Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Beyond medical vs. N95: strategic masking for COVID protection

P. Dileep Kumar, MD, MBA
Conditions
February 28, 2024
Share
Tweet
Share

Do masks prevent COVID-19 infections? You might be thinking that it is a bit late to ponder these questions. But better late than never! As shown in the following graph provided by the CDC, COVID is here to stay with us, at least for the time being. Even though nothing compared to the 140,000 hospitalizations per week during the early 2022 wave, there were still about 40,000 weekly hospitalizations a couple of weeks back.

You might have also wondered during the various phases of the past three years which of the several masks is the most efficient to prevent COVID-19. You might also be thinking there might be hundreds of studies looking into this.

But in reality, according to a recently published systematic review, there were only three randomized controlled trials (RTC) looking at the comparative efficiency of different types of masks to reduce COVID-19 transmission published during the period between January 2020 and January 2023. Two of these studies were conducted in a community setting, and only one was conducted in a health care setting.

However, the authors included 16 observational studies (2 in community settings and 14 in health care settings) to answer this question in their analysis because of a paucity of RCTs. The studies were heterogeneous in their methodology, setting, and timing. They concluded that studies favored wearing a high-quality mask such as N95. However, the authors point out the high risk of bias in all these studies.

A November 2022 article written by Loeb et al. in Annals of Internal Medicine (which was included in the above systematic review) compared surgical masks to N95 masks among health care workers who provided routine care to suspected or confirmed COVID-19 patients. They used a pragmatic randomized trial approach comparing medical masks versus N95 masks. The study was conducted in multiple countries, such as Canada, Israel, Pakistan, and Egypt. The results were inconclusive even though N95 mask wearers experienced a slightly lower incidence of COVID-19 compared to the surgical masks (10.5 percent versus 9.3 percent).

There were several criticisms about the study. The study was done between May 2020 to March 2022. Commentators wondered about the ethics of using ordinary medical masks in such a situation while we already knew by late 2020 that COVID-19 was predominantly spread by aerosols, to which N95 masks offer superior protection. The study was also limited by the usage of masks only during direct care to the patients. Health care workers were not instructed to wear masks elsewhere, and they could easily get infected outside the care setting. The study settings were also very disparate and varied from emergency departments to long-term care facilities. There were waves of COVID-19 strains with different degrees of infectivity during the study, which also confounded the trial.

The question of the efficacy of different masks in preventing COVID-19 is complex. For example, efficacy in a highly infective situation, such as an emergency room, could be vastly different from a low-risk situation, such as a summer outdoor gathering. It also depends on several other factors, such as personal risk, the amount of time spent at the location, the infectivity of strains in circulation at a given time, and the location.

The systematic review also addressed two other issues: the use of masks and the role of mask mandates to reduce infections. Again, the authors struggled to find RCTs and included observational studies in their analysis. Regarding the first question, they were only able to find 2 RCTs and used a total of 47 observational studies. They found that masks reduced transmission in a great majority of studies, but they felt the quality of evidence was low.

They studied 18 observational studies about mask mandates and concluded that mask mandates reduced transmission but again felt that the quality of evidence was low.

Strategic masking

Recently, the concept of “strategic masking” has evolved to address these concerns. The idea is to wear a mask when it matters the most. This protocol recommends masking after assessing the personal risk and taking into consideration other factors such as the need to protect loved ones at high risk, personal risk tolerance, nature of the variants in circulation, specific location, and the total time spent at a location. Everyone can choose their own strategy based on their assessment of the risk at any given time.

The overall lack of randomized trials early in the pandemic addressing a simple basic question, such as the efficacy of masks, is interesting to note. I would not characterize this as a total failure of our research system, given that the pandemic has surprised everyone and it was highly contagious. Moreover, taking care of the patients became a priority for everyone. However, once the initial shock was over, we should have been able to design appropriate trials quite rapidly to provide definitive answers to the questions that were concerning to the public. This also points to the important fact that health care research should be aligned with answering questions that are vital to patient care.

Interestingly, one of the reasons for the delay in the studies cited by Loeb et al. was the lengthy waiting period for ethics approvals and the establishment of contracts with the study sites. These issues should have been addressed at the very beginning of the pandemic by the funding agencies and federal authorities so that more research was encouraged.

The confusion about the usefulness of different types of masks in the setting of COVID-19 probably has something to do with the ensuing controversies about COVID-19. The medical community was unable to provide definitive answers to the lingering questions from the public. There were no concrete recommendations backed by robust scientific data. This created an information vacuum and confusion in the minds of the public, which was promptly filled in by various forms of misinformation and disinformation, which continues to this day.

ADVERTISEMENT

P. Dileep Kumar is a board-certified practicing hospitalist specializing in internal medicine. Dr. Kumar is actively engaged with professional associations such as the American College of Physicians, Michigan State Medical Society, and the American Medical Association. He has held a variety of leadership roles and has authored more than 100 publications in various medical journals and a book on rabies (Biography of Disease Series). Additionally, he has presented more than 50 papers at various national and international medical conferences. Several of his papers are widely cited in the literature and referenced in various textbooks.

Prev

The untold truth of medical residency: a look at its grueling past and present

February 28, 2024 Kevin 0
…
Next

Discover the physician who made a village his family

February 28, 2024 Kevin 0
…

Tagged as: COVID

Post navigation

< Previous Post
The untold truth of medical residency: a look at its grueling past and present
Next Post >
Discover the physician who made a village his family

ADVERTISEMENT

More by P. Dileep Kumar, MD, MBA

  • AI in health care: the black box of prior authorization

    P. Dileep Kumar, MD, MBA
  • Sweden’s controversial COVID-19 strategy: lessons from higher mortality rates

    P. Dileep Kumar, MD, MBA
  • The collapse of rural health care: Why small-town hospitals are closing

    P. Dileep Kumar, MD, MBA

Related Posts

  • Starting medical school in the midst of COVID-19

    Horacio Romero Castillo
  • Major medical groups back mandatory COVID vaccine for health care workers

    Molly Walker
  • COVID-19, medical education, and the role of medical students around the world

    Clarissa C. Ren, Sara K. Hurley, Matthew A. Crane, Ayumi S. Tomishige, and Masato Fumoto
  • Imposter syndrome and COVID: a medical student perspective

    Kimia Zarabian and Mai Hasan
  • Medical education in the COVID-19 pandemic can’t be ignored

    Casey Hribar and Carolyn S. Quinsey, MD
  • The long term effects of COVID-19 on medical education

    Samya Faiq, Harveen Kaur Sekhon, and Sharad Jain, MD

More in Conditions

  • Why medicine must stop worshipping burnout and start valuing humanity

    Sarah White, APRN
  • Why perinatal mental health is the top cause of maternal death in the U.S.

    Sheila Noon
  • A world without vaccines: What history teaches us about public health

    Drew Remignanti, MD, MPH
  • Unraveling the mystery behind one of the most dangerous pregnancy complications: preeclampsia

    Thomas McElrath, MD, PhD and Kara Rood, MD
  • How community paramedicine impacts Indigenous elders

    Noah Weinberg
  • Pain is more than physical: the story your body is trying to tell

    Katie Hatt, DO
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • Why Canada is losing its skilled immigrant doctors

      Olumuyiwa Bamgbade, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

      Gabe Jones, MBA | Tech
    • Why medicine must stop worshipping burnout and start valuing humanity

      Sarah White, APRN | Conditions
    • Why screening for diseases you might have can backfire

      Andy Lazris, MD and Alan Roth, DO | Physician
    • How organizational culture drives top talent away [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...