Human Studies of Masking and SARS-CoV-2 Transmission
Data regarding the “real-world” effectiveness of community masking are limited to observational and epidemiological studies.
An investigation of a high-exposure event, in which 2 symptomatically ill hair stylists interacted for an average of 15 minutes with each of 139 clients during an 8-day period, found that none of the 67 clients who subsequently consented to an interview and testing developed infection. The stylists and all clients universally wore masks in the salon as required by local ordinance and company policy at the time.
In a study of 124 Beijing households with > 1 laboratory-confirmed case of SARS-CoV-2 infection, mask use by the index patient and family contacts before the index patient developed symptoms reduced secondary transmission within the households by 79%.
A retrospective case-control study from Thailand documented that, among more than 1,000 persons interviewed as part of contact tracing investigations, those who reported having always worn a mask during high-risk exposures experienced a greater than 70% reduced risk of acquiring infection compared with people who did not wear masks under these circumstances.
A study of an outbreak aboard the USS Theodore Roosevelt, an environment notable for congregate living quarters and close working environments, found that use of face coverings on-board was associated with a 70% reduced risk.
Investigations involving infected passengers aboard flights longer than 10 hours strongly suggest that masking prevented in-flight transmissions, as demonstrated by the absence of infection developing in other passengers and crew in the 14 days following exposure.
At least ten studies have confirmed the benefit of universal masking in community level analyses: in a unified hospital system, a German city, two U.S. states, a panel of 15 U.S. states and Washington, D.C., as well as both Canada and the U.S. nationally. Each analysis demonstrated that, following directives from organizational and political leadership for universal masking, new infections fell significantly. Two of these studies and an additional analysis of data from 200 countries that included the U.S. also demonstrated reductions in mortality.
Another 10-site study showed reductions in hospitalization growth rates following mask mandate implementation. A separate series of cross-sectional surveys in the U.S. suggested that a 10% increase in self-reported mask wearing tripled the likelihood of stopping community transmission. An economic analysis using U.S. data found that, given these effects, increasing universal masking by 15% could prevent the need for lockdowns and reduce associated losses of up to $1 trillion or about 5% of gross domestic product.
Two studies have been improperly characterized by some sources as showing that surgical or cloth masks offer no benefit. A community-based randomized control trial in Denmark during 2020 assessed whether the use of surgical masks reduced the SARS-CoV-2 infection rate among wearers (personal protection) by more than 50%. Findings were inconclusive, most likely because the actual reduction in infections was lower. The study was too small (i.e., enrolled about 0.1% of the population) to assess whether masks could decrease transmission from wearers to others (source control).
A second study of 14 hospitals in Vietnam during 2015 found that cloth masks were inferior to surgical masks for protection against clinical upper respiratory illness or laboratory-confirmed viral infection. The study had a number of limitations including the lack of a true control (no mask) group for comparison, limited source control as hospitalized patients and staff were not masked, unblinded study arm assignments potentially biasing self-reporting of illness, and the washing and re-use of cloth masks by users introducing the risk of infection from self-washing. A follow up study in 2020 found that healthcare workers whose cloth masks were laundered by the hospital were protected equally as well as those that wore medical masks.
If you need 3 layers face masks:
1) Outer layer: Non- woven fabric
2) Middle layer: Melt- blown fabric
3) Inner layer: absorbent non-woven fabric
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Sources: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases / CDC Centers for Disease Control and Prevention.