Should I wear a facemask to avoid the flu or some other nasty virus like Coronavirus COVIC-19?

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The scientific jury is not unanimous on this issue, but it looks like wearing a surgical mask matters enough to recommend their use under certain conditions, and their use, or the use of a more effective respirator, is recommended under certain conditions. In my experience, face masks are routinely distributed patients arriving in urgent care centers and similar when influenza is cranked up in the community.

Washing your hands a lot AND using a face mask seems to reduce transmission within a household where there is a sick person. This practice probably works, and is standard and recommended, for health care workers. People wandering around on the landscape who don’t have the flu or other virus probably don’t get real protection from wearing a surgical mask, but sick people probably transmit less, if for no other reason than it reduces the amount of nose/mouth-to-hand transfer of viral kooties.

Most of the research on this topic was done during either the H1N1 or SARS hyperawareness period, as expected, but I’ve not seen anything contradictory since. Here are some examples:

” Face masks and hand hygiene combined may reduce the rate of ILI and confirmed influenza in community settings. These non-pharmaceutical measures should be recommended in crowded settings at the start of an influenza pandemic.” (Aiello et al 2012)

“This is the first RCT on mask use to be conducted and provides data to inform pandemic planning. We found compliance to be low, but compliance is affected by perception of risk. In a pandemic, we would expect compliance to improve. In compliant users, masks were highly efficacious. A larger study is required to enumerate the difference in efficacy (if any) between surgical and non-fit tested P2 masks.” (MacIntyre et al, 2008)

“Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not significant. In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT-PCR–confirmed infection seemed reduced, an effect attributable to fewer infections among participants using facemasks plus hand hygiene (adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87]). Adherence to interventions varied.” (Cowling et al. 2009)

The CDC is not sure if asymptomatic non healthcare workers get much benefit, but they don’t say not to do it. They do say to get your vaccinations, and if you get sick, get medical attention which might include an anti-viral. Health care workers are told (by CDC) to always have a mask or respirator if they are within 6 feet of a sneezy coughy diseased person.

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10 thoughts on “Should I wear a facemask to avoid the flu or some other nasty virus like Coronavirus COVIC-19?

  1. I just returned to Boston from Milan – my travel companion and I of course being blissfully unaware that we were in the very locus of large numbers of COVID-19 cases. Incidentally, unlike at London-Gatwick (my stop-over), NO ONE in Milan (neither at the airport nor in train stations nor in public) was wearing a mask – not a single one sighted in 9 days, even on individuals of Chinese descent.

    Here’s what I just wrote to my physician friend on the subject:
    Dear A.,

    Ignorance can be bliss on occasion … I suppose.

    There we were, eating our way through the European epicenter of COVID-19 and didn’t even know it.

    What do you make of local (= various governmental) and world reactions to this? I’m not sure that any computer model or informed analysis can prospectively answer this question but I have to ask it: What is the cost-benefit ratio in terms of public health and world economic impact, of the disparate and uncoordinated (in)actions being taken in various locales that will result in billions if not trillions of dollars in economic losses?

    And what, truly, is the risk of contracting this or any other virus from sitting among a non-coughing audience at La Scala? As we both know germs are everywhere, on every surface we touch, living for hours to weeks … I am not convinced, indeed I am rather skeptical, that “locking down” Italy or anywhere else – at this very late stage (almost 3 months since evidence of initial cases in Wuhan) – will result in anything but massive harm to the vast majority of students, shop-keepers, restauranteurs, working citizens everywhere whose lives are being disrupted. This isn’t the bubonic plague.

    The real problem (yeah, I know preaching to the choir) is that all these folks wearing masks in public will remove them when they get home and then touch their faces, pick their noses, rub their eyes, etc., without washing their hands … And anyway, it’s impossible to disinfect every doorknob or faucet or every object in your home.

    I can imagine a pandemic where everyone (of means) everywhere is walking around in do-it-yourself Hazmat Suits like astronauts from another planet … But for this virus, I say let’s adopt evidence-based medical procedures for people who actually become sick … As for the rest of us, let nature take its course, Once 20 million old people like me die off, the remaining population will have adequate herd immunity, at least until the next seasonal variant and vaccine come onto the scene.

