Four years after the start of COVID-19, Americans are still fighting about what people should or should not do to prevent infection. Tens of millions have decided that they no longer care, even if there is the prospect of devastating long-lasting symptoms. If COVID-19 taught us anything, it is that transmission of viruses through air is a lot more complicated than we used to think. At the beginning of the pandemic, people were told to wash their hands, stand at least six feet apart and not to wear wear N95 masks. That was largely because there weren’t enough and the available supply was supposed to be saved for health workers. People are still arguing about using masks against COVID.
The Surgeon General Said Do NOT Use Masks Against COVID!
In February, 2020 Dr. Jerome Adams was America’s top doc. He told the country:
“Seriously People — STOP BUYING MASKS!” “THEY ARE NOT effective in preventing general public from catching Coronavirus”
We understand that he wanted to save the really effective N95 face masks for healthcare providers. There was also another reason. Most public health professionals believed that the SARS-CoV-2 virus was transmitted in droplets from sneezes and coughs.
People were advised to stand at least six feet away from one another. There was also a huge investment in plexiglass shields. There are still remnants of these plastic barriers in some stores and offices.
Were the Barriers Counterproductive?
Researchers soon discovered that the SARS-CoV-2 virus is not transmitted exclusively in droplets from sneezes and coughs. Instead, it floats through the air and can easily be inhaled.
Dr. Linsey Marr is one of the world’s foremost authorities on transmission of infectious diseases through aerosols. She uses the metaphor of smoke to explain how viruses can drift around a room. She says that if you could smell cigarette smoke, you could also be inhaling invisible viruses. By the way, that holds for cold and flu viruses as well.
An intriguing article in the New York Times (Aug. 19, 2021) by Tara Parker-Pope started with a scary headline:
“Those Anti-Covid Plastic Barriers Probably Don’t Help and May Make Things Worse”
Plastic barriers may actually interfere with good ventilation and permit viral particles to collect in some areas.
Here is how Parker-Pope described the problem:
“Under normal conditions in stores, classrooms and offices, exhaled breath particles disperse, carried by air currents and, depending on the ventilation system, are replaced by fresh air roughly every 15 to 30 minutes. But erecting plastic barriers can change air flow in a room, disrupt normal ventilation and create ‘dead zones,’ where viral aerosol particles can build up and become highly concentrated.”
The Australian Experience:
Researchers in Australia described the transmission of tuberculosis in an office environment where people worked in cubicles (Medical Journal of Australia, Feb. 17, 2014):
“In our case, there were several factors in the workplace design that may have contributed to transmission including a closed air-conditioning system, modern open-plan office design with low profile design of cubicle dividers that allows workers to see and communicate directly with their colleagues without standing…”
Indoor Air Quality Is Not a Public Health Priority:
We have written extensively about indoor air quality. Here is just one article on the topic. Why public health authorities have not encouraged the owners of public buildings to improve air filtration is a mystery to us. Here is a photo we took at a very high-end hotel and restaurant several months ago.
Used air filters from a public establishment
And yes, the air filters looked scary to us.
Why wouldn’t we want our pharmacies, health clinics and even our supermarkets to have high standards for air filtration? We think that all public buildings should have either HEPA or MERV13 air filters. Of course that requires decent heating and air conditioning systems that also bring in fresh air frequently. Given that is not likely to happen any time soon, what about personal protection?
Do Masks Work Against COVID Spread?
Even after four years people are still fighting about viral transmission and the value of masks.
A reader recently asked us:
“Whether and in what situations are masks proven or considered effective in helping to prevent Covid infection? What is the source of the data?”
Almost everything about COVID has been divisive. Masks are no exception. In fact, they are one of the most obvious ways people disagree. Some people are dedicated to wearing masks against COVID. Others argue and scoff.
People Argue About Masks Against COVID:
Here is just a sampling of the hundreds of comments we have received at www.PeoplesPharmacy.com.
One reader complained:
“Masks don’t protect you from viruses. They only protect others from you if you sneeze or cough, and even that is debatable. Masks are stupid and a scam.”
Another person countered:
“Masks work! It was only after I stopped wearing one in 2023 that I caught COVID.”
Sometimes people choose the data they cite based on their opinions:
“No information I have seen showed that masks do anything to stop the spread of COVID. But they cut oxygen intake and raise CO2 and encourage people to touch their faces, thus increasing the risk of transmission.”
We also heard from a retired advance practice nurse:
“I have studied reliable sources on COVID-19 and continued to wear an N95 mask whenever I am in the company of anyone outside my family.”
Why Isn’t There More/Better Research About Masks Against COVID?
Unfortunately, large, well-controlled trials of masking are lacking. The latest review of available research was published in the Jornal Brasileiro de Pneumologia (Jan. 5, 2024). The nine studies analyzed included 2,803 participants. People wearing surgical masks were 49% less likely than unmasked individuals to catch COVID. N95 respirators reduced the risk of infection by 69%. The authors called for better research going forward.
The type of mask people wear makes a difference. Another meta-analysis of six randomized controlled trials (Preventive Medicine Reports, Sept. 12, 2023) found that N95 masks offered significant protection whereas surgical masks did not.
Australian researchers examined masking in nursing homes (Ageing Research Reviews, Jan. 2024). They concluded:
“Universal masking was associated with lower SARS-CoV-2 ARs [attack rates] in ACF [aged care facilities] outbreaks…”
An editorial in the Annals of Internal Medicine, June 2023 notes:
“There is evidence that masks could work to prevent COVID-19, but substantial gaps remain about whether they do work and under what conditions.”
Final Words:
Part of the problem is that there is huge variability in how well masks fit and how consistently people wear them. Most studies find that N95 respirators are helpful, but Americans are less likely to wear them than people in Japan, Korea or China where masks are far more socially acceptable.
Of course, the big problem is that Americans hate wearing masks. We make up all sorts of reasons why masks are no longer necessary. It wouldn’t matter if masks were proven highly effective at preventing infections from colds, influenza or COVID, people in the US are unlikely to ever return to masking. That’s why we keep encouraging public health authorities to improve both ventilation and air filtration.
