Memos from CDC to White House lay out rationale for possible widespread use of face coverings

Medical staff with protective clothing are seen inside a ward specialized in receiving any person who may have been infected with coronavirus, at the Rajiv Gandhi Government General hospital in Chennai, January 29, 2020. REUTERS/P. Ravikumar

Federal officials debating whether to recommend that face coverings be routinely worn in public are responding to increasing evidence that infected people without symptoms can spread the coronavirus, according to internal memos provided to the White House by the Centers for Disease Control and Prevention.

Simple cloth masks that cover the mouth and nose can prevent virus transmission from such individuals when they are out buying groceries or seeking medical care, according to the memos obtained by The Washington Post.

But the documents note that widespread public use of masks is not culturally accepted in the United States the way it is in many Asian countries, where face coverings helped reduce the spread of the virus.

The memos were drafted in recent days by the CDC and sent to officials at the Department of Health and Human Services and the White House coronavirus task force for consideration of masks as an additional measure to slow the pandemic.

If adopted by the White House coronavirus task force, the recommendations would represent a major change in official CDC guidance that healthy people don’t need masks or face coverings. The memos make clear that the coverings under discussion are not medical masks, such as N95 respirators or surgical face masks, which are needed by front-line health-care workers and in extremely short supply.

The office of the vice president, which is overseeing the task force, did not immediately respond to a request for comment.

At a White House briefing Monday, March 30, 2020,  President Donald Trump was asked whether everyone should wear nonmedical fabric masks. “That’s certainly something we could discuss,” he said, adding that “it could be something like that for a limited period of time.”

Wearing cloth masks in public places would be an additional community mitigation tool, according to the memos. Social distancing of at least six feet is still recommended even when wearing a mask. The memos emphasize that a cloth facial mask is intended not so much to protect the wearer but to help prevent the spread of virus to others. A memo dated Thursday noted that people “generate respiratory aerosols when speaking, coughing and sneezing” that can be inhaled by nearby individuals.

That and a more recent memo dated Monday refer generally to increasing evidence that people can spread the virus even when they feel well, often referred to as pre-symptomatic and asymptomatic transmission.

A CDC report last week on asymptomatic infections among residents at a skilled nursing facility in the Seattle area found that of 23 residents who tested positive for the novel coronavirus, 13 were asymptomatic or presymptomatic on the day of testing.

Infectious disease experts say asymptomatic transmission may be playing a larger role in the outbreak than previously thought but just how big remains unknown. Studies are underway at the CDC and elsewhere to better understand such spread.

One of the challenges is figuring out what to call any face covering. In the earlier memo, one suggestion was to refer to it a Courtesy Mask or Universal Source Control.

That memo says face covers should extend above the nose and below the chin to “completely cover the mouth and nostrils.” It should also fit snugly against the sides of the face and be secured with ties or ear loops, and be composed of multiple layers of fabric but not be “overly restrictive to breathe through.” An ideal face cover can be cleaned in a washing machine and machine dried without damage or distorting its shape, the memo said.

Deborah Birx, the White House coronavirus coordinator, initially resisted the idea of universal mask use because of concerns that recommending face coverings might undermine messages that people should stay at home as much as possible, according to a person who has knowledge of the discussions and who spoke on the condition of anonymity because he wasn’t authorized to talk about the issue.

Trump adviser and son-in-law Jared Kushner and others like the idea of recommending face coverings for when people are in public, the individual said.

With coronavirus cases still climbing sharply in the United States, some scientists, health experts, pundits and social influencers have begun vigorously advancing their position that everyone venturing into public or crowded places should wear a mask or face shield – even a homemade one – to lower the rate of transmission of the coronavirus, which causes the disease covid-19.

The Monday document suggested promotional “tag lines” the government could use if it recommended face coverings for the public: “COVID ends with me,” “My mask protects you and your mask protects me” and “I wear my mask to protect my community.”

The document noted that recommending widespread use of face coverings “may pose a challenge to U.S. communities because mask-wearing is uncommon,” according to the memo dated Monday.

Still, it said, “in many international communities, wearing masks in public is common, widely considered to be good hygiene, and is seen as a communal gesture of protecting others from the wearer’s potentially infectious exhales.”

 

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