In May 2020 — in the middle of a global COVID-19 pandemic — a screenshot of a dangerously misapplied Facebook fact-checking flag began circulating which falsely and dangerously contradicts best practices around the use of masks in public places:
We spotted the above screenshot circulating in the wild. The left side shows the meme, which consists of three sets of two people. In the first set, a person labeled “Covid-19 Carrier” is not wearing a mask, and an arrow points to a masked person labeled “Contagion Probability %70.” In the second set, “Covid-19 Carrier” on the left is masked, and the second unmasked person is labeled “Contagion Probability %5.”
In the third and final set, both “Covid-19 Carrier” and the other person (“Contagion Probability %1.5”) are masked. At the bottom, text read: “WEAR IT.”
The meme had what seemed to be specific and easy to understand points:
- If COVID-19 carriers do not wear masks and have the ability to infect others, even those wearing masks, the probability of the uninfected being infected is undesirably high;
- If COVID-19 carriers wear masks and the uninfected do not, the probability they sicken others falls — masks work best in containing COVID-19 when those who are infected wear them;
- If both COVID-19 carriers and the uninfected wear masks, the probability the virus will spread falls a great deal;
- Not implied but important was the fact that many COVID-19 carriers are unaware they are infected or contagious, a condition creating much of the spread of COVID-19 in May 2020;
- In sum, the uninfected, the infected, and those who do not know whether or not they have contracted COVID-19 ought to wear masks in public whenever if possible to curtail the spread of the virus.
On the right side of the screenshot, the meme is seen beneath a Facebook-generated fact-check initiative flag reading “False information” and “Checked by independent fact-checkers,” as well as “See Why.” Underneath that, large text reads: “Conclusion: False,” and “The primary claims in the information are factually inaccurate.”
As the screenshot above implied, and those spreading it reiterated, Facebook’s fact-checking flag suggested that the meme’s claims about masks were “false” because its “primary claims” were “factually inaccurate.” To reiterate our point, its primary claims were that when those who are infected and those who are not both wear masks, the spread of COVID-19 is curtailed.
The Facebook Fact-Check
On May 4 2020, Indian website Newsbreak.in published a fact-check with the following headline: “Does wearing masks reduce COVID-19 transmission probability to 1.5%? Here’s the truth.” In total, the fact-check clocked in at 211 words. Of those 211 words, here is the gist:
We fact-checked the above information and found it to be unsubstantiated and false. To begin with, the infographic does not mention the source of this information. We then checked the WHO website for recommendations on wearing a mask and found that a healthy person is only advised to wear a mask if they are taking care of a COVID-19 affected patient.
Although Facebook labeled the meme as false, the post actually concluded:
Hence, the infographic remains unsubstantiated and although authorities globally have encouraged wearing masks while stepping out during the pandemic, there is no scientific evidence that it will reduce the transmission rate to 1.5%.
In other words, the issue with the meme was not that wearing coverings over the nose and mouth reduces transmission of respiratory illnesses such as COVID-19; it was that they were unable to substantiate that the exact number was legitimate. That means that there is also no evidence the specific figure of 1.5 percent was inaccurate, and the meme was “unsubstantiated.”
Unfortunately, the fact-check was short and poorly researched, and Facebook amplified the distilled inaccuracies across the meme seen above — exacerbating confusion and misunderstanding of worldwide public health directives, and encouraging disinformation about masks to proliferate.
Incidentally, the May 4 2020 fact-check amplified by Facebook appeared to contradict guidance in India, where this particular site is based. An April 24 2020 ABC News item titled “The Latest: India announces easing of lockdown restrictions” reported:
NEW DELHI — India announces easing of a stringent lockdown for 1.3 billion people by allowing opening of neighborhood and standalone shops with restrictions such as 50% of workers with face masks and social distancing.
Initial Mask Guidance From Public Health Authorities in the United States Before Late March 2020
To understand the ongoing confusion around the reliability and efficacy of masks as a tool for supporting public health during COVID-19, it is important to understand the timeline of public health guidance as the pandemic escalated.
