A Perspective on Universal Masking in the COVID Era

This article was last updated on April 16, 2022

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With government-mandated universal masking becoming increasingly common around the world, a Perspective by Dr. Michael Klompas M.D. et al that appeared on May 21, 2020 in the New England Journal of Medicine provides an interesting alternative to the "no mask, no service, big fine" mantra being touted in many jurisdictions.  While this article pertains specifically to the use of masks in a health care setting, the views expressed can be extrapolated into the public arena.

The authors open by noting that as the SARS-CoV-2 pandemic exploded, health care systems around the world took actions to protect both patients and health care workers from the virus.  One of these measures is the use of face masks.  They state that masks form a core component of the personal protective equipment (PPE) which also includes gloves, gowns and eye shields that clinicians need when dealing with symptomatic patients who are suffering from any type of respiratory viral infection.  

The authors suggest that there are two situations in which masks may provide benefits to the wearer in a health care setting:

1.) During the care of a patient with unrecognized COVID-19 – in this setting, a mask will reduce risk only slightly since masks do not provide protection from droplets that enter the eyes or from fomites on the patient or in the patient's environment that health providers may pick up on their hands and carry to their mucous membranes (largely because mask wearers tend to touch their face more often).

2.) Transmission from asymptomatic and mildly symptomatic health care workers – masks worn by health care workers with these conditions may reduce the likelihood of transmission to patients and other health care providers.

Here is a comment from the authors about the wearing of masks in health care settings:

"What is clear, however, is that universal masking alone is not a panacea. A mask will not protect providers caring for a patient with active Covid-19 if it’s not accompanied by meticulous hand hygiene, eye protection, gloves, and a gown. A mask alone will not prevent health care workers with early Covid-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures." (my bold)

While that is certainly understandable given that health care workers have face-to-face contact with COVID-19 patients for extended periods of time, the authors offer this view on the wearing of masks outside of health care facilities:

"We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic." (my bolds)

In their conclusion, the authors state that masks serve a symbolic role; they provide health care workers (and the general public) with a perceived sense of safety and well-being.  The greatest contribution made by the expanded use of masks lies in reducing the transmission of anxiety, an emotion that has grown exponentially thanks to the use of fear by governments during the pandemic.

It is becoming increasingly obvious that the greatest casualty of this pandemic is science.  It has rarely been more apparent that there are very few researchers who agree with their peers when it comes to studying the SARS-CoV-2 virus and the measures that we should be taking to control the spread of the coronavirus responsible for the COVID-19 pandemic.

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