Mask recommendations are all over the place. What should we really be telling patients to do?
Kevin Campbell, MD, says evidence that everyone should wear a
mask is shaky at best, and that maybe the general public shouldn’t be
wasting valuable PPE resources.
The opinions expressed in this commentary are those of the author. The following transcript has been edited for clarity.
As healthcare providers, it is very clear — we must all wear masks to
protect ourselves, our patients, and co-workers in the hospital
setting. But what about wearing masks in other non-healthcare settings?
The media will have you believe that EVERYONE should wear a mask at all
times — what exactly are they basing this recommendation on? The truth
is, the evidence is shaky at best.
The preponderance of evidence suggests that wearing a mask outside of
a healthcare facility offers little, if any, protection from COVID-19
infection.
First of all, a COVID-19 exposure is defined as face-to-face contact
within 6 feet with an infected person (symptoms or not) that is
sustained for at least a few minutes — at least 10 and maybe more. There
is very little chance of passing COVID-19 from a passing interaction.
According to
Harvard researchers,
the risk of COVID-19 transmission is strongly correlated with the
duration and intensity of contact: the risk of transmission among
household members can be as high as 40%, whereas the risk of
transmission from less intense and less sustained encounters is well
below 5%.
While a meta-analysis regarding the protective effects of wearing
masks in the community has been published in the last week, the authors
note that the findings on face masks and eye protection are based on
very limited evidence, and none of the practices examined in the study
fully protected against COVID-19 — there really is no silver bullet.
Another study from Texas A&M published in the
Proceedings of the National Academy of Sciences
concluded that masks were essential in curbing the spread, but the
study was not designed to draw these conclusions — it simply studied how
viral particles were spread and extrapolated that the masks would be
effective. So no real proof. There was no direct comparison or any real
experiment using masks to prevent COVID-19 performed so that evidence —
again — is shaky at best.
Currently, I believe that the media is using masking as a political
prop and ultimately it is a reflexive reaction to anxiety and fear over
the pandemic.
Many of you may be familiar with a recent piece in the
NEJM that reviewed the
data regarding universal masking
in the COVID-19 era for hospitals — here is what the authors found and
here are what I believe are the take-away messages from that study:
Masking in hospitals is already accepted practice. During COVID-19
many hospitals have begun to require both patients and providers to wear
masks, and staff now wears masks in hallways and on wards, as well as
in the operating and procedure rooms. In the past we weren’t allowed to
wear masks in the hall.
Universal masking alone is not the answer even in the healthcare
setting. A mask will not protect doctors caring for a patient with
active COVID-19 if it’s not part of an overall infection-control routine
including hand hygiene, eye protection, gloves, and a gown. Masks do
not keep doctors and nurses from contaminating their hands and spreading
the virus to patients and colleagues. If we focus too much on masks, we
may in fact forget about the other important ways we can prevent
transmission.
Ultimately it may be that masking does not prevent the spread of
COVID-19, it actually both promotes and (in some cases) quells the
spread of anxiety and fear. And furthers political agendas.
S0, what is the bottom line? To be honest, I do not think we really
know conclusively at this time. However, I believe that masking for some
groups in some settings is essential. But for others, it is ineffective
and wastes valuable PPE resources.
According to a letter in The Lancet,
“Global shortage of disposable surgical masks is a real and expanding
problem. So-called mass mask panic has occurred irrespective of advice
from public health authorities.”
Obviously if you are a doctor, nurse, dentist, or other healthcare
worker, you must wear a mask in order to protect yourself, your
patients, your family, and your colleagues.
If you are in a high-risk group — the elderly, those with diabetes,
heart disease, asthma, lung disease, cancer, or if you are
immunosuppressed, you should limit your social interactions and if you
go out in public, you should wear a mask. These are the folks who should
continue to quarantine until there is a vaccine available.
If you are going into a healthcare facility, you should wear a mask.
If you care for someone who is high risk for COVID-19, you should wear a mask.
If you are going to a public place where there is no opportunity for
social distancing or if you will be in a contained space for an extended
period of time, you should wear a mask.
Who does not need a mask?
If you are otherwise healthy and are not high risk, there is no
evidence at this point that by wearing a mask you will decrease the
chance of getting COVID-19 — simply running to the grocery store or the
gas station is not a reason to wear a mask.
If you are golfing, playing tennis, exercising, riding a bike, etc. — there is no need to wear a mask.
If you are driving alone in your car, there is no need to wear a mask.
Simply put, use common sense. Do not let the media and politicians
use masking as a way to fear monger and intimidate. Masking has its
role, but its greatest benefits are in the healthcare setting. Random
masking is a waste of resources and may limit the ability of those who
really need PPE to obtain them.
We have to stop using flawed data and bad science to make decisions.
Politicians are leveraging data that they do not understand in an effort
to set policy and advance their own political agendas. For example, in
North Carolina, Governor Roy Cooper continues to keep the state on
lockdown long beyond what neighboring states have done and is now
threatening to mandate masks for any citizen who goes out in public in
what appears to be another gubernatorial power grab in that state.
It’s time we stopped allowing politics and fear to dictate science —
science and data should dictate good politics and public policy instead.
Kevin Campbell, MD, is a cardiologist based in Raleigh, North Carolina, and chief innovation officer at biocynetic. In addition to his weekly video analyses on MedPage Today
,
he is the official medical expert at WNCN in Raleigh and makes frequent
guest appearances on other national media outlets such as Fox News and
HLN.
https://www.medpagetoday.com/infectiousdisease/covid19/87120