On March 31 2020, we fact-checked what was at that point novel guidance regarding the use of face masks in public in the United States:
As we explained in that fact-check public health officials feared that a worldwide shortage in personal protective equipment was looming — a circumstance which quickly came to pass.
Consequently, U.S. Surgeon General Jerome Adams and the World Health Organization advised that PPE such as masks be reserved for medical workers on the front lines of caring for those who had contracted the virus as of late February 2020. However, as the situation worsened, the guidance shifted:
Because of a worldwide shortage of supplies, there were still concurrent efforts to enlist people with sewing ability to make as many masks as possible for medical professionals. At the same time, the CDC relaxed its guidelines for personal protective equipment (PPE), and masks in particular.
At a time of increased stock put in official recommendations, the CDC and Adams’ message stuck. A March 17 2020 New York Times editorial appeared just two weeks after the early March 2020 article warning Americans away from masks, speculating that the message taken away from earlier guidance on face masks did little to improve either managing supplies or the mitigating transmission. That, in turn, discouraged their use where available and reduced faith in their efficacy[.]
The Times editorial raised a number of counter-reasons masks should be worn in public during the COVID-19 pandemic, among them their known efficacy in reducing pathogen transmission; the existence of asymptomatic carriers; anecdotally lower rates in areas where masks were commonplace; and their ability to visually reinforce the risk of contracting SARS-CoV-2 in public places.
As of March 31 2020, the WHO still hewed to recommendations that masks be reserved for medical professionals. To be clear, those guidelines were rooted in the primary goal of ensuring that medical personnel were not denied masks during a global shortage. A CNN report on WHO guidance made crystal clear the fact that masks absolutely work to reduce transmission. But the organization deeply feared a long-term protective gear shortage and its effects on healthcare around the world:
World Health Organization officials [on March 30 2020] said they still recommend people not wear face masks unless they are sick with Covid-19 or caring for someone who is sick.
That statement indicates that masks worn by both the infected and uninfected reduce rates of transmission; clearly, the WHO’s position was one of conservation, not any denial of the efficacy of masks. Per the World Health Organization, personal protective gear in short shrift — primarily masks — was to be reserved for the contagious and the uninfected.
The CNN article continued:
“There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there’s some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly,” Dr. Mike Ryan, executive director of the WHO health emergencies program, said at a media briefing in Geneva, Switzerland, on [March 30 2020].
“There also is the issue that we have a massive global shortage,” Ryan said about masks and other medical supplies. “Right now the people most at risk from this virus are frontline health workers who are exposed to the virus every second of every day. The thought of them not having masks is horrific.”
Again, the WHO did not deny that masks were effective in preventing the spread of SARS-CoV-2 between infected and uninfected people. Its position, and Adams’ position, was primarily that masks must be reserved for doctors, nurses, and other medical personnel spending much of their day in close contact caring for those already infected.
Related concerns about improper mask usage were occasionally mentioned. However, at the same time mask recommendations for the general public began, public health officials also addressed how to wear and disinfect masks to avoid improper use that might increase the danger of infection:
March 2020: The Public Health Tide Turns Toward Mask Use
Dates and the progression of information during an active and escalating pandemic are of vital importance in understanding why public health officials went from advising the public to avoid hoarding masks to informing the public wearing masks in public was safer from a public health perspective. On April 4 2020, MedPageToday.com’s “It’s Official: CDC Recommends Public Wear Face Masks” explained:
The CDC is now recommending that everyone should wear a cloth face covering when out in public places to protect others in case they are unknowingly infected with the virus.
Late [on the night of April 3 2020], the agency updated its consumer-facing web page for COVID-19 self-protection as follows:
- Cover your mouth and nose with a cloth face cover when around others.
- You could spread COVID-19 to others even if you do not feel sick.
- Everyone should wear a cloth face cover when they have to go out in public, for example to the grocery store or to pick up other necessities.
- Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
- The cloth face cover is meant to protect other people in case you are infected.
- Do NOT use a facemask meant for a healthcare worker.
- Continue to keep about 6 feet between yourself and others. The cloth face cover is not a substitute for social distancing.
