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Sometimes I listen to music late a night, and pretend to look back on my life. I wonder about what I would remember, treasure, miss, value, regret. I look at all the decisions I am making now, and I…

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The Case for Face Masks

This article is not going to suggest that the general public should go out and compete with medical professionals for the limited supply of existing medical-grade face masks.

Let’s get that out of the way at the very beginning.

The supply chain issues are real and we must do everything in our power to support the front-line medical personnel who are battling this virus and taking significant personal risks in doing so. End of story.

This article is about the research and reasoning that supports the wide usage of face masks for the general public in slowing down the transmission of the virus in this epidemic.

In Part II of the article, I will address how we can make face masks ourselves, in our own communities, in a way that doesn’t stress the existing supply chains.

This matters because symptomless carriers are also infectious.

So, basically, you don’t really know who is ‘sick’ and who isn’t.

Or, at least, it’s impossible to tell if a person has the virus, unless either they have completed a strict 7-day quarantine, or they have been very recently tested.

The most effective way to slow transmission therefore is to assume that you do have the virus and also to assume that anyone that you interact with (from a distance of a minimum of 2 meters/ 6 feet at all times) also has the virus.

Given this, if masks were widely available and worn ubiquitously, reason suggests that they would at the very least do no harm and may significantly slow the rate of community transmission, given that they are already actually recommended for people who are displaying symptoms and the people who are caring for them.

‘Face masks are widely used by medical workers as part of droplet precautions when caring for patients with respiratory infections. It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas. As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks.’

Or, you could just say ‘everyone’, because as mentioned earlier, no one knows who the asymptomatic and contagious carriers actually are.

Another argument that has been used against face masks is this one.

This another argument that doesn’t really stand up to the test of reason. First of all, let’s just say that if you are feeling a sense of security that you won’t contract SARS-CoV-2, there are only two possibilities that hold:

It’s crazy infectious.

Hopefully, the public are catching up to this fact and fast.

Face masks are in no way a guarantee that you won’t get the virus, but the important question to consider is still, can they help slow the rate of transmission?

Let’s put this in perspective, in a world that is now spending trillions on economic stimulus packages to deal with the fall out of the epidemic….if there is any proven efficacy to the public use of face masks, and there is little or no harm in doing that, and the supply chain problems can be solved…why wouldn’t you wholeheartedly recommend that people wear them in the appropriate circumstances?

Another frequently used argument is that the public don’t know how to use face masks and that if they are not properly fitted, they are ineffective.

Yes, people shouldn’t adjust their mask too much, or touch the front of them because of the potential exposure to the virus, but any mask offers some protection, however limited, from respiratory droplets.

If the public can get used to social distancing, potentially long periods of quarantine and massive disruption to every possible social norm that existed just a few short weeks ago, why can’t they be taught how to properly use a face mask?

For clarity, here’s a summary:

In comparison to other aspects of the crisis, teaching people how to correctly use face masks doesn’t seem like heavy lifting at all. This is another educational problem, not an argument against efficacy.

So do face masks work? What is the argument for their efficacy? Despite the often repeated phrase by public health care officials that there is little evidence of this, here’s some evidence of this.

First of all, I’m not going to suggest at all that wearing a face mask is a replacement for any other precautionary behaviour or intervention.

It doesn’t replace the need for impeccable hand hygiene.

It doesn’t replace the need for social distancing.

However, face masks used in conjunction with hand hygiene and social distancing have been shown to increase the effectiveness of all of these measures.

You need to do ALL of them.

‘In particular, measures such as hand hygiene that focus on reducing one mode of transmission (i.e. contact) may not be sufficient to control transmission. Measures that may require more detailed consideration include N95-type respirators, improved indoor ventilation, quarantining the infected individuals, and even the use of air humidifiers, given the potential role of humidity in reducing viability of aerosols.’

Not convinced because this isn’t data from a randomised controlled study?

‘Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not significant. [However] transmission of …infection seemed reduced, an effect attributable to fewer infections among participants using facemasks plus hand hygiene.’

Or, in slightly plainer English: ‘Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset.’

To goal was to review the effectiveness of physical interventions to reduce the spread of an epidemic.

This survey was based on the synthesis of 67 studies including randomised controlled trials and observational studies with a mixed risk of bias. The conclusion of the study was:

‘Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures.’

So, there’s that.

Of course, not even the studies that conclude that masks are amongst the best supported of non-pharmaceutical measures are claiming that wearing a face mask will protect you in-and-of-itself.

Just to reiterate, a face mask is just one of many measures you need to employ, including self isolation, social distancing and hand hygiene.

Countries like the UK, US and Australia have certainly been slow to embrace masks, and sometimes quick to ridicule those who choose to wear them.

Is this because of social custom, or is because of the public health advice? Some research suggests that when informed of the potential benefits of wearing a mask, most people then felt it was the responsible thing to do.

In an extraordinary global emergency that currently has 25% of the world’s population in some form of lockdown, perhaps the principle of least harm here should really suggest that encouraging and de-stigmatising the widespread use of face masks as a public health measure is proportionate and reasonable under the circumstances.

coming soon.

People

The Case for Face Masks

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