As adults, we learn that much science is every-changing. Scientists themselves argue continuously on nearly all subjects which, hopefully, bring us better data over time on a myriad of issues. As to the same with face masks and facial coverings. There are some “junk” studies out there, and there are some quality studies that have determined whether face masks (and all their variations) are effective at preventing viruses, including COVID-19. “Experts” are not even able to agree whether COVID-19/SARS-CoV-2 is airborne.
With almost 80% of Floridians saying the government should force them to wear masks, we thought we’d see what the science says. We will limit this article to better quality studies on the issue via RCTs (random control trial studies) and/or peer-reviewed studies. This is a novel coronavirus and we continue to learn more; therefore, anyone who states that the “science is in” or the “science is settled” is mistaken.
One item of note when reading about COVID-19 is that the droplets or shedding by the virus has a particle size (0.06 microns to .1 microns) smaller than many viruses, including the most prevalent influenza this year in America, H1N1 (.12 microns). The single-use “surgical” mask many are wearing today only are effective up to 3 microns, everything smaller will get in or get out. An N95 mask is effective up to .3 microns, still allowing the transmission of COVID-19.These masks are great for keeping out bacteria and bodily fluids, though according to most but not all studies, not COVID-19.
The culmination of 14 RCTs published in May 2020, found that face masks do not have a substantial effect on transmission of laboratory-confirmed influenza. “They similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.” The paper concluded, “Disposable medical masks (also known as surgical masks) are loose-fitting devices that were designed to be worn by medical personnel to protect accidental contamination of patient wounds, and to protect the wearer against splashes or sprays of bodily fluids (36). There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure. Our systematic review found no significant effect of face masks on transmission of laboratory-confirmed influenza.”
The Lancet released a paper in June 2020, which refutes the above collection of 14 RTC studies, by taking the meta-data from 172 observational studies but excluded random control studies. It is unknown why the W.H.O. funded study would focus on observational studies rather than the more scientifically robust random controlled studies. It found that face masks could reduce risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty).
There was a randomized trial of 1,437 college-aged adults during the 2006-2007 flu season. The study found, “Face mask use alone showed a similar reduction in ILI compared with the control group, but adjusted estimates were not statistically significant. Neither face mask use and hand hygiene nor face mask use alone was associated with a significant reduction in the rate of ILI cumulatively.
In 2015, a randomized control study was done with 1,607 hospital care workers and they “caution against the use of cloth masks.” In April 2020, the authors of the study offered an update in leu of COVID-19, saying to wear a cloth mask as a “last resort.”
In a study sent to me, it had the title “Universal use of face masks for success against COVID-19: evidence and implications for prevention policies.” It stated, “As SARS-CoV-2 is also embedded in aerosols <5 μm in diameter, it cannot be determined whether they are always effective.” The study also referenced another study that dealt with comparing N95 and surgical masks which concluded, “The use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory‐confirmed influenza. It suggests that N95 respirators should not be recommended for general public and nonhigh‐risk medical staff those are not in close contact with influenza patients or suspected patients.”
Another study sent to me included this study in its references, which contradicted the original study. It concluded, “A modest proportion of attendees of MGs [mass gatherings] use facemask, the practice is more widespread among health care workers. Facemask use seems to be beneficial against certain respiratory infections at MGs but its effectiveness against specific infection remains unproven.”
So, taking all this data in, it is clear there is no consensus, regardless of what people are saying, it is more important to look at unbiased data, regarding the efficacy on masks regarding viruses and especially relating to COVID-19/SARS-CoV-2.
To be frank, when I started this story a few days ago I had expected different results and was surprised, and disappointed, we do not have better data at this point. Perhaps future RCTs will offer a better consensus as it relates specifically to COVID-19/SARS-CoV-2.
The masks most Americans are using may help behaviour to keep one from touching their nose and mouth, but as we see with the data, that does not seem to be of any consequence relating to whether or not one will contract COVID-19. It is no wonder that Hong Kong, with a 97% rate of wearing face masks in public, is going through a third wave of COVID-19.
Even the famous Dr. Anthony Fauci isn’t sure whether or not masks are effective. During a 60 Minutes interview in March 2020, Fauci said that people should not be walking around wearing masks. He said, “When you are in the middle of an outbreak, wearing a mask may make people feel a little better and it might make even block a droplet, but it’s not providing the perfect protection that people think that it is. And often there are unintended consequences.”
Then, on July 17, 2020, Fauci said that everyone needs to wear masks in order for the country to reopen.