In those bullet points, several things are made clear in guidance as of April 3 2020, superseding guidance issued before that date:
- All members of the public were advised to cover their mouths and noses in all public spaces;
- It was possible to be asymptomatic, unaware you are infected, and still spread SARS-CoV-2;
- “Everyone” should wear a cloth mask in public places, if they were over the age of two or otherwise could not safely wear a mask: “anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance”;
- The cloth face cover’s primary purpose is to protect uninfected people from asymptomatic spreaders;
- Face masks intended for use in medical settings were to be reserved for healthcare workers.
The article’s final paragraph once again hinted at an evolution of public health guidelines against a backdrop of an active pandemic and disinformation that clouded the issues around the transmission and the severity of the virus:
While asymptomatic transmission of the virus outside of China was discovered in late January , White House officials had initially suggested that it was not an important driver of transmission. “You really need to just focus on the individuals that are symptomatic,” HHS Secretary Alex Azar told ABC News in March .
That article referenced a CDC page last updated on April 3 2020, “Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission.” Once again, the key points — reiterated everywhere — appeared:
CDC continues to study the spread and effects of the novel coronavirus across the United States. We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms (“asymptomatic”) and that even those who eventually develop symptoms (“pre-symptomatic”) can transmit the virus to others before showing symptoms. This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms. In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.
It is critical to emphasize that maintaining 6-feet social distancing remains important to slowing the spread of the virus. CDC is additionally advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.
The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.
To reiterate what the Centers for Disease Control and Prevention said:
- As of late March and early April 2020, the proliferation of asymptomatic and pre-symptomatic spread of SARS-CoV-2 emerged as a primary factor in increased transmission;
- “In light of [that] new evidence,” the CDC advised all members of the public wear cloth face masks in any public setting;
- The purpose of the cloth face masks was primarily to prevent asymptomatic and pre-symptomatic spreaders from infecting others unknowingly;
- Many of the people in those two categories did not know they were infected or contagious;
- The masks also protected the uninfected, but were more efficient in containing the virus than protecting the uninfected;
- The guidance was issued with a caveat that medical-grade PPE was not to be work or used by the general public.
The Mask Meme Itself
Although Newsmobile.in didn’t address the origin of the mask, we were able to managed to track down the creator of the graphic.
We learned that the graphic came years before SARS-CoV-2, and was created in 2010 by Larry Bowen of In-Tox Products. Bowen clearly did not create the image as advice about a virus not yet in existence in 2010. Here’s what Bowen had to say when our debunker Arturo Garcia contacted him via email to ask about the graphic and COVID-19:
Maybe I can offer this succinct synopsis regarding face masks and COVID-19:
I have worked in high-containment bio labs for many years and worn several types of respiratory protection including face masks and respirators. Knowing what I have learned or have been told about the COVID-19 and all that is still unknown, I would not walk into a room that had any amount (concentration) of airborne COVID-19 while wearing any of the face masks (including the N95 respirator) I tested in my paper without understanding there is some level of risk and danger to my health. Any other interpretation would give a sense of false security – in my humble opinion.
Bowen highlighted an unavoidable element of the COVID-19 pandemic — as a novel coronavirus, very little was known about the rate of spread and efficacy of masks. Papers to cite did not yet exist, and firm numbers remained elusive.
What we had in their absence were best guesses based on existing information, such as Bowen’s 2010 image explaining how masks worked to protect and reduce transmission of airborne pathogens.
Facebook’s fact-checking program dangerously and incautiously labeled a meme indicating masks primarily worked to contain spread of SARS-CoV-2 during the pandemic; when we saw it shared, the poster commented “Even the “fact checkers” don’t buy into this 🤷♂️.”
Unfortunately, Facebook’s flags have far larger reach than the initial meme — a meme now suppressed by the algorithm, ironically, as spreading “false” information.
A 211-word-long “fact check” was cited as the reasoning behind flagging the meme. That fact-check leaned on WHO guidance about reserving PPE, such as masks, for healthcare workers; it was not only based on outdated information, but posed a threat to public health by heavily implying that masks did not work in the way the meme suggested. In fact, the CDC explicitly stated it was “advising the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.”