The fierce debate on whether masks work (or not) in the general population

One of the big debates these days is whether or not masks are of any use in the general population. While the health authorities have repeatedly defended that healthy people should not use the mask only in very specific situations, in Asian countries (the countries that, theoretically, have implemented the most successful strategies), the use of These devices'.

We examine the arguments behind each strategy and contextualize a much more complex debate than it seems.

Two great public health strategies

Tam wai

The first of these is that of the World Health Organization and that which has been followed by most European countries. The WHO is quite clear in its recommendations: "If you are healthy, you only need to wear a mask if you are caring for someone who suspects SARS-CoV-2 infection." He also recommends taking it if you "have a cough or sneeze."

In addition, he explains that "the masks are only effective if they are combined with frequent hand washing with a hydroalcoholic solution or with soap or water" and, of course, "we learn to use and eliminate it correctly". The rationale for the recommendation is that, if we respect social distancing measures, becoming infected with the virus 'through the air' becomes somewhat less likely than being infected 'through the hands'.

In a context like that, wearing masks can end up being a problem to the extent that it makes us touch the face area much more than if we did not wear them. For this reason, he insists that its use is only effective if it is combined with frequent hand washing. Something similar happens with gloves: if we do not learn to take them off well, the fact of using them only makes us touch more things to end up contaminating our hands in the process of removing them.

This strategy contrasts with the fact that most Asian countries have generalized (even made mandatory) the use of the mask. This is based on two ideas: the first is that the widespread use of the mask would reduce the amount of viruses on surfaces and environments. Therefore, although the individual risk of misusing the mask increases, in population terms the risk should fall.

This theory gained weight when, in January, the first studies began to show that presymptomatic patients could spread the virus. By restricting the use of the mask only to those with symptoms, we are creating a gap in the epidemiological barrier that is more than considerable. For this reason, in a situation of "uncontrolled community contagion", intensive use seemed most reasonable.

Which strategy works best?

Ani Kolleshi

The truth is that it is difficult to say. Both approaches have epidemiological arguments behind them and the choice of one or the other depends not only on the characteristics of the virus (things such as the role of presymptomatic infections), but also on the availability of masks or on the plausibility of implementing distancing measures. social or surface disinfection. Contingency plans, as we see, have to take into account a huge number of factors when deciding which prophylactic strategy is best.

To this we must add that, like all prophylaxis, anti-coronavirus strategies have, at least, two effectiveness: the "perfect use" and the "habitual use". One of the settings where this difference has been best studied is in contraceptive methods. The condom has a perfect use effectiveness of 97% and a regular use effectiveness of between 82-85%. This means that there is a margin of between 13 and 15% of cases in which the method malfunctions, does not prune factory defects, but because users mishandle it, it has been poorly preserved or a long series of factors that may affect its effectiveness outside of laboratory tests.

When we talk about public health, the categorical responses fade. The problem when facing the issue of masks is that we do not have data on regular use (and, in fact, there are few data on perfect use in the general population). Firstly, for an ethical issue (the Pearl index applied to this case would consist of giving different groups different methods and seeing the results) and, secondly, because, although there is a set, it does not seem that the topic has prompted research Enough to make an evidence-based judgment.

This confronts us, at the outset, with the recognition that it seems reasonable to abandon a certain claim that one or the other strategy is wrong. per se. In particular, in the Spanish context, the idea that masks do not work in the general population. The technical debate, as we see, is much more complex and trying to falsely close the question does not make much sense. It is true that, unfortunately, we do not have all the data to evaluate the decisions of the different countries in their context, but that does not mean that the debate is meaningless.

Image | Michael Amadeus

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