Colby Cosh: The debate over routine use of masks is going to stay with us (2023)

The question here is usually 'How much protection do masks impart to the wearer?' The general answer is 'Quite a lot, and it seems any mask is better than no mask'

Author of the article:

Colby Cosh

Publishing date:

Mar 25, 2020March 25, 20204 minute read

23 Comments

Colby Cosh: The debate over routine use of masks is going to stay with us (1)

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There is something odd about our public health doctrine on the social use of masks for disease prevention. I don’t intend to play Monday morning quarterback here: I am not qualified to say we have made a public health mistake in failing to adopt Asian social practices in at least a preparatory way. But there is definitely something funny about the discussion we are having about masks, and if you were to ask me to bet on what topic we will be second-guessing when the smoke has cleared, this is it.

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It appears from comparative testing and mortality data as though East Asian countries, China and its neighbours, have some trick that makes them more effective in defending against the novel coronavirus than Europe and the U.S. It is hard to know which part of the recipe is most important. Even for South Korea and Japan one could mumble about a stronger spirit of instinctive social compliance, or about greater tolerance of quarantine and epidemiological surveillance methods that we are rightly lily-livered about. But the social use of masks in East Asian countries is obvious enough to now be noticed here in Canada among new immigrants, visitors and tourists.

Colby Cosh: The debate over routine use of masks is going to stay with us Back to video

By “masks” I don’t mean the N95 respirators that are in short supply in hospitals. I don’t even necessarily mean surgical masks. Our public health officials have been consistent in telling us not to bother with masks, and even so, it turns out that people confronted with serious epidemic disease immediately begin hoarding the most sophisticated masks they can find.

Colby Cosh: The debate over routine use of masks is going to stay with us (2)

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There is no point to this hoarding: literally any doctor will tell you that gold-standard respirators take a lot of effort to learn to fit correctly, and there is cause for doubt in the scientific literature that even doctors accomplish this consistently once their boot-camp-style training is in the past.

Colby Cosh: The debate over routine use of masks is going to stay with us (3)

What I’m asking is whether even homemade masks or scarves would help prevent random social transmission of a coronavirus. Much study has been devoted to the effectiveness of masks in health-care settings, environments awash in respired viral material. The question here is usually “How much protection do they impart to the wearer?” The general answer is “Quite a lot, and it seems any mask is better than no mask.”

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This part of the literature is looking for very large effects, of the sort that can be found in a relatively small, low-powered study. The situations in which you can do a test with an unmasked control group are rare: a lot of what we know comes from certain corners of the SARS-1 epidemic. And the endpoint sought in the studies is often, as I say, the protection of the wearer. But even then, there are hints that improvised masks might offer some benefit, even if it is not the 99 per cent a health-care worker might need.

Let’s say you’re 10 per cent less likely to be infected with a circulating coronavirus if you go about with a regular surgical mask, or a painter’s mask, or a scarf around your nose and mouth. We don’t know that the number’s 10 per cent, but it seems unlikely to me that we would know it if it were. Ten per cent is a number worth thinking about if you’re going outdoors in a land of overflowing intensive care units and morgues in hockey rinks. But the real issue is how much protection an informal, homemade or improvised mask might give other people — the strangers around you. Could you be 10 per cent less likely to infect someone else if you wear a crummy mask?

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The mask issue is not, with exceptions, being discussed much from that point of view. It is not clear that the public health establishment is thinking of it in those terms yet, or ever has; and the “evidence” concerning the effectiveness of masks doesn’t address the issue much. This, as I say, seems weird to me. When it comes to the self-isolation and social distancing we are all practising right now, we have all been made aware, by means of constant hectoring, that these things are for everyone else’s benefit as well as our own.

Colby Cosh: The debate over routine use of masks is going to stay with us (4)

The paramount goal of public health at a time like this is to suppress transmission of viral infections. Period. A 10 per cent gain from the street use of masks, or a five per cent gain, seems very much worth adding to the economic destruction and personal misery we have all accepted.

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So is there a danger that encouraging the wearing of cute or cool fashionable masks would actually add to the transmission rate? Perhaps it was thought best to impose distancing and isolation without giving anyone late-arriving advice on what to do when they do visit the grocery once a week. We might start feeling invincible — stop washing our hands, maintaining social distance and doing other more important things — because we were wearing a mask. (This is the economists’ concept of “risk compensation.”)

So maybe social mask use could only have been combined with the other measures if we had made it part of our fighting doctrine against pandemic viral disease in the first place — something we all understood, in advance, to be worth using with other measures, rather than instead of them. Asian countries, by contrast, were able to incorporate masks naturally into their strategy: nobody needed instruction or indoctrination at all. Does anyone doubt that we’ll begin to imitate them a little more, and with less self-consciousness, when COVID-19 is behind us?

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