As the number of COVID-19 cases soars over 38,000 in New York City, the rate of infection stands in stark contrast to several other large cities such as Tokyo and Hong Kong which have thus far avoided a dramatic escalation in cases. Tokyo, a city of 9 million people, has recently seen an uptick in new cases but still has fewer than 500. Hong Kong, a city of 7 million, has just over 600 cases.

While these numbers are surely understated (as is anticipated in the U.S.), and though Japan may be facing a renewed threat, the resiliency of these Asian cities in the face of such a virulent outbreak has been impressive. Early and effective action may have played a large role in keeping cases down. Warmer temperatures, too, may be an influence for places such as Hong Kong. But there’s another potential explanation: the use of masks.

Using The Factual’s database of articles, we’ve retraced a timeline of credible news articles from mid-January to March 30, revealing a U.S. media establishment that did not sufficiently challenge official guidance on masks even as parts of the world were directly contradicting it. Our investigation demonstrates how even credible articles might not tell the whole story, that multiple perspectives are needed to get the whole picture, and that official guidance can always benefit from careful scrutiny.

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How Article Credibility Works

Our analysis looked at over 350 articles from January 21 to March 30 related to mask use in the COVID-19 crisis. See our How It Works page for more information on our article database and how we track article credibility.

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FT Graphic: John Burn-Murdoch. Note: Mask use in China has increased rapidly since the initial outbreak and may have helped flatten their curve. Also, Singapore’s official recommendations for mask use are similar to that of the U.S.

Official Guidance on Masks: Asia vs. U.S./Europe

In parts of Asia, mask use was already a part of everyday life for some. For example, Japan reportedly “goes through 5.5 billion face masks every year — 43 per person.” Officials in several countries swiftly encouraged their use following the outbreak, a factor that medical experts say likely had a positive impact in reducing the spread of the virus. In Hong Kong, exports of masks were ordered to stop on January 27, and a slowed rate of infection has, at least in part, been to attributed their frequent use early on.  A microbiologist in Hong Kong, quoted in the Straits Times, a Singapore-based publication, said on March 10th

“The temporary success of virus control in Hong Kong this time is not only due to population controls, but also contributed by the early advocacy for mask-wearing, hand-washing, and social distancing. Otherwise, with such a dense population in Hong Kong, the epidemic would very likely have spread the same way as in Italy or Daegu in South Korea.” – Yuen Kwok-yung

By contrast, the narrative around the use of masks — both N-95 respirators and surgical masks — in the U.S. has largely been one of discouragement and conflicting messaging. The U.S. Centers for Disease Control (CDC) has firmly stuck to its position that masks are not recommended to the general public because they are ineffective if not used properly and because it is essential to prioritize masks for sick people and health care personnel. So why has official U.S. guidance differed so much from countries that have — at least thus far — more effectively managed the virus? And in terms of the news, did the media adequately investigate the truth about masks?

Who First Captured the Conflicting Realities on Masks?

The CDC’s messaging as communicated through U.S. media remained clear, and the primary message in most articles was that “[the CDC] does not recommend the routine use of respirators outside of workplace settings (in the community).”

But even in acknowledging this official position, articles began to paint conflicting pictures. For example, the official guidance subtly clashed with pictures of masked travelers, pharmacies selling out of masks, and shortages in the personal protective equipment industry. Nowhere was this contrast more clear, however, than in the discussion of mask efficacy.

Back in January, three articles in particular captured glimpses of the divergence between official recommendations and publicly available information about masks and their potential benefits.

Coronavirus spurs a run on face masks. But do they work? – Washington Post
By Miriam Berger | Author expertise: World | January 24 | Article credibility grade: 82%

While the necessity to retain adequate supplies for health workers was repeated early and often, the partial protective value of masks was captured by the Washington Post as early as January 24: “the science suggests they are a flawed but valid line of defense.” The same article also noted that N-95 respirators could be highly effective in filtering our viruses when fitted and handled properly.  

Face Masks: What Doctors Say About Their Role In Containing Coronavirus – NPR
By Maria Godoy | Author expertise: Health and Food | January 29 | Article credibility grade: 84%

Apart from discussing the proper usage of N-95 respirators and the critical role such masks would play for medical personnel dealing with the illness, this January 29 article acknowledged the potential benefits — however meagre — provided by simple surgical masks: “[surgical masks] do provide some benefit but they’re far from foolproof.” 

