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Masking – The Cochrane Controversy

April 10, 2023

Written by Clay Smith

Spoon Feed
We try really hard to spoon feed you good information that is scientifically accurate. We need to discuss the nuances of masking related to COVID and other respiratory viral illnesses.

Why does this matter?
After Cochrane released a new review of physical interventions to prevent the spread of respiratory viruses, there was quite the kerfuffle about their conclusion that, “wearing a mask may make little to no difference in how many people caught a flu-like illness/COVID-like illness.” So, let’s talk about it. But before we do, I would just like to make this request. Please be kind. There is quite enough anger and emotion and sadness to go around, especially right now in my hometown (Nashville). So, let’s explore this with curiosity and remember that we are friends and colleagues who are trying to do the right thing for ourselves, our patients, and our communities. We are not enemies. We are fellow emergency medicine professionals, a band of brothers and sisters.

Who was that masked man?
This Cochrane review and our post about it have taken some heat – some warranted, some not. What this review concluded about masks is probably true – given the way they were worn, or more importantly – not worn, in the included studies. General community masking probably doesn’t make a big difference in viral respiratory illness transmission, though it may make a small difference. But there is so much nuance to this issue – nuance that is hard to capture in a brief blog post – and I should have done a better job making sure we were clear in our communication. Importantly, this review doesn’t indicate that masks don’t work as much as that people simply don’t wear them properly or consistently. It does not mean mask use is altogether worthless. Another problem is that mask use seems to only delay the inevitable – many people eventually get infected. However, in the right circumstances, that delay could save lives if it prevents hospitals from being overwhelmed or buys time for development of new vaccines or therapeutic agents. Masking, as a long-term strategy to prevent viral transmission, is prone to failure, because masks themselves are imperfect – and the humans that wear them are too.

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 Syst Rev. 2023 Jan 30;1(1):CD006207. doi: 10.1002/14651858.CD006207.pub6.

What are your thoughts?