Critically Questioning the Efficacy of Masks for COVID-19.

In my home county of Windsor-Essex (WEC), our health unit came down with the directive that masks are now mandatory inside commercial businesses. The reason for this is to get WEC out of stage 1 of the Conservative COVID-19 plan and mitigate the spread of the virus. I question the rash and heavy-handed decision by the health unit on a mandatory mask, and question freedom of choice from an individual. The fair way to critique with this lens is to understand the efficacy of masks through peer-reviewed literature and develop an understanding.

The limitations are to consider that this is a short review and I am limited to the amount of research that can be codified. A true meta-analysis takes into account 20-30 articles, and dives deep to code specific themes and topics. For this review I will search on Google Scholar for the 5 most relevant articles relating to “efficacy of masks for COVID 19”. The five peer-reviewed, and most relevant research articles will be used for this review.

After reviewing the articles, the efficacy seems undetermined. Further research is needed and non-linear statistical significance are found with efficacy of masks on COVID-19 (Eikenberry et al., 2020; Liu, 2020). In addition, Greenhalgh et al. (2020) suggests through a meta-analysis of 31 studies, and 12 controlled trials, there was no statistical significance for the efficacy of wearing masks relating to reduction in transmission rates. Further research suggests that surgical masks can stop particles, but not aerosolized particles, and may instill a false sense of security (Javid et al., 2020; Leung et al., 2020).

Out of the five articles reviewed, only two had a stance on universal mask wearing, where other more followed a recommendation model. Most felt that more research needed to be done on masks, especially the use of homemade cloth masks, where only one (though inconclusive) suggests that cloth will stop water particles better than no mask (Javid et al., 2020).

Coding the data would suggest that mask wearing can be beneficial to the population, but the data is inconclusive. Rather, there is widespread agreement that the data is statistically insignificant, and more research needs to be done on the efficacy. Over half suggest theoretically it could help the population if only from a social stance of solidarity against the virus, but not a medical or scientific stance, and few believe they should be universally accepted by a population. From this I would conclude:

1. Masks can be beneficial for peace of mind as a benefit to the population but may not fully protect you from COVID-19.
2. The data is statistically insignificant on the efficacy of masks and more research needs to be done.
3. Masks can prevent from droplets but not from aerosolized particles, and home made masks are far less significant to stopping viruses, but inconclusively be better than no mask.

So this introduces the concept of choice and policy around mask wearing. Sure as a concept of a ‘social unity’ standard which is out of the realm of statistical and scientific conclusions, a mask may be beneficial to some individuals and not others. Ultimately, it should come down to the choice of the individual and policy makers should understand this. More or less policy decisions made with lack of data and significance is irresponsible and produce negative future implications.

References

Eikenberry, S. E. et al. (2020). To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infectious Disease Modeling, 5, 293-308. https://doi.org/10.1016/j.idm.2020.04.001

Greenhalgh, T., Schmid, M. B., Czypionka, T., Bassler, D., & Gruer, L. (2020). Face masks for the public during the covid-19 crisis. British Medical Journal, 1-4. https://www.bmj.com/content/bmj/369/bmj.m1435.full.pdf

Javid, B., Weekes, M. P., Matheson, N. J. (2020). Covid-19: should the public wear face masks? British Medical Journal, 1-2. https://www.bmj.com/content/bmj/369/bmj.m1442.full.pdf

Leung, N. H. L. et al. (2020). Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Medicine, 26, 676-680. https://www.nature.com/articles/s41591-020-0843-2.pdf

Liu, X. (2020). COVID-19: Face masks and human-to-human transmission. Wiley Correspondence. https://onlinelibrary.wiley.com/doi/pdf/10.1111/irv.12740