PROS & CONS of Public Recommendations for Surgical & Cloth DIY Masks to Prevent Coronavirus

March 18, 2020

Should Surgical Masks Be Recommended to the Public

1. CON It will cause a shortage for health care workers.

“If there’s a general recommendation that people wear face masks, we won’t have enough supply for healthcare workers”  -Dr. William Schaffner, professor in Vanderbilt University’s Division of Infectious Diseases (Time, 2020)

1. PRO Different mask types can be used that will not cause any shortage.

While the supply of masks needs to be prioritized for healthcare workers. recommendations for Cloth, DIY or home masks will not affect the supply of masks.

2. CON “Scant evidence” [for] recommending face masks to the public.  -Dr. William Schaffner, professor in Vanderbilt University’s Division of Infectious Diseases (Time, 2020)

2. PRO Sufficient evidence exists for healthcare workers and the public to make recommendations in an emergency situation that the public wear face masks.

2A. PRO No conclusive (“scant”) evidence exists for any medical face masks. However, despite the evidence, or lack thereof, recommendations are still made that medical professional should be wearing them. If the level of evidence is sufficient for medical professionals, it should be satisfactory for the public. Therefore,  recommendations should encourage the public to wear face masks. 

22B.PRO Even if evidence is lacking it is “not a reason to dismiss” especially when “we need to do anything” to buy us time and when any delay could “be devastating.” “You can’t say, ‘Let’s wait a month until we have the data…we need to make…decisions now” 

Dr. Jeremy Farrar, infectious disease specialist and director of the research charity Wellcome, in London

2C. PRO Better evidence isn’t possible. Randomized controlled trials for face masks aren’t possible, since exposing individuals to a virus without a mask would be unethical. Therefore, most evidence comes from laboratory or observations studies. Of note, there are at least 19 studies on cloth masks that suggest efficacy as well as anecdotal data. 

-David Hui, respiratory medicine expert, Chinese University of Hong Kong, studied the 2002 to 2003 SARS outbreak extensively

3. CON [Face masks] don’t fit snugly” for members of general public” 

3. PRO Snug Fit is not a major issue for barriers from large droplets and not relevant to the current guidelines as N95 is only recommended for physicians performing procedures.

Should Cloth Masks Be Used?

Cloth Masks – include cotton and gauze masks that are homemade or woven Chughtai 2015

4. CON Lack of quality assurance, regulation wide range of cloth masks or improvised masks include cotton and gauze masks that are homemade or woven used around the world.

4. PRO Surgical masks used in healthcare face similar issues to cloth masks Chughtai 2015, unlike NIOSH certified N95 masks. Though surgical masks superiority appears to ability to used in the operating room due to fluid resistance IOM 2006

5. CON Concern that cloth masks may encourage risk taking or decrease other hygiene measures due to a false sense of protection Chughtai 2015

5. PRO Currently being used successfully in countries in Asia with successful response and…

5. PROS Cloth Masks Have Worked and Been Recommended by DOH & CDC During Supply Shortage

  • Non-disposable cloth masks were used to protect healthcare workers from scarlet fever, measles, influenza, plague and tuberculosis. Mcintyre et al 2015
  • Use continues today in developing countries like India because they last long, easy to carry, nonallergenic, comfortable, affordable, and washable. IOM 2006
  • During the SARS Outbreak in 2002 the public in Asia was encouraged to wear reusable gauze or cotton masks that could be washed with disinfectants or sterilized with high pressure and temperature. IOM 2006
  • Use of masks, social distancing and hand hygiene were found be strongly protective and significantly reduced the risk for SARS IOM 2006
  • CDC recommended using cotton masks for infection control of viral hemorrhagic fevers in the African health care setting when surgical masks are not available
  • Regional pandemic influenza plans (Sonoma County DOH in 2006) discuss the use of cloth masks in the event of a shortage of N95 and surgical masks Chughtai et al 2013
    • Implies cloth masks protect against droplet as well as against airborne particles
    • Research has shown cloth from a Hanes Sweatshirt can filter out 55% of particles in the 20-1000 nanometer range during penetration testing Shaffer et al 2010


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