While COVID-19 news changes on the hour, it’s widely accepted that masks are a key mitigation strategy. What’s been less clear is what kind of mask actually helps, who should be wearing masks and when to wear them.

In 2020 when it became clear that masks help slow the spread of COVID-19, staff at Lifescan Labs were quick to decide to wear masks at all times in the building. Accustomed to already wearing masks in a medical setting, it was a natural adjustment to also wear them indoors at work.

And while the Lifescan team enjoyed the post vaccination period prior to the rise of the Delta variant when we no longer needed to don masks, our staff was quick to start wearing them again indoors once the rise of breakthrough infections became apparent. We’re committed to keeping our team safe, so we once again started wearing masks indoors even prior to the Illinois Governor’s Mandate.

Lifescan Labs Medical Director Dr. Sam Lipshitz says, “It’s clear that those who are wearing masks and practicing social distancing are less likely to get COVID-19.”

In the U.S., the CDC recommends that those who are over age 2 wear a mask in indoor public settings if they are:

  • Not fully vaccinated
  • Fully vaccinated and in an area with substantial or high transmission
  • Fully vaccinated and with weakened immune systems

There is insufficient evidence to show that wearing a mask is necessary in an outdoor setting because the transmission of COVID-19 outdoors is so low.

The history of wearing masks in medicine According to The Lancet: “Covering the nose and mouth had been part of traditional sanitary practices against contagious diseases in early modern Europe. This protection was primarily about neutralising so-called miasma in the air through perfumes and spices held under a mask, such as the plague doctors’ bird-like masks. Such practices, however, had become marginal by the 18th century. Face masks, as they are used today in health care and in the community, can be largely traced back historically to a more recent period when a new understanding of contagion based on germ theory was applied to surgery.”

It wasn’t until around the Depression area that most surgeons wore masks in the operating room. The same article in The Lancet cites a study of more than 1000 photographs of surgeons in operating rooms in the U.S. and Europe between 1863-1969 that indicated that by 1923 over two-thirds of them wore masks and by 1935 most of them were using masks.

To anyone in the medical profession, recommendations to wear a mask during the COVID-19 pandemic was not a surprise.

 

What kind of masks help prevent the spread of COVID-19?

A large, randomized trial in Bangladesh released on September 1 found that wearing a surgical face mask is an effective way helped reduce the spread of COVID-19

“We now have evidence from a randomized, controlled trial that mask promotion increases the use of face coverings and prevents the spread of COVID-19,” said Stephen Luby, MD, professor of medicine at Stanford.

Ashley Styczynski, MD, an infectious disease fellow at Stanford University who collaborated on the study says, “I think people who have been holding out on wearing masks because [they] felt like there wasn’t enough evidence for it, we’re hoping this will really help bridge that gap for them.”

The study showed that surgical masks provide better protection than cloth masks, but cloth masks still do help. Bangladeshi villages where surgical masks were worn had 11% fewer COVID-19 cases than villages where masks were not worn. In villages where cloth masks were worn, infections were reduced by only 5%.

 

Wearing masks in schools

While wearing masks indoors has been recommended by the CDC for anyone over age 2 who is not vaccinated, the New York Magazine reports on how many nations around the world have exempted kids, with varying age cutoffs, from wearing masks in classrooms. This includes the U.K., Ireland, all of Scandinavia, France, the Netherlands, Switzerland, and Italy. These countries did not face higher rates of outbreaks in schools, although this data comparison is from before the Delta variant outbreak, which has proved to be more contagious.

The World Health Organization recommends children over age 5 wear masks.

The American Academy of Pediatrics recommends everyone in school over age 2 should wear masks, regardless of vaccination status.

COVID cases among unvaccinated children vary widely by the percentage of adults in their area who are vaccinated, which indicates that the best way to protect unvaccinated children and vulnerable citizens is to increase vaccination rate of the adults around them. Ashish Jha, the dean of Brown University School of Public Health, explains this on a Twitter thread.

San Francisco schools and LA, where adults have a high vaccination rate, have had minimal COVID cases since opening.

While COVID data is constantly evolving, what’s clear is that surgical masks, worn properly indoors and under certain conditions are one key mitigation tool for protecting us from the spread of coronavirus.

The best tool in the arsenal continues to be vaccination, which has proved to substantially reduce the spread of COVID-19, along with the severity of any breakthrough infections due to the Delta variant.