Urgency and uncertainty: covid-19, face masks, and evidence informed policy

Martin, Graham; Hanna, Esmée; Dingwall, Robert

doi:10.1136/bmj.m2017

Cited by 28 publications

(31 citation statements)

References 8 publications

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“…While there is an emerging body of literature indicating that mask-wearing can be effective in reducing transmission, the bulk of evidence comes from healthcare settings 24 . In non-healthcare settings, risk compensation 25 may play a larger role, potentially reducing effectiveness. While our results cast doubt on reports that mask-wearing is the main determinant shaping a country’s epidemic 23 , the policy still seems promising given all available evidence, due to its comparatively low economic and social costs.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of eight nonpharmaceutical interventions against COVID-19 in 41 countries

Brauner

Mindermann

Sharma

et al. 2020

Preprint

176

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Background: Existing analyses of nonpharmaceutical interventions (NPIs) against COVID19 transmission have concentrated on the joint effectiveness of large-scale NPIs. With increasing data, we can move beyond estimating joint effects towards disentangling individual effects. In addition to effectiveness, policy decisions ought to account for the burden placed by different NPIs on the population. Methods: To our knowledge, this is the largest data-driven study of NPI effectiveness to date. We collected chronological data on 9 NPIs in 41 countries between January and April 2020, using extensive fact-checking to ensure high data quality. We infer NPI effectiveness with a novel semi-mechanistic Bayesian hierarchical model, modelling both confirmed cases and deaths to increase the signal from which NPI effects can be inferred. Finally, we study how much perceived burden different NPIs impose on the population with an online survey of preferences using the MaxDiff method. Results: Eight NPIs have a >95% posterior probability of being effective: closing schools (mean reduction in R: 50%; 95% credible interval: 39%-59%), closing nonessential businesses (34%; 16%-49%), closing high-risk businesses (26%; 8%-42%), and limiting gatherings to 10 people or less (28%; 8%-45%), to 100 people or less (17%; -3%-35%), to 1000 people or less (16%; -2%-31%), issuing stay-at-home orders (14%; -2%-29%), and testing patients with respiratory symptoms (13%; -1%-26%). As validation is crucial for NPI models, we performed 15 sensitivity analyses and evaluated predictions on unseen data, finding strong support for our results. We combine the effectiveness and preference results to estimate effectiveness-to-burden ratios. Conclusions: Our results suggest a surprisingly large role for schools in COVID-19 transmission, a contribution to the ongoing debate about the relevance of asymptomatic carriers in disease spreading. We identify additional interventions with good effectiveness-burden tradeoffs, namely symptomatic testing, closing high-risk businesses, and limiting gathering size. Closing most nonessential businesses and issuing stay-at-home orders impose a high burden while having a limited additional effect.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of eight nonpharmaceutical interventions against COVID-19 in 41 countries

Brauner

Mindermann

Sharma

et al. 2020

Preprint

176

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“…Although the use of facemasks from healthcare workers is generally accepted, there is a great debate regarding the necessity of facemask usage from general public [1,6,7]. Among the supporters of this aspect, the prevailing theory is that facemasks increase the persons' sense of security reducing thus their compliance to other protective measures [7,9,12]. However, according to the latest directive of the WHO [9], facemask use is strongly advised for the general public even for outdoor activities.…”

Section: Introductionmentioning

confidence: 99%

Determinants of compliance to the facemask directive in Greece: A population study

et al. 2021

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Purpose Primary objective of this study was to identify potential difficulties and/or discomfort when using a facemask. Moreover, to explore the impact of spectacles, contact lenses and visual acuity on the compliance to the facemask directive. Methods This is a prospective study that was conducted at the Department of Ophthalmology, University Hospital of Alexandroupolis, Greece between June 2020 and August 2020. Greek speaking citizens with permanent residency in Greece above 18 years old were included. A custom questionnaire (DeMask-20) was constructed and validated, which pertained to the perceived difficulty and discomfort when using a facemask. It contained 20 items grouped in 8 subscales (driving, near vision, distance vision, ocular discomfort, role limitation, collaboration, dependency on others, emotional stress). Perceived difficulty and discomfort when using a facemask, compliance and correlations of compliance with DeMask-20 scores, demographics, spectacle and/or contact lens use, and visual acuity were evaluated. Results The number of factors was determined through factor analysis. Cronbach’s alpha ranged from 0.716 for the “Role limitation” subscale to 0.938 for “Ocular discomfort” subscale. 1,214 participants (402 men, 812 women, mean age 36.79±12.50 years) completed the DeMask-20 instrument. Mean DeMask-20 score of all study participants was 3.79±0.71. Significant differences in DeMask-20 score were detected in gender (p = 0.009), spectacle use (p = 0.034), contact lens use (p = 0.049), and binocular distance visual acuity (bDVA) (p = 0.001). Mean compliance of all participants was 4.05±0.96. Men, people <50 years and spectacle wearers showed significantly worse compliance (p<0.05). Moreover, professional workers and professional drivers demonstrated significantly better compliance (p = 0.008 and p = 0.047). Significant correlation was detected between compliance and DeMask-20 score (p<0.001, R2 = 0.471). Significant correlations were detected with driving, near vision, distance vision, collaboration, role limitation, emotional stress (p<0.05, R2: 0.386–0.493). Conclusions Factor analysis suggested that the DeMask-20 instrument demonstrates adequate validity, while Cronbach’s alpha indicated sufficient internal consistency of all subscales. This study provided the necessary methods that could evaluate compliance trends and the efficacy of healthcare interventions against COVID-19. Our outcomes suggest that young males who use spectacles should be targeted by Greek Healthcare authorities in order to improve compliance rates.

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“…Communication about wearing masks also needs to consider negative unintended outcomes. One such concern is they could cause anxiety by being a constant reminder of being in danger (Martin et al, 2020). Another relates to the phenomenon of "risk compensation", when adopting a protective measure results in reducing the use of other protective measures or even taking more risks because one feels protected.…”

Section: Wearing Face Masks or Coveringsmentioning

confidence: 99%

Ethical Issues in COVID-19 Communication to Mitigate the Pandemic: Dilemmas and Practical Implications

Guttman

Lev

2020

Health Communication

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Urgency and uncertainty: covid-19, face masks, and evidence informed policy

Cited by 28 publications

References 8 publications

The effectiveness of eight nonpharmaceutical interventions against COVID-19 in 41 countries

The effectiveness of eight nonpharmaceutical interventions against COVID-19 in 41 countries

Determinants of compliance to the facemask directive in Greece: A population study

Ethical Issues in COVID-19 Communication to Mitigate the Pandemic: Dilemmas and Practical Implications

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