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:

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 from the coughs of patients with COVID-19 to the environment and external mask surface.”

The World Health Organization does not support healthy people wearing masks

The World Health Organization (WHO) has as its mission to direct international health within the United Nations’ system and to lead partners in global health responses.  So what does the WHO recommend when it comes to healthy people wearing masks? “WHO stands by recommendation to not wear masks if you are not sick or not caring for someone who is sick.”

“There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit,” Dr. Mike Ryan, an epidemiologist who specializes in infectious diseases and public health and who is the executive director of the WHO health emergencies program, said at a media briefing. “In fact, there’s some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly” (source).

The CDC’s mixed mask messages

According to the CDC, avoiding close contact with sick individuals; frequently washing your hands with soap and water; not touching your eyes, nose, or mouth with unwashed hands are effective prevention tips. The CDC also recommends covering your mouth and nose with a cloth face cover when around others, and practicing good respiratory hygiene (source). But here’s the rub. The CDC then goes on to say that the cloth face cover is meant to protect other people in case you are infected but there are no scientific citations to support that wearing a mask is effective at preventing you from spreading the virus to others. As a matter of fact, one of the reasons America’s surgeon general, Jerome Adams, M.D., M.P.H., said in an interview in March that masks can be dangerous is because people tend to touch their masks many times per hour and can spread the disease that way. A CNN News story that has since been removed from the internet had a headline that read: “Masks may actually increase your coronavirus risk if worn improperly, surgeon general warns” (click here to read it via the Wayback Machine):

You can increase your risk of getting it by wearing a mask if you are not a health care provider,” Adams said during an interview on Fox & Friends on Monday morning. “Folks who don’t know how to wear them properly tend to touch their faces a lot and actually can increase the spread of coronavirus,” Adams said. “We’re certainly seeing more spread in communities, but it’s important for folks to know that right now their risk as American citizens remains low. There are things people can do to stay safe. There are things they shouldn’t be doing and one of the things they shouldn’t be doing in the general public is going out and buying masks,” he said.

On a separate page, the CDC discusses masks. They write:

CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.”

However, there are no scientific citations provided to support this on that page. They go on to say that the recommendation has changed because they have figured out it is transmissible person to person.

These mixed messages are confusing. But what we know for sure is that the CDC knew from February 26 when the first community spread case documented in the U.S. that this virus was transmitted person to person; and not only was there no recommendation to wear a mask then, they strongly opposed the general public wearing masks.

Additionally, The World Health Organization warned of human to human transmission on January 14, 2020:

WHO’s technical lead for the response noted in a press briefing there may have been limited human-to-human transmission of the coronavirus (in the 41 confirmed cases), mainly through family members, and that there was a risk of a possible wider outbreak. The lead also said that human-to-human transmission would not be surprising given our experience with SARS, MERS and other respiratory pathogens” (source).

The CDC has known for decades that the influenza virus is transmitted person to person, but we have never been told to wear a mask to stop the spread of that virus. As a matter of fact, the CDC specifically says masks don’t work; and they do not recommend wearing a mask, to prevent transmission of the flu!

No recommendation can be made at this time for mask use in the community by asymptomatic persons, including those at high risk for complications, to prevent exposure to influenza viruses” (source).

But wait. On this separate page related to the recommendation to wear a face covering, the CDC does provide seven recent publications to support the use of masks for COVID –

Here is a brief summary of each study listed. I recommend you read them in their entirety.

1. Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. The New England Journal of Medicine. 2020;382(10):970-971.

This study is about transmission from one person exposed to four people- “The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak.” There is nothing in this study about masks related to benefits or risks of wearing one.

2. Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. The New England Journal of Medicine. 2020;382(12):1177-1179.