An infographic showing the rules for wearing a protective mask against the spread of covid-19 coronavirus. How to protect yourself from virus. Pandemic 2020. Isolated on white. 3D illustration.
What evidence do we have that wearing a mask is effective in preventing COVID-19?
There are several strands of evidence supporting the efficacy of masks.
One category of evidence comes from laboratory studies of respiratory droplets and the ability of various masks to block them. An experiment using high-speed video found that hundreds of droplets ranging from 20 to 500 micrometers were generated when saying a simple phrase, but that nearly all these droplets were blocked when the mouth was covered by a damp washcloth. Another study of people who had influenza or the common cold found that wearing a surgical mask significantly reduced the amount of these respiratory viruses emitted in droplets and aerosols.
But the strongest evidence in favor of masks come from studies of real-world scenarios. “The most important thing are the epidemiologic data,” said Rutherford. Because it would be unethical to assign people to not wear a mask during a pandemic, the epidemiological evidence has come from so-called “experiments of nature.”
A recent study published in Health Affairs, for example, compared the COVID-19 growth rate before and after mask mandates in 15 states and the District of Columbia. It found that mask mandates led to a slowdown in daily COVID-19 growth rate, which became more apparent over time. The first five days after a mandate, the daily growth rate slowed by 0.9 percentage-points compared to the five days prior to the mandate; at three weeks, the daily growth rate had slowed by 2 percentage-points.
Another study looked at coronavirus deaths across 198 countries and found that those with cultural norms or government policies favoring mask-wearing had lower death rates.
Two compelling case reports also suggest that masks can prevent transmission in high-risk scenarios, said Chin-Hong and Rutherford. In one case, a man flew from China to Toronto and subsequently tested positive for COVID-19. He had a dry cough and wore a mask on the flight, and all 25 people closest to him on the flight tested negative for COVID-19. In another case, in late May, two hair stylists in Missouri had close contact with 140 clients while sick with COVID-19. Everyone wore a mask and none of the clients tested positive.
Do masks protect the people wearing them or the people around them?
“I think there’s enough evidence to say that the best benefit is for people who have COVID-19 to protect them from giving COVID-19 to other people, but you’re still going to get a benefit from wearing a mask if you don’t have COVID-19,” said Chin-Hong.
Masks may be more effective as a “source control” because they can prevent larger expelled droplets from evaporating into smaller droplets that can travel farther.
Another factor to remember, noted Rutherford, is that you could still catch the virus through the membranes in your eyes, a risk that masking does not eliminate.
How many people need to wear masks to reduce community transmission?
“What you want is 100 percent of people to wear masks, but you’ll settle for 80 percent,” said Rutherford. In one simulation, researchers predicted that 80 percent of the population wearing masks would do more to reduce COVID-19 spread than a strict lockdown.
The latest forecast from the Institute of Health Metrics and Evaluation suggests that 33,000 deaths could be avoided by October 1 if 95 percent of people wore masks in public.
Even if you live in a community where few people wear masks, you would still reduce your own chances of catching the virus by wearing one, said Chin-Hong and Rutherford.
Does the type of mask matter?
Studies have compared various mask materials, but for the general public, the most important consideration may be comfort. The best mask is one you can wear comfortably and consistently, said Chin-Hong. N95 respirators are only necessary in medical situations such as intubation. Surgical masks are generally more protective than cloth masks, and some people find them lighter and more comfortable to wear.
The bottom line is that any mask that covers the nose and mouth will be of benefit.
“The concept is risk reduction rather than absolute prevention,” said Chin-Hong. “You don’t throw up your hands if you think a mask is not 100 percent effective. That’s silly. Nobody’s taking a cholesterol medicine because they’re going to prevent a heart attack 100 percent of the time, but you’re reducing your risk substantially.”
If we’re practicing social distancing, do we still need to wear masks?
A mnemonic that Chin-Hong likes is the “Three W’s to ward off COVID-19:” wearing a mask, washing your hands, and watching your distance.
“But of the three, the most important thing is wearing a mask,” he said. Compared to wearing a mask, cleaning your iPhone or wiping down your groceries are “just distractors.” There’s little evidence that fomites (contaminated surfaces) are a major source of transmission, whereas there is a lot of evidence of transmission through inhaled droplets, said Chin-Hong.
“You should always wear masks and socially distance,” said Rutherford. “I would be hesitant to try to parse it apart. But, yes, I think mask wearing is more important.”