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Public Wearing of Face Masks During the COVID-19 Crisis
TAKE-HOME MESSAGE
- This short commentary posits that widescale wearing of masks by the general public in our current COVID-19 reality is a commonsense precaution. Wearing masks in public, and, when necessary, at home can prevent some transmission of the infection.
- Waiting for randomized controlled trial evidence before adopting masks as a policy is likely to cause harm when even limited protection offered by mask wearing is likely to save some lives.
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe precautionary principle is, according to Wikipedia, “a strategy for approaching issues of potential harm when extensive scientific knowledge on the matter is lacking.” The evidence base on the efficacy and acceptability of the different types of face mask in preventing respiratory infections during epidemics is sparse and contested. But covid-19 is a serious illness that currently has no known treatment or vaccine and is spreading in an immune naive population. Deaths are rising steeply, and health systems are under strain.
This raises an ethical question: should policy makers apply the precautionary principle now and encourage people to wear face masks on the grounds that we have little to lose and potentially something to gain from this measure? We believe they should.
Additional Info
Disclosure statements are available on the authors' profiles:
Face Masks for the Public During the Covid-19 Crisis
BMJ 2020 Apr 09;[EPub Ahead of Print], T Greenhalgh, MB Schmid, T Czypionka, D Bassler, L GruerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
COVID-19: Face masks for the public
It is my new morning ritual. I drive to my office (I am still considered essential) and park (street parking has been wonderfully available). I don my well-worn surgical mask and walk to the entrance of the hospital where I undergo symptom screening and a temperature check to earn a new colored adhesive dot for my name tag. I walk through the tunnel to our attached academic building, use the hand sanitizer dispenser on the wall, enter my office, and doff the mask.
Likewise, when I go the grocery store and the hardware store, I sport my mask. If I jog or walk, I have it with me, just in case I encounter others on the empty routes I usually choose. I cannot, however, exercise for long within its confines. Overall, it is a small inconvenience.
A brief evidence review for the use of face masks while in public provides some useful insights as well as underscores the limits of our knowledge. Despite the high frequency of respiratory virus infection across humankind and the low cost of masks, there is a dearth of good studies on face mask use (this is in some ways a commentary on our collective priorities). From five systematic reviews that have been published and two pre-print systematic reviews, one can glean the following:
Justifications for not wearing a mask in public include the limited assessments of effectiveness, the likelihood that they are not worn properly or consistently, the possibility that wearers may feel protected and avoid other public health interventions, and the need to reserve masks for healthcare workers.
In this review, the authors invoke the precautionary principle in approaching an issue of potential harm when scientific knowledge is lacking. In other words, when it comes to using a simple and cheap intervention that may be effective, they suggest wearing a face mask in public.
Given the thinness of the evidence and my penchant for an evidenced-based approach, why have I adopted a new ritual? I think that there are actually three reasons. First, I do so out of respect for, and in solidarity with, my frontline colleagues who depend on PPE for their safety and that of their families. Second, when out and about in my small town, I see myself as a role model for good social behavior. Finally, like the authors, I believe in the precautionary principle when it comes to this strange and frightening virus. What do I have to lose?