Universal Masking in the Covid-19 Era

In one of last month’s fundraiser posts, as part of the discussion on face masks and the Wuhan Coronavirus, I quoted a paragraph from an article published in April by The New England Journal of Medicine:

We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.

I wasn’t the only right-wing extremist referencing this excerpt; it was bouncing around all over the place in the deplorable regions of the Intertubes.

Before I quote the latest from the NEJM, I must note that all the most contentious issues surrounding COVID-19 — face masks, the effectiveness (or danger) of hydroxychloroquine, “social distancing”, etc. — are political issues rather than medical issues. The scientific and medical aspects of these questions might be argued and debated, but since they are political issues, the science is settled, and brooks no debate.

The importance of any given topic and the extent to which it inflames the talking heads among media snoids depends upon Donald Trump’s position on it. If Mr. Trump supports it, the hue and cry against it blares at top volume day and night. If he opposes it, then earnest experts appear on every TV news or talk show to promote it. That’s just the way the game works.

Evidently the top brass at NEJM noticed the use to which their article had been put by right-wing pinheads, and felt compelled to do damage control by explaining the nuances of their policy on face masks.

Thus endeth my editorial opinion. Here’s the latest from the NEJM:

Universal Masking in the Covid-19 Era

We understand that some people are citing our Perspective article (published on April 1 at NEJM.org) as support for discrediting widespread masking. In truth, the intent of our article was to push for more masking, not less. It is apparent that many people with SARS-CoV-2 infection are asymptomatic or presymptomatic yet highly contagious and that these people account for a substantial fraction of all transmissions. Universal masking helps to prevent such people from spreading virus-laden secretions, whether they recognize that they are infected or not.

We did state in the article that “wearing a mask outside health care facilities offers little, if any, protection from infection,” but as the rest of the paragraph makes clear, we intended this statement to apply to passing encounters in public spaces, not sustained interactions within closed environments. A growing body of research shows that the risk of SARS-CoV-2 transmission is strongly correlated with the duration and intensity of contact: the risk of transmission among household members can be as high as 40%, whereas the risk of transmission from less intense and less sustained encounters is below 5%. This finding is also borne out by recent research associating mask wearing with less transmission of SARS-CoV-2, particularly in closed settings. We therefore strongly support the calls of public health agencies for all people to wear masks when circumstances compel them to be within 6 ft of others for sustained periods.

  • Michael Klompas, M.D., M.P.H.
    Harvard Medical School, Boston, MA
  • Charles A. Morris, M.D., M.P.H.
    Brigham and Women’s Hospital, Boston, MA
  • Erica S. Shenoy, M.D., Ph.D.
    Massachusetts General Hospital, Boston, MA

This letter was published on June 3, 2020, at NEJM.org.

Hat tip: JF.

6 thoughts on “Universal Masking in the Covid-19 Era

  1. Well, the WHO’s latest pronouncement that transmission by asymptomatic carriers is extremely rare blows NEJM’s idiotic rebuttal out if the water. Of course WHO may now “clarify” that, too.

    Yes, it is all political, and from my experience the Right is losing the battle.

  2. The argument for masking when in contact with people we now know are outside the demographic for which the virus is fatal, is flawed in that if followed, it serves only to delay herd immunity.

    Yes, it is all political. All about control. Scuence and common sense be damned.

    • Speaking as a 72-year-old, who’s unlikely to survive infection because of my meds (and I’m male, and I smoke), I’d quite like other people on public transport and in shops to wear the damned things in case they cough or sneeze in my vicinity!

      Also, younger people who are more likely to survive contact may still have to endure weeks or more of feeling lousy, and self-isolation, with all the disruption this brings.

  3. of course, because masks must be disposed of on a daily basis lest you breathe in the contagion you have exhaled, a continuous supply of masks must be provided. Because most are too poor to afford the continuous supply as the result of having been laid off from their employment during the ‘shelter in place’ phase of the response to the COVID-19 plannedemic, the government will need to intervene with public assistance. Actually, the program is already in place and it is being colloquially referred to as “Masker Aid” that supports the masquerade that we all must endure.

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