Should you wear a mask?

There is much discussion at the moment on whether or not to wear masks. The following is clearly not based upon any specific medical knowledge, but simply on an analysis of the available evidence, and what may perhaps best be described as informed common sense.

So that anyone reading this knows where I am coming from, I will start from saying it is my view that masks do prevent transmission of the virus, and it is irresponsible for anyone without good reason, not to wear one. The scepticism regarding the wearing of masks that we see in both the UK and the US is in my view totally irrational.

In referring to masks I also include proper face coverings, not simply a scarf, bandana or similar that is seen by many as being ok.

I first started looking at this subject many years ago during the SARS, swine flu, and other similar outbreaks, primarily in China, Hong Kong and other places in the region.

I do appreciate that Covid-19 is a new virus, but it is after all just another coronavirus, so what is relevant to one is clearly applicable to all.

Also, my view has always been that the government and to an extent WHO policy was initially driven by shortage, and not by the health argument.

It also appears to be likely, although many governments have not yet admitted it, that the virus can be airborne. Simple logic dictates that this is the only way that it could have spread like it has. If it was spread simply by coughing etc, and droplets landing on surfaces, there would not have been the massive rate of transmission and infection we have seen.

Earlier this month an article in the BMJ reported that 239 scientists had signed an open letter appealing to the medical community and relevant national and international bodies to recognise the potential for the airborne spread of Covid-19. This concluded with the following. Controlling the pandemic is difficult when the fundamental science determining the response is misunderstood. Accepting the importance of airborne transmission may prove a crucial breakthrough and should not be delayed further.

Although there are a number of other factors, many of the countries particularly in the Asia Pacific region that have seen far smaller infection rates advise and in many places were the first to mandate the wearing of masks, and people generally comply. If as we are constantly told in the UK that decisions are based upon science, how can their health care experts and scientific advisers be so different to ours? Ours are held up to be the best, but if they are that good, why in the UK are we seeing some of the highest per capita death rates in the world.

It is also basic common sense. Surely masks not only help those that haven’t got the virus, as well as preventing those that already have it, from spreading it further. It can also substantially reduce hand to face contact.

As far back as, 2003 the New Scientist published an article detailing a Hong Kong study, usefully titled “Face masks are best protection against SARS”. This came to the conclusion that wearing a mask gave 13 times more protection to health workers than not wearing one. This can be found here.

I am prepared to be corrected, but I have yet to see any peer reviewed studies that say they do more harm than good. I have listened to the opinion of many experts and uninformed commentators, but much of the so-called informed opinion would appear to be based upon personal non-evidence based views or simply pandering to an agenda, whether media or other.

The vast majority of health experts insist the evidence is clear that masks can help prevent the spread of Covid-19, and that the more people wearing masks the better.

Many studies have found that the viral load peaks in the days before symptoms begin and that speaking is enough to expel virus carrying droplets. This is even more relevant in the case of those people, particularly those under 30 who may be carrying the virus, but who never display any symptoms.

As early as May of this year evidence-based studies were appearing supporting the efficacy of masks. One such comprehensive document can be found here.

Of the many comments contained within this document one states, The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts. Public mask wearing is most effective at stopping spread of the virus when compliance is high. The decreased transmissibility could substantially reduce the death toll and economic impact. 

However, the strongest evidence in favour of masks comes from real world studies, all of which indicate that wearing masks does prevent transmission.

Also, and something I have always wondered when hearing differing views, and I appreciate this may seem rather simplistic, but if masks don’t work, why do staff wear them in every hospital in the world.

And almost finally, when people say how pointless they are and how difficult it is to breathe with a mask on, I work on the basis that it is not as difficult as breathing with the aid of a ventilator.

The following are links to a number of articles that reinforce the view that mask wearing prevents transmission. I appreciate I can be accused of cherry-picking articles that support my view, but why not, everyone else does.

Singapore Government

University of California SF

Healthline

University of Oxford

Stanford University

UCHealth

Ian Horrocks

Senior Consultant

BGP Global Services