Major Update: Masks for Prevention of SARS-CoV-2 in Health Care and Community Settings
Authors: Binh Ngo, Marc S. Rendell
Journal: Annals of Internal Medicine (2023)

LettersDecember 2023Major Update: Masks for Prevention of SARS-CoV-2 in Health Care and Community SettingsFREEBinh Ngo, MD, and Marc S. Rendell, MDBinh Ngo, MDKeck USC School of Medicine, Los Angeles, Los Angeles, CaliforniaSearch for more papers by this author, and Marc S. Rendell, MDThe Rose Salter Medical Research Foundation, Newport Coast, CaliforniaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L23-0358 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: We read Chou and Dana's review (1) with interest. Barrier methods to prevent transmission of infectious disease by interpersonal contact are considered highly effective but rely on committed personal behavior (2). Chou and Dana have doggedly pursued the trail of studies on the use of masks and repeatedly published their findings throughout the pandemic in order to come to evidence-based conclusions. Their task was challenging given the diversity of studies in different countries and the progression of SARS-CoV-2 variants over the past 3 years.Dana and Chou persevered even though heterogeneity constituted an insurmountable obstacle to a true meta-analysis and concluded that community masking may offer a modest degree of protection compared with no masking. They also concluded that N95 respirators may provide superior protection compared with surgical masks in the health care setting. They did not compare masking with no masking in the health care setting because masking is well accepted by health care workers and the public in medical care. We must recognize that protection against respiratory pathogens by masks depends on correct use and attention to detail—that is why the Occupational Safety and Health Administration has established very specific guidelines for use of respirators, including mask fitting tests for employees (3).Chou and Dana recognize that little work has been done on the possible harms of mask wearing. In a recent commentary that proposes eliminating universal masking in the health care setting, Shenoy and colleagues (4) raise concerns that masks interfere with the social interaction, communication, and empathy valued in the physician–patient relationship. One could add that facial rashes associated with masking can develop in a few patients. However, the strongest objection to mask wearing is that people simply don't like or want it. That is why so few people in the community now wear masks.Still, health care settings are not a social venue. People typically visit a physician because of a health problem and deserve protection against pathogenic agents, which often concentrate in areas harboring disease. Immunosuppression is a common problem. Much more consideration must be given to the balance of personal preference while protecting oneself and others before ending current masking recommendations in health care. Moreover, we should strive to promote such recommendations by education rather than compulsion.References1. Chou R, Dana T. Major update: masks for prevention of SARS-CoV-2 in health care and community settings—final update of a living, rapid review. Ann Intern Med. 2023;176:827-835. [PMID: 37186920] doi:10.7326/M23-0570 LinkGoogle Scholar2. Department of Health and Human Services; Centers for Disease Control and Prevention. Condoms and STDs: fact sheet for public health personnel. 2022. Accessed at www.cdc.gov/condomeffectiveness/docs/condoms_and_stds.pdf on 20 October 2023. Google Scholar3. Occupational Safety and Health Administration. Updated 1 October 2023. Occupational safety and health standards: personal protective equipment. Standard no. 1910.134(c)(1)(iii). Accessed at www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134 on 20 October 2023. Google Scholar4. Shenoy ES, Babcock HM, Brust KB, et al. Universal masking in health care settings: a pandemic strategy whose time has come and gone, for now [Editorial]. Ann Intern Med. 2023;176:859-861. [PMID: 37068281] doi:10.7326/M23-0793 LinkGoogle Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Binh Ngo, MD; Marc S. Rendell, MDAffiliations: Keck USC School of Medicine, Los Angeles, Los Angeles, CaliforniaThe Rose Salter Medical Research Foundation, Newport Coast, CaliforniaDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L23-0358. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMajor Update: Masks for Prevention of SARS-CoV-2 in Health Care and Community Settings—Final Update of a Living, Rapid Review Roger Chou , and Tracy Dana Metrics Current Issue December 2023Volume 176, Issue 12 Keywords COVID-19 Health care Infection control Personal protective equipment Respirators Systematic reviews ePublished: 19 December 2023 Issue Published: December 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...