The professionals at the Cochrane Review are generally and widely trusted in clinical medicine. From Wikipedia, one can learn that The Cochrane Library is a “database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine.”
A recent review referenced by Vinay Prasad on Substack is entitled “Do physical measures such as hand washing and masking stop or slow down the spread of respiratory viruses?” Their conclusion after reviewing all relevant good quality studies is that there is no evidence that masking is of measurable benefit in preventing the spread of such viruses. This finding is in stark contrast to the standard practice in most US hospitals, including the one where I practiced the last 20 years, which insist on universal masking in common areas, even in clinics where only chronically ill patients are seen. I find this curious and even troubling. At the same time, my recent time in airports suggest that only about 5% of travelers are voluntarily wearing masks, mostly paper surgical masks. I have not read any recent surveys to assess the knowledge base of the American lay public. Despite all that has been written, I suspect that there remains great ignorance. Today, on a brisk windy winter day in Texas on my morning bicycle ride, I encountered others who were wearing surgical masks.
So let me provide an update on my understanding on the science and literature on face masks when it comes to containing the contagion of respiratory viruses.
Cloth masks are entirely worthless in protecting the wearer or his/her contacts. The pores within the threads are too large to effectively keep viruses from penetrating in or out.
Surgical masks are made of paper and have been used to prevent surgical patients with open wounds from being contaminated by the oral and nasal secretions of caretakers. Although not systemically studied, there is empiric evidence of fairly good efficacy.
N-95 masks were created to protect the wearer from acquiring highly infectious organisms from acutely infected patients. Classically, the rare individuals with active pulmonary tuberculosis are ideally cared for in negative pressure rooms by individuals wearing “fitted” N-95 masks. KN-95 masks were modeled on the N-95 and are likely almost as effective although the multiple different commercial brands have not been subjected to study.
The outdoor environment dissipates viral dispersion from individuals who are infected so effectively so that unless a person is seated next to another infected individual with variable physical touch at close quarters for a length of time, there is virtually ZERO chance of being infected by another person. In other words, wearing masks outdoors has never made any sense during the pandemic with the possible exception of organized closely seated events outdoors.
Masking is often associated with physical distancing by recommendation, by conscious or subconscious behavior, or via the effect of written warnings. Thus, alleged protection by masking has always been difficult to separate from associated behaviors.
The continued insistence on masking in healthcare settings may have contributed to the general loss of respect that appears to have spread through the US population in the last three years. Confusing and contradictory recommendations with poor retrospective explanations by Dr. Fauci and other public health individuals has contributed to the confusion and cynicism of the general population. The evident academic disaster and concomitant uptick in psychological dysfunction over the last 2.5 years among the young may be, in part, due to the insistence on masking in even the youngest children.
I believe that if the prevalence of COVID is high enough in a given US community, masking in the Emergency Department or Intensive Care Units may be appropriate but in other parts of hospitals where all patients have screened negative for COVID and in almost all clinics, there should be an immediate suspension of masking requirements. Free surgical masks should be available to visitors and families and N-95 masks should be on sale in gift shops or vending machines.
Human faces communicate the most important of emotions and are key for all forms of communication. Communication is vital in healthcare. We should NEVER allow the restriction of family visitors in the future for the deathly ill and dying patients in the hospital. Just one man’s opinion.