Rational use of face masks in the COVID-19 pandemic

Original Article: Feng S., Shen C., Xia N., Song W., Fan M., Cowl B.J., Rational use of face masks in the COVID-19 pandemic, The Lancet.

Author of summary: Silvia Mercurio; Reviewer: Corrado Minetti

Original Article Published on March 20th, 2020

In this study, face mask use recommendations by different health authorities of the world were compared. Despite the consistency in recommending that symptomatic individuals and those in health-care settings should wear face masks, differences were observed in the recommendations for the general public. Evidence about face mask effectiveness in protecting against respiratory infections is scarce. Due to limited supplies, rational use of face masks should prioritize the needs of health-care worker and vulnerable individuals.

Since the outbreak of SARS-CoV-2, the use of face masks has become common in China and other Asian countries. The use of face masks in public areas has even become compulsory in some provinces in China; however, China’s national guidelines have adopted a risk-based approach in recommending face masks among health-care workers and the general public.

In this study, authors compared face mask use recommendations by different health authorities (WHO, China, Hong Kong, Singapore, Japan, USA, UK, Germany).

Despite the consistency in recommending that symptomatic individuals and those in health-care settings should wear face masks, differences were observed in the recommendations for the general public. For example, the USA Center of Disease Control and Prevention as well as WHO discouraged the use of face masks by healthy people while Hong Kong suggested the use of surgical masks in crowded places.

One important reason to reduce widespread use of face mask is to preserve supplies for professional use. During epidemics, the use of masks by general public increases substantially exacerbating the global supply and thus endangering health-care workers. People from some regions opted for repeated usage of disposable masks but the improper use of face masks could strongly reduce their protective effect and even increase the risk of infection.

Currently, evidence that face masks can effectively protect against respiratory infections is scarce, as pointed out in recommendations from UK and Germany.

WHO recommends that people should wear a mask if they show respiratory symptoms or are caring for someone that is sick. Perhaps it would be reasonable to suggest that people in quarantine wear face mask if they need to leave home. Similarly, face mask use could be recommended in high-risk areas to vulnerable populations, such as older adults and people with underlying health conditions. Authorities should optimize face mask distribution to prioritize the need of health-care worker and vulnerable individuals.

Universal use of face masks could be considered if supplies permit. As COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone wears a face mask.

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