is important that people wear masks. This is a weird case where we have to balance risks and honoring individual freedom and responsibility of where they are as a citizen and the overall common good of society. All these things are obtuse concepts and they’re critically important in decreasing the spread and the prevalence of COVID.

For more information on how requiring face masks in public helps in mitigating COVID-19 spread, click here.

For more COVID-19 news, click here.