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COVID-19 Pandemic: Do You Need to Wear a Face Mask? Perhaps.

Do You Need to Wear a Face Mask?   

In the wake of the 2019-20 COVID-19 pandemic, both the general public and medical community precipitated a significant increase in demand for face masks. Medical professionals advised consumers not to purchase face masks, blaming them for complicating shortages of basic medical supplies in healthcare facilities.1 This begs the question: how effective are face masks in mitigating the spread of COVID-19?

COVID-19: Should I wear Face Masks to protect myself from COVID-19?

World Health Organization WHO on Face Masks

            The World Health Organization (WHO) recommends that the general public should wear a face mask only if they have contracted COVID-19, are exhibiting the virus’ systems, or are caring for those diagnosed with or suspected of having contracted COVID-19.2 Similarly, the U.S. Centers for Disease Control (CDC) “does not recommend the routine use of respirators outside of workplace settings,” such as medical facilities, stating that the “spread of respiratory viruses from person-to-person happens among close contacts” and instead advises the public to “[avoid] people who are sick, [avoid] touching your eyes or nose, and [cover] your cough or sneeze…”3

Public’s Response to Face Masks

            However, the general public’s response to the medical community’s advice has been lackluster. With increasing skepticism towards the medical community, particularly given their adamance that medical professionals need face masks so as to not contract the virus themselves, the messaging of the WHO and CDC appears to have backfired.4

Science: How Effective Are Face Masks?

            In a 2010 study published by the United States’ National Center for Biotechnology Information, Marylouise McLaws, epidemiology Professor of the University of New South Wales Sydney, and Jan Gralton, senior adviser to the Infection Prevention and Control and Healthcare Associated Infections division of the Australian Commission on Safety and Quality in Healthcare, analysis of face mask efficacy per WHO guidelines found that the “guidelines for certain mask types cannot be supported or nullified given the current evidence,” appearing to contradict the WHO’s recommendations on face mask use.5

The CDC’s guidelines in 2009 during the H1N1 influenza pandemic appear to corroborate the findings of McLaws and Gralton, stating that “information on the effectiveness of facemasks and respirators… is extremely limited,” whilst at the same time contradicting CDC advice to the general public that face masks are ineffective in protecting individuals from COVID-19.6

Face Mask Efficacy in Reducing Viral Spread

            A 2009 study similarly published by the United States’ National Center for Biotechnology Information by Ben Cowling, Professor and Division Head of the Division of Epidemiology and Biostatistics at Hong Kong University’s Li Ka Shang Faculty of Medicine, School of Public Health, et al., the largest study of face mask efficacy to date, found that although “the interventions did not lead to statistically significant reductions in household transmission,” there were “significant reductions where interventions were applied early after symptom onset in the index patient.7 Although the study was specific to influenza, it is important to note that both COVID-19 and influenza spread through respiratory droplets, and that the study’s authors prescribe their findings “broad generalizability.”7 The study’s findings would suggest that generally there is a lack of evidence entirely on the causal relationship between face mask and mitigation of viral spread through respiratory droplets, and that extant evidence is unable to definitively determine the relationship, but that when executed correctly, transmission rates decrease dramatically.

            Such has been the impetus for recent research findings, particularly that of Shuo Feng, Oxford Vaccine Group of the University of Oxford, et al., published in The Lancet Respiratory Medicine, which found that although “health authorities should optimize face mask distribution to prioritize the needs of frontline health-care workers,” that it should also follow “that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission.”8 Shuo commended the response of the governments of Hong Kong and Taiwan, where face mask use is more prevalent, and which Shuo associates with decreased rates of COVID-19 transmission and infection.

            The Government of Hong Kong Special Administrative Region recommends that individuals “fully cover [their] nose, mouth and chin with mask,”9 similar to the advice of the Taiwan Centers for Disease Control, which strongly encourages the general public to “wear surgical masks when coughing or sneezing.”10 Such appears to be contradictory to the advice of the CDC and WHO which strongly recommend against the use of face masks; although the WHO similarly suggests the use of face masks when an individual exhibits COVID-19 symptoms, it is important to note that this is one of the primary means of prevention employed by Taiwan. Although an explicit connection between face mask use and coronavirus transmission cannot necessarily be tangibly identified, at the time of writing Hong Kong had reported 518 cases of COVID-19 and four deaths, while Taiwan had reported 267 cases of the virus and two deaths, suggesting that even though their outbreaks have been longer than western countries, COVID-19 transmission has been less pronounced.9 10

COVID-19 Conclusion: Are Face Masks Practical?

            Thus, although the CDC and WHO recommend against the use of face masks by the general public, extant scientific research does not demonstrate a causal relationship in their inefficacy. The use of face masks by medical practitioners, determined to be effective in limiting the spread of viral infections that transmit through respiratory droplets, when examined through the lens of case studies in Hong Kong and Taiwan, as well as the conclusion of Cowling’s study, suggest face mask use as practical for the general public.

Works Cited

1. Cramer, Maria, and Knvul Sheikh. “Surgeon General Urges the Public to Stop Buying Face Masks.” The New York Times, The New York Times, 29 Feb. 2020, http://www.nytimes.com/2020/02/29/health/coronavirus-n95-face-masks.html.

2. “When and How to Use Masks.” World Health Organization, World Health Organization, http://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks.

3. “Frequently Asked Questions about Personal Protective Equipment.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 14 Mar. 2020, http://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html.

4. Lopez, German. “Why America Ran out of Protective Masks – and What Can Be Done about It.” Vox, Vox, 27 Mar. 2020, http://www.vox.com/policy-and-politics/2020/3/27/21194402/coronavirus-masks-n95-respirators-personal-protective-equipment-ppe.

5. Gralton J, McLaws ML. “Protecting healthcare workers from pandemic influenza: N95 or surgical masks?” Critical Care Medicine 2010; 38(2): 657-667.

6. “Interim Recommendations for Facemask and Respirator Use to Reduce 2009 Influenza A (H1N1) Virus Transmission.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 24 Sept. 2009, 10:00 A.M., http://www.cdc.gov/h1n1flu/masks.htm.

7. Cowling BJ, Chan K, Fang VJ, et al. “Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Cluster Randomized Trial.” Ann Intern Med. 2009;151:437–446. doi: https://doi.org/10.7326/0003-4819-151-7-200910060-00142

8. Feng, Shuo et al. “Rational use of face masks in the COVID-19 pandemic.” The Lancet Respiratory Medicine, Volume 0, Issue 0.

9. “COVID-19 Thematic Website, Together, We Fight the Virus, Home.” COVID-19 Thematic Website – Together, We Fight the Virus – Home, 2020, http://www.coronavirus.gov.hk/eng/index.html.

10. “Home.” Taiwanese Center for Disease Control, http://www.cdc.gov.tw/En.

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