Mask by guilt
My catholic school upbringing has always led me to have a healthy dose of guilt if I caught myself breaking rules. Case in point, masks. As we enter our third year of Covid, I still wear a mask at the grocery store and at most public places.
But is masking effective against the spread of covid?
On January 30, the Cochrane Library issued a new report on masking, casting doubts on the efficacy of masks, including N95 masks and P2 respirators as effective safeguards against Covid infections. “Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks,” said researchers. Cochrane Reviews are important and considered the gold standard of medical analysis, highly respected among the scientific community.
Masks divide experts
It divided experts. Some say masks continue to be an effective tool in containing the spread of Covid-19 infections. Others state vaccines are the best prevention against infection and that masks are unnecessary. At a recent Ethnic Media Services (EMS) briefing, three physicians offered insight into this debate which is a continuing and contentious issue, and advised keeping ourselves and our children safely masked amid the ongoing health crisis.
Researchers have investigated masks for disease protection since the 19th century. Through the present day in the Eastern part of the world, masks are used in the winter months to prevent getting and giving infections, stated Dr. William Schaffner, Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine.
Scientists, doctors, and the CDC encouraged mask-wearing and enforced mandates during the COVID-19 pandemic primarily to block smaller pathogens, protecting both the wearers and serving as source control, stopping people from infecting others.
However, studies reveal that “most mask studies are notoriously difficult to conduct,” explained Dr. Schaffner. The Cochrane report reviewed a meta-analysis of a very large number of studies conducted primarily before the pandemic and focused mainly on the flu. Influenza is far less contagious than COVID-19. The review included studies where it was hard to monitor people’s behavior whether they were wearing their masks every day and properly—tightly fitted, covering the nose and mouth.
Cloth masks are worthless
All three experts agreed that Randomized Controlled Trials (RCTs) on mask use (more reliable than observational studies) reveal that cloth masks are worthless. The blue surgical masks primarily used by surgeons prevent their bacteria from going into the wounds of their patients, the gaps on both sides rendering them useless for the general public. They concluded that N-95 masks seem not to make much difference.
“Masks are not magic but are suggested for people in high-risk groups,” cautioned Dr. Schaffner. “So, let’s look at who should wear them. Let’s look at the people involved—older people in group settings, indoors (at conventions, religious services, etc.), anyone who is immunocompromised, or with an underlying condition like heart disease, diabetes, pregnant women.”
What makes the difference
What makes a difference are vaccinations and a well-ventilated setting, advised Dr. Mina Hakim, Pediatrics Specialist, South Central Family Health Center. Other effective measures are hand sanitization, washing hands with soap, and surface sanitization.
While the CDC continues to recommend masking all students in communities where infection rates are rising, it is hard to enforce mask mandates for children. “The limitations of wearing masks are to wear them really well, kids can’t keep a thing on, we’ll be lucky if at the end of the day they keep their pants on,” said a smiling Dr. Hakim. They tend to touch different things, then touch their masks and eat and drink throughout the day, which means that children may not wear their masks the correct way.
Heavy-handed mask mandates
Dr. Hakim says that the rate of routine vaccinations in children has fallen due to mistrust of vaccines. “Recommendations vs mandates will help us get where we need to be,” he adds.
“I think our heavy-handed approach during around mask mandates, in particular, did decrease trust in public health,” agreed Dr. Monica Gandhi, Professor of Medicine and Associate Division Chief (Clinical Operations/ Education) of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF/ San Francisco General Hospital.
During the Delta surge, two LA counties had different mandates—Orange county did not require masks, whereas neighboring LA county did. They were side by side, “zero difference” in Covid cases where masks were concerned. Vaccinations were more effective.
“We live in the real world and masks do not work. We aren’t mannequins and wearing masks below your nose or looping it around the ear, is useless. In a perfect world, a very well-fitting respirator on all human beings would reduce respiratory pathogens, but it didn’t, and that is the conclusion of Cochrane as well,” explained Dr. Gandhi.
The research has been evolving, leading to a credibility crisis around the public healthcare system. These new findings lead us to several new questions: To what extent can we trust the experts? Are there political reasons behind these decisions? Can we trust the science?
Can we trust the science?
“The hardest thing for the general public to grasp is that people in public health will give you our best advice today. But, if we find something else tonight, we have to change that advice tomorrow. This is an on-going process,” explained Dr. Schaffner. So clear science-based communication is vital, “that’s the way science works, we change our minds as we learn more.”
At the start of the pandemic, covering our nose and mouth made complete sense, agreed Dr. Gandhi. But now the research suggests otherwise. “Gaining public trust is very important and if the evidence rate is not high enough to support the efficacy of masks, then it should be a personal choice.”
The question then becomes a population-level question — does masking reduce the spread of viruses in the community or protect individuals from contracting the disease?
The review concludes: “Wearing masks in the community probably makes little or no difference to the outcome of laboratory-confirmed influenza/SARS-CoV-2 compared to not wearing masks.”
Photo by aboodi vesakaran on Unsplash
“Coverage is supported by funding by Valley Health Foundation, through the County of Santa Clara Federal Coronavirus State and Local Fiscal Recovery Funds under the American Rescue Plan Act.”