As a scientist, I question the efficacy of paper surgical masks in preventing the transmission of COVID-19, as my hospital reintroduced a mandate for healthcare providers to wear them.

Although many debate the effectiveness of paper masks, I am more interested in the evidence supporting wearing one rather than the politics surrounding masking.

Mixed Feelings

I remember wearing a paper surgical mask during a particularly busy shift at the hospital last winter.

As I moved from one patient’s room to another, I couldn’t help but notice the discomfort caused by the mask’s straps constantly tugging at my ears.

Despite the inconvenience, I also couldn’t ignore the sense of protection and responsibility that came with wearing it.

I work in cancer medicine, after all.

It’s a strange juxtaposition — the physical discomfort versus the mental reassurance.

Moreover, my patients prefer to see my face.

Moments like these make me reflect on the true effectiveness of these masks and whether they are truly making a difference in preventing the transmission of viruses.

Overview

While we adopted widespread mask use as a public health measure, the evidence supporting their effectiveness remains contested.

Observational studies (and even some randomized controlled trials) suggest a benefit, but there is no high-level, conclusive evidence that masks reduce COVID-19 transmission.

You may be surprised to hear this doctor admit that.

Today, I want to examine a recent study that hails the effectiveness of masking.

The big reveal: We need more rigorous investigations to determine the precise role of paper surgical masks in mitigating the spread of the virus.

A New Study

Atle Freithem and colleagues report the results of a pragmatic randomized control trial in the British Medical Journal:

Personal protective effect of wearing surgical face masks in public spaces.

www.bmj.com.

The take-home message is this:

Wearing a surgical mask for two weeks during the winter of 2023 reduced the spread of self-reported viral illness.

This research proves that paper masks work, right?

Study Details

Purpose: This study aimed to see if wearing a surgical mask in public places like stores, streets, and public transport for two weeks could protect people from getting sick with respiratory infections like colds or the flu.

How the study worked: Researchers randomly divided almost 4,700 adults in Norway into two groups. They told one group of participants to wear surgical masks in public for two weeks while asking the other group not to.

What researchers examined: The scientists were mainly interested in whether people got sick with respiratory infections. They also looked at whether people reported getting COVID-19 or had it confirmed by a doctor.

Important note: The investigators did not tell subjects to wear masks at home or work, only when in public.

Study Results

Here are the study results:

Over the study period, about 9 percent of those who wore masks reported cold or flu-like symptoms, compared to 12 percent of those who didn’t.

This finding suggests that wearing masks might slightly lower your chances of contracting a respiratory infection.

My Take

First, kudos to the researchers for completing a practical, randomized clinical trial evaluating paper mask effectiveness.

We can do randomized clinical trials in the COVID-19 realm.

Second, the study does not prove that paper masks reduce COVID-19 transmission.

Many people believe masks are effective, and this study didn’t use a placebo or fake mask to account for that belief.

The results may reflect that people feel better because they wear a mask rather than a mask that prevents illness.

We Need Studies With Objective Measures

I hope we get a study that uses objective measures of infection.

I wish the authors had used regular virus tests or blood tests checking for COVID-19 antibodies.

And mandated mask wearing for more than a couple of weeks.

The study, as conducted, tells us that people wearing masks reported fewer illnesses, not that they were actually sick less often or felt better overall.

While the study didn’t find a benefit in confirmed COVID-19 cases, it might not have been large enough to detect a small difference.

Bottom Line

This study does not prove masks reduce COVID-19 transmission; the study’s primary endpoint was self-reported illness.

After so much trumpeting of the value of paper masks to reduce COVID-19 contagiousness, we still need high-level evidence to convince me.

Per my hospital’s mandate, I will continue to don my paper mask faithfully in designated places in my workplace.

But am I better off donning a mask year after year for a virus that has diminished in lethality for healthy individuals like me?

If I had a big upcoming event, I would wear an N-95 mask.

Many counterfeit N-95 and K-95 masks are out there, and many don’t fit them properly.

But that is another story.

Do you regularly wear a paper surgical mask? What motivates you to do so?

Effectiveness of Face Mask or Respirator Use.

This report describes face mask or respirator effectiveness in helping protect against COVID-19 infection.

www.cdc.gov.

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