ECDC Technical Report: Using Face Masks in the Community – Effectiveness In Reducing Transmission Of COVID-19

I suspect that 10 or 20 years from now, after enough time has passed to dispassionately analyse this COVID-19 pandemic, one of our biggest failures will seen as our not immediately producing – on a war footing – massive quantities of medical grade PPEs for Healthcare workers, and `standardized’ face covers for everyone else.

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#15,809

I suspect that 10 or 20 years from now, after enough time has passed to dispassionately analyse this COVID-19 pandemic, one of our biggest failures will seen as our not immediately producing – on a war footing – massive quantities of medical grade PPEs for Healthcare workers, and `standardized’ face covers for everyone else.

We’ve known for well over a decade that we’d face huge shortages of PPEs (see 2009’s Caught With Our Masks Down) during any pandemic, and yet the world did nothing substantial to prepare. 

How we find ourselves –  a year into this pandemic – still faced with shortages of N95s for HCWs, and the public continuing to struggle with a hodgepodge of sketchy commercial and/or homemade face covers simply boggles the mind.

In Asian nations where public mask wearing has been nearly universal (Hong Kong, Taiwan, South Korea, etc.), COVID-19 remains largely suppressed.  Not that face masks offer perfect protection; they don’t.  

But when consistently and correctly worn, they have been shown to reduce the transmission of COVID. 

A recent MMWR Study (see below) found that when properly fitted and worn, even non-medical face masks can reduce exposure from infected wearers and reduce exposure of uninfected wearers. 

Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021


Early Release / February 10, 2021 / 70
Please note:. This report has been corrected.

John T. Brooks, MD1; Donald H. Beezhold, PhD2; John D. Noti, PhD2; Jayme P. Coyle, PhD2; Raymond C. Derk, MS2; Francoise M. Blachere, MS2; William G. Lindsley, PhD2

Summary

What is already known about this topic?

Universal masking is recommended to slow the spread of COVID-19. Cloth masks and medical procedure masks substantially reduce exposure from infected wearers (source control) and reduce exposure of uninfected wearers (wearer exposure).

What is added by this report?

CDC conducted experiments to assess two ways of improving the fit of medical procedure masks: fitting a cloth mask over a medical procedure mask, and knotting the ear loops of a medical procedure mask and then tucking in and flattening the extra material close to the face. Each modification substantially improved source control and reduced wearer exposure.

What are the implications for public health?

These experiments highlight the importance of good fit to maximize mask performance. There are multiple simple ways to achieve better fit of masks to more effectively slow the spread of COVID-19. 

MMWR%2BMask.png

Today the ECDC has published a 31-page Technical Report on the use of face masks (both medical and non-medical) by the public to reduce the transmission of COVID-19. 
The quality of the evidence on the effectiveness of non-medical grade masks is admittedly scant and of low certainty, mostly because few studies have been conducted, and there is no universal `standard‘ for these types of PPEs. 
Nevertheless, the ECDC recommends the use of both medical and (in some circumstances) non-medical face covers by the public in situations where the virus is circulating and exposure is likely. 

I’ve reproduced the executive summary below, which includes their recommendations for mask wearing, but you’ll want to follow the link to download and read the report in its entirety. 

Using face masks in the community: first update – Effectiveness in reducing transmission of COVID-19


Technical report
15 Feb 2021 

This technical report reviews the evidence that has been accumulated since the emergence of COVID-19, in addition to what has existed on this topic prior to the pandemic, and updates the ECDC opinion on the suitability of using face masks in the community published on 9 April 2020.


Executive summary

The role of face masks in the control and prevention of COVID-19 remains an issue of debate. Prior to COVID-19, most studies assessing the effectiveness of face masks as a protective measure in the community came from studies on influenza, which provided little evidence to support their use.

Assessment of the evidence

The evidence regarding the effectiveness of medical face masks for the prevention of COVID-19 in the community is compatible with a small to moderate protective effect, but there are still significant uncertainties about the size of this effect. Evidence for the effectiveness of non-medical face masks, face shields/visors and respirators in the community is scarce and of very low certainty.

Additional high-quality studies are needed to assess the relevance of the use of medical face masks in the COVID-19 pandemic.


Recommendations

Although the evidence for the use of medical face masks in the community to prevent COVID-19 is limited, face masks should be considered as a non-pharmaceutical intervention in combination with other measures as part of efforts to control the COVID-19 pandemic.

Taking into account the available evidence, the transmission characteristics of SARS-CoV-2, the feasibility and potential harms associated with the use of various types of face masks, the following options are proposed:

  • In areas with community transmission of COVID-19, wearing a medical or non-medical face mask is recommended in confined public spaces and can be considered in crowded outdoor settings.
  • For people vulnerable to severe COVID-19, such as the elderly or those with underlying medical conditions, the use of medical face masks is recommended as a means of personal protection in the above-mentioned settings.
  • In households, the use of medical face masks is recommended for people with symptoms of COVID-19 or confirmed COVID-19 and for the people who share their household.
  • Based on the assessment of the available scientific evidence, no recommendation can be made on the preferred use of medical or non-medical face masks in the community.
  • When non-medical face masks are used, it is advisable that masks that comply with available guidelines for filtration efficacy and breathability are preferred.


The very limited scientific evidence regarding the use of respirators in the community does not support their mandatory use in place of other types of face masks in the community. Although respirators would not be expected to be inferior to non-medical or medical face masks, the difficulties to ensure their appropriate fitting and use in community settings as well as potential adverse effects related to lower breathability should be taken into account.

The use of face masks in the community should complement and not replace other preventive measures such as physical distancing, staying home when ill, teleworking if possible, respiratory etiquette, meticulous hand hygiene and avoiding touching the face, nose, eyes and mouth.

The appropriate use of face masks and promoting compliance with their use when recommended as public health measures are key to the effectiveness of the measure and can be improved through education campaigns.

Using face masks in the community: first update – Effectiveness in reducing transmission of COVID-19 – EN – [PDF-702.58 KB]