January 31, 2023
As a doctor in public view I have always stated that I have no problem wearing a mask as I have always done when seeing a patient in the cardiac catheterization laboratory, operating room, or in hospital respiratory isolation.
However, the craze over community masking has preoccupied the public and the questioning media, and thus, the paper from the Cochrane Acute Respiratory Illnesses Group by Jefferson et al, is an important summary to quote for the schools, employers, travel, and hospitals. This UK group is known to be exhaustive and fair balanced in their conclusions.
Jefferson et al included 12 trials (10 cluster-RCTs) comparing medical/surgical masks versus no masks to prevent the spread of viral respiratory illness (two trials with healthcare workers and 10 in the community).
Wearing masks in the community probably makes little or no difference to the outcome of viral illness and laboratory confirmed viral disease risk ratio (RR) 0.95, 95% confidence interval (CI) 0.84 to 1.09; 9 trials, 276,917 participants; RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate-certainty evidence, respectively.
Healthcare Workers N95/P2 versus Standard Surgical Masks
Five studies of N95/P2 respirators compared with medical/surgical masks on the outcome of clinical respiratory illness (RR 0.70, 95% CI 0.45 to 1.10; 3 trials, 7779 participants; very low-certainty evidence). One previously reported ongoing RCT has now been published and observed that medical/surgical masks were non-inferior to N95 respirators in a large study of 1009 healthcare workers in four countries providing direct care to COVID-19 patients.
In summary, my views have not changed. I will wear a mask as I have always done in appropriate healthcare settings. Mask mandates and public masking can be dropped with no misgivings based on these data. The use of masking in public should remain a personal choice without judgement.
Yesterday I a saw an immunocompromised liver transplant patient in the office wearing a mask—perfectly appropriate for him given the wide range of pathogens he could encounter in elevators and waiting rooms. Most importantly, our public health officials should stop any further embarrassing comments on masking since we are back to where we have been for decades on this issue in clinical practice.
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Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database of Systematic Reviews 2023, Issue 1. Art. No.: CD00620