    That’s harsh, but realistic, and ultimately less harmful to the global world order!
    This has been a public service announcement from Joseph M., PhD <– "the kind of doctor that does nobody any good" (– Jeremy Knowles, 1935–2008)
    Note to readers of GLB:
    • See my many posts on this coronavirus on Greg's first blog article on the topic
    • I advised you guys to get N-95 masks … Well, guess what? It's TOO LATE.
    Word of the day: FOMITE

  2. IMPORTANT:  I’d like to offer an unsolicited request, on behalf of Greg Laden (cloned to his three Covid-19 blog posts up to this date):

    Fellow GLB blog readers, each of Greg’s three posts since this story went viral (sorry) earlier this year devoted itself to a specific aspect or question concerning Covid-19. It shouldn’t be all that difficult to keep our comments more or less on-topic – yet I notice they’re now spread out all over the place. This diminishes the accessibility and utility of the considerable amount of information that appears on the aforementioned posts.

    Not surprisingly, several recent comments that have little to do with sub-Saharan Africa appear following Greg’s most recent (Feb. 25) column. I mean, it’s the most recent post, and hence the most physically accessible. This being said, if someone comments “ectopically” on an issue that was already introduced/covered at length in an earlier published essay, any would-be replier has no choice but to reply to the inconveniently-located new comment, creating a positive feedback cycle of fluctuating on-/off-topic/malpositioned posts.

    Come on, folks, we can do better than this.

    Greg, on January 26, wrote [“famous last words?” OR “the best-laid plans …”?] as follows: “I’m not really going to live blog this virus.” But with its exploding, deleterious impact on personal and public health, economy, civil liberties, political systems, supply chains, international relations (etc.) likely to get much worse very quickly (I mean, let’s get real – this is terrible enough that many of us are bound to lose family members and friends to this disease), Greg will probably have little choice but to follow up on the scientific dimensions of Covid-19 that lie within his domains of interest and expertise.

    Let’s try our best not to complicate things by asking the writer/moderator of this blog to clean up/curate our mess. After all, irrespective of whether Greg composes further “main features” on the subject, due to its very nature – and if this discussion remains alive and current – there will soon be dozens of links, hundreds of comments, and thousands of words on Covid-19 – all theoretically accessible here. If we do our part.

    There’s some good information (and timely references) available here, covering many dimensions of this crisis – which make this a useful go-to source, especially given that it is such a wide-ranging (“Evolution – Climate Change – Education – Politics [and now, Coronavirus?]”) blog on the intersection of science and society.

    So here’s my suggestion: If you have contributions to the ongoing discussion here concerning this novel human coronavirus – any aspect of it – use the Search function (*the little magnifying glass!) at the top right of Greg’s masthead, and figure out which of these three columns is the most relevant place to post your remarks, regardless of where you’ve posted them previously. And if they don’t truly fit under the two recent specialized subtopics (African Covid-19 / Face masks and contagion prevention) – then, please, go back to “Live Blogging 2019-nCoV (Wuhan coronavirus) (Jan. 26)” and post there. This way, your general and miscellaneous remark(s) on Covid-19 will appear highlighted in red for all to see – under Recent Comments at the top of GLB – thereby keeping “Live Blogging 2019-nCoV” alive.

    GLB READER’S GUIDE TO COVID-19 COLUMNS (Jan. 26–Feb. 25) — *Remember the magnifying glass – you don’t have to scroll through dozens of posts!

    • Lack of coronavirus COVID-19 in Subsaharan Africa? (Feb. 25)

    • Should I wear a facemask to avoid the flu or some other nasty virus like Coronavirus COVIC-19? (February 12)

    • Live Blogging 2019-nCoV (Wuhan coronavirus) (Jan. 26)

  3. UPDATE on the (non?)advisability of wearing masks if you are healthy:

    • This op-ed from yesterday’s Boston Globe is provocative – to put it mildly. Note the credentials of the authors,, at the bottom of this post..

    • Since I realize this link to the article won’t work for everyone, I have copied and pasted its text here:
    “GUIDANCE AGAINST WEARING MASKS FOR THE CORONAVIRUS IS WRONG – YOU SHOULD COVER YOUR FACE: If you can successfully block access to your nose, throat, and eyes, you will avoid infection by the coronavirus, flu, and any of several hundred other respiratory viruses.”

