Standing in line at the grocery store, I noticed the cart behind me full of junk food (cookies, ice cream, processed foods, etc.) and the obese man behind the cart. When I noticed the mask he was wearing I almost laughed out loud! Using the mask to protect himself from the coronavirus (or maybe he was trying to protect me) should have been the least of his concerns considering his food choices and weight! Masks have become the new fashion accessory and it sounds like its one accessory that may be around for a while, but are they worth their hype? As a result of my education over the last few years, I am spending a lot of time doing research instead of watching the newscasters deliver more fear. So I decided to delve into the effectiveness of wearing a mask for disease prevention and here’s what I found.
Since Covid-19 is a relatively new virus, as expected, there isn’t a lot of research specifically on it and the cotton masks we are being told to wear. I did find a study from South Korea that compares the effectiveness of surgical and cotton masks at blocking the coronavirus1. The participants were exposed to the virus and while wearing and not wearing the masks coughed into a petri dish. The inside and outside of the masks were tested. The testing showed the same amount of germs on the inside and outside of the masks allowing the researchers to conclude that the germs traveled through the material or went around the edges of the mask. This is why the researchers noted the importance of washing hands once you touch the mask. Although the study had a small number of participants which makes it hard to draw definitive conclusions from, the researchers said that both masks were ineffective at preventing disease spread. A larger study was conducted in 2015 also comparing the effectiveness of cloth and medical masks2. This study involved healthcare workers who wore their given mask on their shifts for four weeks. The masks were evaluated for their effectiveness at preventing the spread of clinical respiratory illness, influenza like illness, and respiratory virus infections. The rate of infection for all diseases was the highest with the cloth masks. Overall, 97% of the particles were able to penetrate through the cloth masks and 44% of the particles through the surgical masks. The surgical masks were better at preventing spread than the cloth masks but did not eliminate the spread. The authors feel that the problem with the cloth masks may be moisture retention, the reuse of them, and poor filtration which may increase the risk of infection. Therefore they do not recommend health care workers using them. The authors of this study wrote a follow up article that was published on March 30, 2020 in response to the Covid- 19 outbreak because health workers were asking them if they should use cloth masks in lieu of the limited supply of PPEs. The authors feel that the workers should have protection and if cloth is all that is available they should use that. They offer some guidance such as washing and drying the masks after daily use and using an appropriate sanitizer during the day on the mask. This information they caution is not based upon research. They also state that different types of cotton material may make a difference when it comes to effectiveness, but studies have not been completed in this area. Finally, I found a letter written to Dr. Droegemeier in the Office of Science and Technology Policy at the White House from Dr. Richard Besser a member of the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats3. Dr. Droegemeier wanted to acquire information on the effectiveness of cloth masks being worn by the general public during this current pandemic. A team of people from the National Academies of Science, Engineering and Medicine put together information regarding his request. A study is currently being done that compares thicknesses of cotton masks and their effect on stopping the spread viruses as well as the person’s ability to breathe easily while wearing a mask. The team also indicated that the person wearing the mask plays a role in its effectiveness. The mask has to fit correctly to prevent germs from escaping and if the Velcro/straps are weak that will affect the fit. They speculate that wearing a mask could be a reminder to socially distance when out in public. However they were concerned that people wearing masks would not take other precautionary measures to prevent spread. The conclusion of the document states that there is not enough evidence to know if cloth masks are effective and more research needs to be done. The extent of the protection is based upon how the mask is made and worn and how many other preventive behaviors a person employs.
Depending upon your work situation, you may be required to wear a mask while others of us will have to make that choice for ourselves when we go out. Let’s just make sure that the wearing of a mask is not distracting us from making changes in our lives that would truly be beneficial and already proven by research. The man I saw at the grocery store would benefit more by losing weight, since obesity is a risk factor for many diseases that make Covid- 19 worse, and eating a whole food plant based diet to strengthen his immune system than walking around wearing a mask. In the end this eating pattern may not keep us from getting the corona virus or any other disease that becomes the next pandemic, but it can help us fight it and be less impactful on our health.
1Seongman Bae, MD; Min-Chul Kim, MD, Ji Yeun Kim, PhD , et al. Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients. Annals of Internal Medicine. April 2020.
2 MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015;5(4):e006577. Published 2015 Apr 22. doi:10.1136/bmjopen-2014-006577
3Besser M.D., Richard, Fischoff, Baruch; Rapid Consultation on the Effectiveness of Fabric Masks for the CoVid- 19 Pandemic; April 8, 2020.