Concerns around public health recommendations on face mask use among individuals who are not medically diagnosed with COVID-19 supported by a systematic review search for evidence.

Abstract

BackgroundContradicting and inconsistent public health recommendations regarding face mask use have been provided to individuals who are not yet medically diagnosed with COVID-19, which is significantly a large population. Face masks are being used by individuals who are not medically diagnosed with COVID-19 as a means to limit the spread of COVID-19 in several countries around the world. While some countries recommend the use of face masks, other countries strictly do not recommend their use to limit the transmission of COVID-19 among individuals who are not medically diagnosed with COVID-19. This paper critically analyses public health recommendations provided to this population regarding face mask use by public health and health professionals of different countries supported by a systematic review that searched for evidence on face mask use among this specific population in limiting the spread of COVID-19.MethodsTo carry out the systematic review portion of this paper, databases Cochrane Library, EMBASE, Google Scholar, PubMed, and Scopus were searched for relevant studies. Two groups of keywords were combined: those relating to face masks and COVID-19.ResultsThe systematic review search did not find any studies that investigated the effectiveness of face mask use in limiting the spread of COVID-19 among those who are not medically diagnosed with COVID-19 to support current public health recommendations.ConclusionsThe finding of the systematic review search, which is a lack of scientific evidence, questions the basis of inconsistent public health recommendations that have been provided to the public at a very early yet a crucial stage of an outbreak. A closer attention need to be given to the procedures and practices behind providing public health guidelines and recommendations during an outbreak by public health and health professionals around the world. This paper calls for 1) evidence-based public health recommendations; 2) considerations when providing public health recommendations in the absence of evidence; 3) evidence and knowledge transparency on current public health recommendations; 4) global alignment on public health recommendations; and 5) further research to strengthen public health recommendations.

Face Masks Considerably Reduce Covid-19 Cases in Germany

“…Greenhalgh et al (2020) mainly presents evidence on the effect of face masks during non-Covid epidemics (influenza and SARS). Marasinghe (2020) reports that they “ did not find any studies that investigated the effectiveness of face mask use in limiting the spread of COVID-19 among those who are not medically diagnosed with COVID-19 to support current public health recommendations ”. In addition to medical aspects (like transmission characteristics of Covid-19 and filtering capabilities of masks), Howard et al (2020) survey evidence on mask efficiency and on the effect of a population. They first stress that “ no randomized control trials on the use of masks <…> has been published ”.…”

How effective is a mask in preventing COVID‐19 infection?

“…In order to control the development of the epidemic, the US Centers for Disease Control and Prevention (CDC) recommended the public to wear cloth masks on 3 April 2020 (Eikenberry et al, 2020), while the effectiveness of a mask was initially not clearly described and confirmed especially during the escalation phase in the first quarter of 2020. Some of the comments by medical researchers even posted quite different and controversial opinions on the issues of mask wearing that resulted in some confusions in the public (Cheng et al, 2020; Marasinghe, 2020; Zhou et al, 2020). Mask wearing policies and regulations have also varied from different countries and stages since the pandemic outbreak.…”

Behavior in the use of face masks in the context of COVID‐19

“…However, as the general population is not familiar with wearing a face mask, incorrect use is inevitable. Systemic measures to change the health‐related behavior of individuals can only be effective, if people are informed about the meaning, purpose, and intended objectives of the measure (Howard et al., 2020) in a target‐group‐specific manner and under sufficient time conditions (Marasinghe, 2020). However, due to the urgent need for action in the context of COVID‐19 pandemic, suggested public health measures (World Health Organization, 2020b) could not be sufficiently addressed to all persons concerned by policymakers.…”