ARGUMENT: Getting Real about MasksWhat Can Masks Do?

Facemasks have been a contentious issue since the outbreak of the COVID-19 epidemic, and the discussion of whether or not the wearing of facemasks should be required – and who has the right, if any, to mandate the wearing of facemasks – has become thoroughly politicized.

Lisa M Brosseau and colleagues, in a 2-part series in CIDRAP, examine the important issues: whether facemasks are effective in preventing or slowing down the spread of COVID-19, and whether the various studies of facemask effectiveness were properly conducted.

Their answer to both questions is a qualified “no.”

The authors write:

we want to make clear that we are not “anti-mask.” Rather, we are in favor of wearing the most protective facepiece for the setting—such as a non-fit tested respirator when spending more than a few minutes in a crowded indoor space—and in combination with other interventions.

The data are clear that most cloth face coverings and surgical masks offer very limited source control (protection of others from pathogens by limiting emissions from an infected person) and personal protection against small inhalable infectious particles and should not be considered a replacement for other, more effective methods of reducing one’s exposure to SARS-CoV-2, such as vaccination and good ventilation.

They add:

Mask wearing has been an extremely polarizing and politicized topic across the world, but especially in the United States. Endless unrealistic expectations, along with gross misinterpretation and overconfidence, have been evident, including claims that masks alone would “flatten the curve,” “end the pandemic,” or “reduce the clinical severity of COVID-19.” Now, one and a half years into the pandemic, if masks were as effective as many believed them to be, we should have seen significant impacts. But that has not been the case anywhere on the globe.

This is not to say that masks do not play a role in disease control, but that public health officials should not oversell the role of masks. Rather, they need to encourage appropriate mask use in the context of other highly effective interventions such as vaccination.

They conclude:

It is time to lower the unrealistic expectations about masks—or any single intervention. Public health messaging needs to be focused on many interventions, starting with those at the top of the hierarchy. Masks offer very limited source control, and personal protection and should not be considered a replacement for vaccination or equivalent to interventions such as limiting time and numbers of people in a shared space or improving air movement.

Scientists must return to the time-honored practice of waiting for peer review before touting their study findings. No single study, regardless of the number of subjects, deserves to skip that important step in the process of building a body of evidence.

We urge journalists to not be taken in by scientists’ claims for their non–peer-reviewed studies, even if those scientists hail from highly reputable institutions. Rather, we urge journalists and news outlets to question closely why scientists find it necessary to advertise their study ahead of peer review.

We are well past the emergency phase of this pandemic, and it should be well-known by now that wearing cloth face coverings or surgical masks, universal or otherwise, has a very minor role to play in preventing person-to-person transmission. It is time to stop overselling their efficacy and unrealistic expectations about their ability to end the pandemic.