Masking plays a vital role in reducing the spread of coronavirus, health experts say.

Yet in Yakima County, where hospitals exceed staffing capacity because of COVID-19, only about a third of people wear masks in public.

The issue is complicated, and not just here.

Since the first confirmed case of COVID-19 hit the United States in Washington in January, health leaders including the Centers for Disease Control and Prevention and the World Health Organization have been scrambling to issue and update recommendations to protect the public.

Those directives have, at times, seemed contradictory. In early March, the CDC announced people should not wear masks to protect themselves from COVID-19, as doing so was not believed to be effective against catching the virus. But by April, national health leaders and the state Department of Health were urging people to use cloth face coverings.

Why the change? Health officials had learned that a “significant portion” of people who could be transmitting the disease — up to 25% — were “asymptomatic,” or not showing symptoms. They also had discovered that people considered “pre-symptomatic” — people who had the virus, but were not yet showing symptoms — could be infecting others.

The primary way people catch COVID-19 is through respiratory droplets from an infected person, such as when an infected individual coughs or sneezes. The rationale became that masking people, who may or may not know if they are infected, could help catch those droplets and slow the spread of the virus.

As COVID-19 infections increased, June escalated the masking recommendations in Yakima County. The Yakima Health District and the Yakima City Council both issued masking directives. The county launched a “Mask Up to Open Up” campaign, and the health district and the Office of Emergency Management announced plans to distribute 330,000 masks.

With the county reporting a per capita infection rate of about 700 for every 100,000 people, Gov. Jay Inslee announced plans Saturday to roll out a “No Mask, No Service” order requiring Yakima County residents to wear masks in public and for businesses to turn away customers who won’t comply.

Although Washington is not the pioneer in taking such measures — New Jersey became the first state to require masking in public back in early April, and has since been joined by more than a dozen other states — some community members have pushed back.

Their main arguments, voiced during protests, on social media and in letters to the editor, have centered around some people’s beliefs that the virus is not real, that asking people to wear masks infringes on their freedom, and that masking has not proven effective in slowing the spread or protecting the wearers.

Here’s a recap of what’s known about masking and Yakima County’s response and continuing efforts:

Are masks effective?

Research reports varied results about whether wearing masks “works.”

Factors include the type of mask used, whether the mask is being worn properly, and whether other key factors such as social distancing and good hygiene also are taking place.

The Mayo Clinic, a nonprofit academic medical center with multiple locations throughout the United States, notes that different types of masks offer different levels and types of protection:

  • N95 masks: Actually a type of ventilator, an N95 mask blocks an estimated 95% of particulate matter that could be carrying germs and offers the highest level of protection for wearers. However, certain types of N95 masks release unfiltered air, meaning that people who come in contact with the wearers would not be protected from catching COVID-19 if the wearer is infected.
  • Surgical masks: Also called medical masks, these disposable, loose-fitting masks are estimated to block 70% of particulate matter in the air that could be carrying germs while also blocking a significant amount of possible pathogens from entering the air if an infected wearer sneezes or coughs.
  • Cloth masks:

While cloth masks don’t provide as much protection

  • , they block a significant amount of virus from entering the air from infected people who sneeze or cough.

That’s mirrored in Yakima County’s ongoing messaging to residents: You don’t wear masks to protect yourself, you wear them to protect others in the event you could be infected.

The CDC, WHO and the Mayo Clinic also note masks are only effective if worn properly, with the mask fitting snugly against a person’s face and fully covering a person’s nose and mouth.

The organizations acknowledge that masking by itself will not stop the spread of the COVID-19 pandemic. But they agree that masking properly is an important tool, when used in conjunction with social distancing and appropriate hygiene.

The Yakima Health District’s continued advice for residents also acknowledges that trifecta.

“The mask could help by blocking infectious droplets from spreading when someone with the infection coughs, sneezes, breathes or speaks,” the district said. “The recommendation for face masks is always in tandem with other recommendations such as social distancing, hand washing and sanitizing services.”

But to reap any positive benefits from masking, people have to wear masks. In Yakima County, that largely hasn’t been the case, according to a survey from the Yakima Health District.

The survey reported that only 35% of more than 2,000 people observed completing essential tasks over Memorial Day weekend chose to wear masks while they were out and about.

What has the county done?

The health district conducted the first round of the “Operation Unmasked” survey in May.

On May 23 and May 24, evaluators observed 2,574 people entering 50 retail stores to see if people were choosing to mask. The survey reported 65% of observed individuals were not wearing masks. For those who were wearing masks, 59% were female and 41% were male, according to the survey’s results.

Yakima Health Officer Teresa Everson said that percentage was nowhere near the county’s goal of getting 80% of people to mask — a goal that accounts for those who could not safely wear masks, she said.

The Yakima Health District issued a mask directive June 1, encouraging people to wear masks while out in public. The directive allowed exceptions for those not able to safely wear masks, including people with breathing problems and very young children. The directive carried no enforcement authority or penalties for those who choose not to wear masks. The Yakima City Council approved a proclamation from Mayor Patricia Byers at its June 2 meeting that also encouraged city residents to voluntarily wear masks when in public.

Yakima County, along with the Greater Yakima Chamber of Commerce and the Yakima Health District, have since launched the “Mask Up to Open Up” campaign.

The Yakima Health District is distributing 330,000 surgical masks. The city of Yakima helped distribute 95,000 of those masks, and the city of Wapato also made 5,000 available to its residents.

Also in June, county staff have distributed masks at 16 grocery stores for free distribution to shoppers.

The Yakima Valley Office of Emergency Management has coordinated mask distribution efforts through a Yakima County Businesses Mask Campaign and a cloth mask campaign for low-income people and agricultural workers.

For the business campaign, the office has sent out 190,000 masks to 180 businesses throughout the county. An additional 184,000 masks have gone to cities within the county.

The office also has sent out 220,000 masks for low-income individuals and agricultural workers; 40,000 masks through school district lunch programs; 6,800 masks to Yakima Valley College and Pacific Northwest University of Health Sciences; and 4,000 masks to food banks and homeless shelters.

The office posted information about the masks in English and Spanish on its social media platforms, as well as through emails to partners — including business contacts, health care and first-responder communities, churches, agricultural facilities, colleges, food banks, shelters, and schools — and has worked with media contacts, including within the Yakama Nation, the Yakima Farm Workers Clinic, Neighborhood Health, and Spanish-language television, newspaper and radio partners.

What else is in the works?

Details of Inslee’s “No Mask, No Service” order for Yakima County are expected to be finalized early this week.

The Yakima Health District plans to release results of a second survey sometime this week, which will include observations of whether people are wearing masks as they go about essential tasks.

The county Office of Emergency Management has 110,000 masks for small businesses as well as additional masks for cities upon request.

“The masks do not provide any benefit if they are sitting in our warehouse,” emergency management said in a news release.

Coronavirus Coverage

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Reach Lex Talamo at ltalamo@yakimaherald.com or on Twitter: @LexTalamo.