Godoy also illustrated that the calculation on mask use may be different for people in places such as Wuhan, where the virus was quickly spreading, by quoting an infectious disease researcher: “If it’s someone in Wuhan, where most of the cases have been, then there might be some value to it.”

Q&A on COVID-19 –
By Jessica McDonald | Author expertise: Health and Science | January 30 | Article credibility grade 98%

Early on, Jessica McDonald, who we’ve ranked as the most credible journalist on COVID-19 coverage, also noted the potential added benefit of even simple surgical masks, adding that they would be a wise choice for people in high-risk areas: “The basic surgical masks aren’t worthless — for those in crowded areas of China, they’re a good idea because they will limit some exposure  — but they’re not especially protective.”

Emphasis in all quotes has been added by the author and does not appear in the original stories.

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Media’s Stance Begins to Change in Mid-March

While reserving masks for medical personnel was a critical public message, it clashed with reporting that indicated that masks were ineffective. These divergent realities about masks were not effectively reconciled in one place until March 17.

It took almost six weeks for someone to effectively encapsulate the failed messaging on mask usage, and when the message was finally given some clarity, it was not a journalist but an academic, Zeynep Tufekci, who delivered. Tufekci acknowledged precisely just what was wrong with CDC messaging. 

Why Telling People They Don’t Need Masks BackfiredNew York Times
By Zeynep Tufekci | Author expertise: Science/Technology | March 17 | Article credibility grade: 66%

“It is of course true that masks don’t work perfectly, that they don’t replace hand-washing and social distancing, and that they work better if they fit properly. And of course, surgical masks (the disposable type that surgeons wear) don’t filter out small viral particles the way medical-grade respirator masks rated N95 and above do. However, even surgical masks protect a bit more than not wearing masks at all. … [The CDC] is recommending that surgical masks are ‘an acceptable alternative’ for health care workers … because some protection, even if imperfect, is better than none. In the face of this, publicly presenting an absolute answer — ‘You don’t need them’ — for something that requires a qualified response just makes people trust authorities even less.” (emphasis added)

Over the weekend, other articles have begun to echo this sentiment, from venues such as Science Magazine and Slate. As of publication, this guidance still contradicts the official recommendations of both the CDC and the WHO. However, the CDC has indicated that health care workers who lack adequate supplies of masks can use bandannas or similar clothing items as a stop-gap measure, even if their efficacy is unproven. While some have suggested that the CDC may be considering a shift in official guidance, the CDC firmly denies such a plan. 

Screen Shot 2020-03-29 at 10.13.25 PM

All of this leaves many of us wondering whether the same rules should apply to daily life and whether official guidance — and the media at large — has struggled to keep up with a fast-moving, insidious virus. 

Lessons Learned

We can emerge from this story with two implications. 

  1. What we now understand or expect to be the truth about masks in the context of the COVID-19 outbreak was discernible in bits and pieces across different articles early on. Individual articles, even if credible given the available information and official guidance, failed to tell the whole story, and only through a synthesis of a range of available information did someone finally emerge with what we expect now to be the right message.
  2. The official government position and the guidance passed along by the media was not particularly forthright or clear. While this guidance wasn’t exactly false, it also wasn’t the full truth. This may have been an earnest coordinated effort to give medical personnel a head start, however small, in securing the limited supply of masks available in the U.S., or it could have been a result of the intense pressure of the COVID-19 news cycle and incomplete information. Either way, it is a pertinent reminder that even official guidance should warrant scrutiny from the media and the public.


So… Should You Wear a Mask?

If you already have one that can’t be donated to medical personnel and you know how to use it safely in a manner that reduces risk to yourself and others, the answer is probably yes.

Should you go out to buy one? You are unlikely to find an N-95 mask at this time, and if you do, medical professionals need them far more than you. But, if you are indeed in crowded spaces, then a surgical mask or makeshift alternative is probably a good idea, though they can’t be relied on to keep you safe.

For now, the best advice remains to wash your hands often (for at least 20 seconds), practice social distancing, and only go out when absolutely essential.

Published by Phillip Meylan

Phillip is a writer, researcher, and editor. At The Factual, he leads research efforts that utilize the company's ever growing data on the media ecosystem. He is also a contributor to FP Analytics, Foreign Policy's research and advisory division, and an adjunct fellow with the Center for Strategic and International Studies.