Healthy People Wearing Masks, Should They or Shouldn’t They?

Updated: Oct 5, 2020

Healthy people wearing masks. These days you see them everywhere. But according to Patricia Neuenschwander, M.S.N., R.N., C.P.N.P.-P.C., an emergency room nurse with over two decades of experience, the science doesn’t support healthy people wearing masks.


 

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Original Post: https://jennifermargulis.net/healthy-people-wearing-masks-during-covid19


When Neuenschwander found out that her grandchild’s Montessori preschool was going to require even toddlers to wear masks, she did a deep dive into the research to better educate herself and her grandchild’s school about mask-wearing.


The following is a version of the letter Patricia Neuenschwander sent to the preschool administrators.


Should Healthy People Be Wearing Masks During This COVID-19 Crisis?

By Patricia Neuenschwander, M.S.N., R.N., C.P.N.P.-P.C.


In the process of making decisions one must evaluate the options, including the risks and benefits of the recommendation. While there is considerable debate about this subject, because of the current coronavirus situation, healthy people are being told by government officials to wear masks. To evaluate this recommendation, we have to ask some commonsense questions:


  • What are the risks of serious complications or death from COVID-19?

  • What are the benefits—using science and data—of healthy people wearing masks to prevent spreading a virus?

  • What are the risks to healthy people wearing masks?


Risk of death from coronavirus


Looking at risk of death from this novel coronavirus, we need to look at real numbers. The models and predictions have not been shown to be accurate. The population in the United States is approximately 326,700,000. As of May 9, 76,934 have been reported to die from COVID, as a complication of it, or with it. Using the real numbers of people potentially at risk (as we all are) and the number of these deaths, it works out to be 0.00023 or 0.023% of the population. That is essentially a 0% death rate in the general population.


It looks like the death rate from this is higher because not everybody has been exposed, so the death rate is higher in those known to be exposed. The problem is we don’t know how many have been exposed. Without an accurate denominator, we don’t really know the risk of dying if you become infected.


However, several studies show most people infected have mild to no symptoms and fully recover. A few recent studies looking at populations with real data of people who were infected, that did not have symptoms or receive treatment, have shown the death rate to be much lower than previously reported.


Because most of the people tested were sick or were at a very high risk of infection based on exposure, we have no idea how many fully recovered. We do know that older adults and people who have severe underlying medical conditions (like heart or lung disease or diabetes) seem to be at higher risk for developing serious complications from COVID-19 illness.

As none of these risk factors are applicable to healthy children, children with no underlying health issues remain at an extremely low risk of being seriously affected or dying from this infection.


I have no qualms with people at high risk staying home or wearing a mask in public to try to protect themselves from contracting this infection. I do have qualms about healthy people wearing masks, asking them to partake in an intervention that has not shown to benefit anyone (using science and data) and can potentially cause harm.


Does wearing a mask help prevent coronavirus infection?


An important study using science to evaluate cloth mask use to prevent infection was conducted in March 2011. It is a large, prospective, randomized clinical trial; and the first randomized clinical trial ever conducted of cloth masks. The international team of researchers concluded:

This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.”

This study doesn’t provide evidence for effectiveness in high-risk populations; it certainly does not support healthy people wearing cloth masks.


More recently, researchers from University of Illinois at Chicago School of Public Health reviewed the scientific literature. While not an exhaustive review of masks and respirators as source control and personal protection equipment (PPE), this review was made in an effort to locate and review the most relevant studies of laboratory and real-world performance to inform our recommendations. The review, which has 52 citations, concludes:

We do not recommend requiring the general public who do not have symptoms of COVID-19-like illness to routinely wear cloth or surgical masks because:
  • There is no scientific evidence they are effective in reducing the risk of SARS-CoV-2 transmission

  • Their use may result in those wearing the masks to relax other distancing efforts because they have a sense of protection

  • We need to preserve the supply of surgical masks for at-risk healthcare workers.


A 2020 study in Seoul, South Korea looked at the effectiveness of surgical and cotton masks in blocking COVID-19 in a controlled comparison of four patients. The COVID-infected patients were put in negative pressure-isolation rooms. The scientists compared disposable surgical masks (3 layers) with reusable cotton masks.


Patients were instructed to cough 5 times while wearing no mask, surgical mask, or cotton mask. Interestingly, all swabs from the outer masks—including surgical masks—were positive for COVID-19. Inner masks were also found to be contaminated. That means the mask did not effectively filter out the COVID virus since it is too small. The authors assert:

Neither surgical nor cotton masks effectively filtered {COVID-19} during coughs by infected patients.” Conclusion: “both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2