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A current hot topic is the wearing of facemasks as a protection against infection during COVID-19. I’ve seen many people now selling cloth facemasks that have been advocated by the US CDC online. Meanwhile, I have also seen social media influencers standing by the UK government’s policy on facemasks.

From the outset of the pandemic, I have felt that the general public should be wearing facemasks. There are however several arguments that have been presented against the use of face masks by the general public.

The first argument against is that there is limited evidence to show that masks are effective. There has been an Australian trial which did demonstrate that masks, when worn, reduced the risk of influenza during an outbreak although they were worn less than 50% of the time. A systematic review demonstrated that masks were effective when worn by people who had respiratory symptoms. Two systematic reviews have been released online prior to publication showing no benefit of masks in influenza while a further systematic review has suggested there is a small but non-significant reduction in infections when masks are worn. A study published this month has shown that shedding is reduced by wearing a mask. So, there is undoubtedly some evidence. It is important to note that these studies were carried out at a time when the motivation to wear a mask in a study was low, given that there was not a pandemic with a high death rate occurring at the times of these studies.

It is also thought that people would not wear masks frequently or adequately enough or might worsen the situation by touching their masks repeatedly. Education on how to properly fit and use of mask could easily remedy this. Also, given that this is an unprecedented situation with a high global death toll, in my experience, people have been extremely keen to understand how they can best prevent spread.

Opponents of public mask-wearing have also suggested that the wearing of masks may give a false sense of security and lead to other risk-taking behaviour. This is, of course, nonsense. People do not put on a house security alarm but then decide to leave the door open. Nor do people wear a seat-belt and then choose to drive more recklessly because they are wearing the seatbelt.

Another argument against the wearing of facemasks is that it may reduce the risk of supply to healthcare providers. However, this is actually an argument for the increased manufacture of more effective masks. Furthermore, healthcare providers should be given N95/ FFP3 masks to protect themselves against the spread in order to for them to be protected from aerosols that spread COVID-19. The public needs masks that stop pre-symptomatic or asymptomatic persons from spreading COVID-19 to other people by droplet spread. They do not need to be special surgical masks, the US have good simple guidelines on how to make simple cloth masks here.

While there may not be an abundance of evidence to support wearing the masks, we should be wearing masks precisely because they might be effective. The public should be taught to wear masks in combination with social distancing and other hygiene practices such as hand washing. The stakes are high and common sense rather than an absence of evidence should prevail.

Dr Hugh Coyne