COVID 19: To Mask or Not To Mask

There has been a lot of controversy regarding the use of face masks to prevent the spread of COVID 19. Although most of the data do suggest some reduction in spread of the virus, the question is whether the reduction was actually caused by the mask or was it due to other conditions caused by our changing lives from the COVID 19 pandemic.

JAMA Study

A recent study in JAMA demonstrated that facemasks have significantly decreased the spread of COVID 19.[1] They quote a study performed in a large hospital system from March until now that showed a significant decrease in COVID-19 transmission in hospitals where mandatory facemasks were required.[2] The rate dropped from 14.7% to 11.5%, a mean decrease of 0.49% per day. This 3% total drop difference is really not much, compared to the high hype that the media are giving this modality.

Just think, every time you’re wearing a mask diligently everywhere, you’re only reducing the rate of you getting COVOID 19 by about a half of one percent. What a deal! Even the JAMA study says that this decrease may be particularly important for hospitals. But even in this hospital system that sees a lot of COVID 19 patients, the decrease was only around 3%. This is important for those working in a hospital, but would the rate be the same in public systems?

There is much evidence that those who are symptomatic from the virus can spread it. The CDC has said that their evidence suggests those who are asymptomatic rarely spread it, and this has been confirmed by other studies. Those studies that have said there is much symptomatic spread are largely antecdotal case studies and not well supported by science.[3]

A Korean study found that casual interactions with the general public show a 1% spread to others in the young and a 2% spread in middle age, with a 3%-4% transmission in those age 64 to over 85. [4] This and other studies were done in high population density areas, and these have higher rates of COVID 19. The percentages are not huge amounts of spread to support the need for everyone to wear a face mask, especially in lesser populated areas.

Confounding Factors

Other studies have shown a reduction in COVID 19 transmission when universal masking was required. This was anywhere from 0.3% to 3% reduction. The study was done in New York and Italy, primarily in high density population areas such as Milan.[5]

However, during the period of the required universal masking, pollution rates were markedly reduced. And the higher the pollution, the easier it is for viruses to be transmitted. Perhaps part of this reduction was from the lowered pollution and not the masks.

In addition, in the lower part of the United States we have had a dust cloud invade us from Saudi Arabia. This may have partly been the reason for the huge uptick in cases of COVID 19. The masks may decrease transmission of the dust, but this has not been substantiated.

Population density may also be a factor, as New York, Milan, Dallas and other metropolitan areas show increased COVID 19 transmission. However, smaller population cities, especially rural areas do not show these increased rates. It is questionable whether wearing masks in those areas does much good. In fact, may refuse to wear masks and don’t show a spike in transmission rates because of this.

Another factor is that most people don’t wear masks appropriately. In order for the N95 masks to works, which have been shown to decrease viral transmission, they must seal over the face, and the person must only breath through the fibers of the mask. Unfortunately, most people can’t tolerate these at all. When presented with the minimal reduction in transmission, most refuse to wear them.

Mask wearing is not completely safe. N95 masks have been shown to induce an initial hypoxia (lack of O2) and hypercapnia (build up of CO2). This can lead to respiratory alkalosis and metabolic acidosis with respiratory problems.[6] Other face masks may cause these problems too. In fact, many physicians have stated that wearing a mask may endanger the health in those with respiratory disease and heart disease.[7]

Moreover, most people hate wearing just regular masks. Many say they just “can’t breathe” with them on. This is more common than not. So they usually open the mask up at the top or bottom so they can breathe, which defeats the purpose of the mask.

Masks or cloth face covering are made of fibers woven together. Microscopically the space between the fibers is very wide compared to the size of the COVID 19 virus. They can pass through them without a problem. One of my patients put it truthfully this way, “it’s like putting up mosquito netting using chicken wire.”

Many people say that they know that they are not protected from COVID 19, but masks prevent the spread of the virus if you’re symptomatic. Unfortunately, studies have shown that mask prevent only about 1/36th as many droplets from cough if the person is 8 inches away from the person coughing.[8]

What is it that we Fear from COVID-19?

The biggest thing that we fear from COVID-19 is the possibility that we might get the virus infection and die. But what is the chance of this happening? For most of those under the age of 64, the chance is very small, <1% in those under 35 and this increases gradually over 64 to 85. However, it can be safe to say that the chance of recovering from the virus and/or having an asymptomatic case is around 98% to 99%.

Therefore, the question is whether fearing 0.49% chance of dying from this virus that is curable in around 98% to 99% is worth worrying about and worth all this mask wearing and social distancing is something each of us should ponder. The fear of death from COVID 19 appears to be a more media created hype than a reality with percentages. Bottom-line, you should not fear this anymore than you do when you drive your car every day, which has a much higher death rate.

Facemask manufacturers generally place on their labels that the facemask will not protect the person wearing it from bacterial or viral illness. Some even blankly state that they will not protect against COVID 19. Even the CDC has stated that face covering will not prevent a person from getting COVID 19 but may decrease transmission to others if you have it. However, as mentioned earlier, even this statement is questionable.

Conclusion

The percent decrease in transmission with universal masking may be up to a 10% change, but this difference has been in association with other factors including environmental factors. The possibility of getting COVID 19 on a casual pass-by of a person or minimal exposure of a person is around ½ of 1%.  Thus, the choice to choose should I mask or not depends on you. Everyone should evaluate this data and decide on whether they are willing to accept these risks, knowing that nothing is totally safe. Is it best for them to continue supporting laws that require masking from governments, or not have such controlling governments who have obviously educated themselves and read the new data?

[1] Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission—The Time Is Now. JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.13107

[2] Wang X, et al. Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA. Published online July 14, 2020. doi:10.1001/jama.2020.12897

[3] Furukawa NW, Brooks JT, Sobel J. Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic. Emerg Infect Dis. 2020;26(7):e201595. doi:10.3201/eid2607.201595

[4] Park YJ, et al. Contact tracing during coronavirus disease outbreak, South Korea, 2020. Emerg Infect Dis. 2020 Oct. doi.org/10.3201/eid2610.201315

[5] Renyi Zhang, Yixin Li, Annie L. Zhang, Yuan Wang, Mario J. Molina. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proceedings of the National Academy of Sciences Jun 2020, 202009637; DOI: 10.1073/pnas.2009637117

[6] Johnson AT. Respirator masks protect health but impact performance: a review. J Biol Eng 2016;10:4. doi 10.1186/s13036-016-0025-4

[7] MWGFD. Positionspapier der MWGFD zu ‘COVID-19.’ Available at: https:// www.mwgfd.de/2020/05/positionspapier-der-mwgfd-zu-covid-19/. Accessed June 20220

[8] Greenhalgh T. Episode 6: Policymaking on masks for general public. Royal Society of Medicine COVID-19 Series; Apr 21,2020.

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