    – By Shan Soe-Lin and Robert Hecht (The Boston Globe – March 19, 2020)

    “Since the beginning of the COVID-19 outbreak, public health authorities have advised us that masks are not necessary and should not be used by the general public for protection against the rapidly spreading virus.

    “While it is true that N95s and surgical masks — which have become scarce due to hoarding — should be prioritized for use by medical professionals at greatest risk for infection, the rest of us could and should wear other protective face coverings. There are compelling scientific reasons for this:

    “Masks work. There is widespread evidence from the field of occupational health, the SARS epidemic, and other outbreaks that wearing masks protects us from germs and interrupts the transmission of disease from sick to healthy people.

    “Masks are the best way to enforce the “do not touch your face” mantra we are hearing about for COVID-19. The coronavirus, like all respiratory viruses, needs to enter mucous membranes in the nose, throat, and eyes to cause infection. If you can successfully block access to these critical entry points, you will avoid infection by the coronavirus, flu, and any of several hundred other respiratory viruses. Unfortunately, we humans are relatively unique among mammals in that we continuously touch our eyes, noses, and mouths for seemingly no reason every 2.5 minutes. This behavior is hard-wired and starts in utero. Let’s get real — we’re not going to be able to instantly stop doing something we’ve been doing our whole lives.

    “So what’s the answer? Cover your face with a mask. This will deny you access to your own face and make you conscious of how often you are tempted to touch your nose and mouth. A nonmedical mask will not protect you from a direct cough or sneeze from an infected person, but if you’re practicing good social distancing, any type of face covering is great protection from your biggest threat: your own hands.

    “Wearing masks is a powerful signal to others that these are not normal times, and that we all need to change our behaviors to stop a potentially devastating epidemic. Wearing a mask for the first time can be deeply uncomfortable, especially when others are not doing the same. We felt strange at first, but after a few days, we’ve become proud rather than embarrassed to wear a mask outside. If more people donned masks, it would become a social norm as well as a public health good. If we can stop handshaking to fight COVID-19, we can also end mask stigma.

    “Asian countries that have been successful in containing the virus without locking down society, such as Hong Kong, Singapore, and Taiwan, routinely use masks. As of March 17, the three countries together had fewer than 1,000 cases of the coronavirus — despite having close connections to China’s Hubei province, where the epidemic originated and exploded late last year. There are many explanations for this success, including the rapid recognition of the threat, swift application of lessons learned during the 2002 SARS outbreak, and widespread testing and strict isolation of confirmed cases. But masks are also used routinely for protection against infectious diseases in these countries, and universal mask use is part of their coronavirus guidance. In Taiwan, masks are such an important first line of defense that artificial intelligence is used to create live maps of local supplies of face masks so that citizens know where to get them.

    “So what needs to be done here in the United States? Cover your face. Nonmedical masks should be worn by everyone going outside. Inexpensive cloth masks are available for purchase online. Alternatively, scarves, bandana-style neck gaiters, and other similar face coverings can work effectively. Masks should be placed over the mouth and nose and removed carefully, without touching the outside surface, and cloth masks should be washed frequently.

    “We must also encourage others to cover their faces too. We need to change our perception that masks are only for sick people and that it’s weird or shameful to wear one. Instead, donning a mask needs to be seen as a responsible action to protect the wearer’s health and the health of those in close proximity to her. If our political leaders and cultural influencers put on masks, we could change our social attitudes and norms rapidly
    “This will not be easy. Adding further instructions on top of everything we are being asked to do to stop COVID-19 could lead to overload and fatigue. However, handwashing, social distancing, and doing your best not to touch your face are not enough to stop the coronavirus. For the health of your neighbor and yourself, wear a mask.”
    • SHAN SOE-LIN is managing director of the Boston-based Pharos Global Health Advisors and a lecturer in global health at the Jackson Institute for Global Affairs at Yale University. ROBERT HECHT is the president of Pharos Global Health Advisors and a clinical professor of epidemiology at the Yale School of Public Health.
    The Covid-19 pandemic is a very flluid situation. Science is dynamic. Criteria for making rational decisions (collectively andindividually) are not static. Open minds are required, and critical thinking faculties must never be suspended.–JM

    COMMENTS, anyone?

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