In the fight to ward off COVID-19 we believe the wearing of face masks is the single most important measure the public is being asked to take. This does not negate the efficacy of the other measures — washing hands, staying home when feeling ill, etc. — but if we are correct that wearing a mask is paramount, it brings into question the measure that has had an enormous negative effect on how our society and economy operates.

Social distancing, which aims to accomplish the same goal of preventing airborne viral-transmission as mask-wearing, may become less necessary as restrictions ease.

The efficacy of the face mask has been recognized in the mainstream media recently for the good reason that it is backed up by good science. It is unfortunate that the federal Centers for Disease Control and Prevention (CDC) and others discouraged face mask use in the early stages of this pandemic. There seems to have been other factors at work; regardless, it is unfortunate.

While social distancing has been long accepted as a preventative measure, its value should also be evaluated in the context of face-mask use.

So, how effective are face coverings — what does science tell us? Studies over the last 20 years we found online generally agree on the effectiveness of face masks. A representative, recent (March 25) study out of China comes from the Wiley Journal of Medical Virology, entitled “Potential utilities of mask-wearing and instant hand hygiene for fighting SARS -CoV-2.”

The results for masks stated: “This study showed that N95 masks blocked nearly all the mock virus, and medical masks blocked approximately 97% of the virus, and the homemade mask blocked approximately 95% of the virus.” These positive results for the first two types of masks are in keeping with other studies, and usage in hospital situations, where risks are much higher than the public faces in everyday life (onlinelibrary.wiley.com/doi/full/10.1002/jmv.25805).

However, the general public shouldn’t use the N95 mask, which is overkill, harder to breathe through, and in short supply for medical professionals. Disposable medical masks used in hospital situations are a good choice provided they are available and certified, and they do not appear to be in short supply, as there are dozens of options to buy them on Amazon and at drug stores, some as cheap as 50 cents apiece.

While the efficacy of the cloth, homemade mask does not have universal agreement in the medical literature, the mask in the March 25 study that is clearly very effective was comprised of one-layer polyester combined with four-layer paper towel material. Additionally, when worn by an infected person, any escaping virus would stay close and be of low dosage.

As there are numerous materials, thicknesses and filters that could make up a cloth mask, it’s clear that many cloth masks can be as effective as the mask tested here, and we hope for more research. We note the CDC now promotes cloth masks.

The efficacy of the face mask indicates health and elected officials may be wise to strengthen mask-use guidelines and requirements with good messaging and robust enforcement, at the same time as rigorous social distancing becomes less practical in the reemerging world.

The public needs to be informed, and trusted to follow or take the appropriate measures. It could be argued that there is greater risk without the 6-foot distancing, but we contend if all the other guidelines are followed, that few additional cases will result, with benefits outweighing risks.

Hawaii’s transmission rate is extremely low presently, and this is the time to be thinking creatively about all the risks facing us.

Dr. Philip Foti is a pulmonologist; Anton Krucky is former president/CEO of Tissue Genesis, Inc.; Gaylord Wilcox is president of Hanalei Commercial Inc.