By Laura (Layla) H. Kwong
Do masks work? And if so, should you reach for an N95, a surgical mask, a cloth mask or a gaiter?
Over the past year and a half, researchers have produced a lot of laboratory, model-based and observational evidence on the effectiveness of masks. For many people it has understandably been hard to keep track of what works and what doesn’t.
I’m an assistant professor of environmental health sciences. I, too, have wondered about the answers to these questions, and earlier this year I led a study that examined the research about which materials are best.
Recently, I was part of the largest randomized controlled trial to date testing the effectiveness of mask-wearing. The study has yet to be peer reviewed but has been well received by the medical community. What we found provides gold-standard evidence that confirms previous research: Wearing masks, particularly surgical masks, prevents COVID-19.
Lab and observational studies
People have been using masks to protect themselves from contracting diseases since the Manchurian outbreak of plague in 1910.
During the coronavirus pandemic, the focus has been on masks as a way of preventing infected persons from contaminating the air around them – called source control. Recent laboratory evidence supports this idea. In April 2020, researchers showed that people infected with a coronavirus – but not SARS-CoV-2 – exhaled less coronavirus RNA into the air around them if they wore a mask. A number of additional laboratory studies have also supported the efficacy of masks.
Out in the real world, many epidemiologists have examined the impact of masking and mask policies to see if masks help slow the spread of COVID-19. One observational study – meaning it was not a controlled study with people wearing or not wearing masks – published in late 2020 looked at demographics, testing, lockdowns and mask-wearing in 196 countries. The researchers found that after controlling for other factors, countries with cultural norms or policies that supported mask-wearing saw weekly per capita coronavirus mortality increase 16% during outbreaks, compared with a 62% weekly increase in countries without mask-wearing norms.
Large-scale randomized mask-wearing
Laboratory, observational and modeling studies, have consistently supported the value of many types of masks. But these approaches are not as strong as large-scale randomized controlled trials among the general public, which compare groups after the intervention has been implemented in some randomly selected groups and not implemented in comparison groups. One such study done in Denmark in early 2020 was inconclusive, but it was relatively small and relied on participants to self-report mask-wearing.
From November 2020 to April 2021, my colleagues Jason Abaluck, Ahmed Mushfiq Mobarak, Stephen P. Luby, Ashley Styczynski and I – in close collaboration with partners in the Bangladeshi government and the research nonprofit Innovations for Poverty Action – conducted a large-scale randomized controlled trial on masking in Bangladesh. Our goals were to learn the best ways to increase mask-wearing without a mandate, understand the effect of mask-wearing on COVID-19, and compare cloth masks and surgical masks.
The study involved 341,126 adults in 600 villages in rural Bangladesh. In 300 villages we did not promote masks, and people continued wearing masks, or not, as they had before. In 200 villages we promoted the use of surgical masks, and in 100 villages we promoted cloth masks, testing a number of different outreach strategies in each group.
Over the course of eight weeks, our team distributed free masks to each adult in the mask groups at their homes, provided information about the risks of COVID-19 and the value of mask-wearing. We also worked with community and religious leaders to model and promote mask-wearing and hired staff to walk around the village and politely ask people who were not wearing a mask to put one on. Plainclothes staff recorded whether people wore masks properly over their mouth and nose, improperly or not at all.
Both five weeks and nine weeks after starting the study, we collected data from all adults on symptoms of COVID-19 during the study period. If a person reported any symptoms of COVID-19, we took and tested a blood sample for evidence of infection.
Mask-wearing reduced COVID-19
The first question my colleagues and I needed to answer was whether our efforts led to increased mask-wearing. Mask usage more than tripled, from 13% in the group that wasn’t given masks to 42% in the group that was. Interestingly, physical distancing also increased by 5% in the villages where we promoted masks.
In the 300 villages where we distributed any type of mask, we saw a 9% reduction in COVID-19 compared with villages where we did not promote masks. Because of the small number of villages where we promoted cloth masks, we were not able to tell whether cloth or surgical masks were better at reducing COVID-19.
We did have a large enough sample size to determine that in villages where we distributed surgical masks, COVID-19 fell by 12%. In those villages COVID-19 fell by 35% for people 60 years and older and 23% for people 50-60 years old. When looking at COVID-19-like symptoms we found that both surgical and cloth masks resulted in a 12% reduction.
The body of evidence supports masks
Before this study there was a lack of gold-standard evidence on the effectiveness of masks to reduce COVID-19 in daily life. Our study provides strong real-world evidence that surgical masks reduce COVID-19, particularly for older adults who face higher rates of death and disability if they get infected.
Policymakers and public health officials now have evidence from laboratories, models, observations and real-world trials that support mask-wearing to reduce respiratory diseases, including COVID-19. Given that COVID-19 can so easily spread from person to person, if more people wear masks the benefits increase.
So next time you are wondering if you should wear a mask, the answer is yes. Cloth masks are likely better than nothing, but high-quality surgical masks or masks with even higher filtration efficiency and better fit – such as KF94s, KN95s and N95s – are the most effective at preventing COVID-19.
Laura (Layla) H. Kwongis Assistant Professor of Environmental Health Sciences at the University of California, Berkeley
Mark says
Do they reduce the rate of spread by blocking the spreading of or by reducing the contracting of COVID? Inquiring minds would like to know.
beachcomberT says
Interesting findings but I doubt many Americans, especially older ones with weak lungs, are going to decide a 9 percent difference in catching Covid-19 is worth the irritation of wearing a mask.
FlaglerLive says
Beachcomber is misleading in singling out one detail of the study as opposed to its totality. In totality, the researchers concluded: “We did have a large enough sample size to determine that in villages where we distributed surgical masks, COVID-19 fell by 12%. In those villages COVID-19 fell by 35% for people 60 years and older and 23% for people 50-60 years old. When looking at COVID-19-like symptoms we found that both surgical and cloth masks resulted in a 12% reduction.”
Mike Cocchiola says
Of course, masks work. But medical science, professional studies, and qualified experience mean nothing to Flagler’s or Florida’s anti-maskers and anti-vaxxers. They dismiss knowledge and trust their beliefs gained from mind pollution by quacks on Fox, Newsmax, OANN, and Breitbart.
Good news… many “anties” repent as they face intubation in hospital ICUs. If they live they accept the truth of medical experts.
Trailer Bob says
“KF94s, KN95s and N95s – are the most effective at preventing COVID-19”. This is true, but I have read many high level studies which illustrate that N95s masks absolutely have the highest level of protection. I believe it was the CDC some time ago that said the same thing. When it comes to a matter of life or death in some cases, saving a buck or two isn’t worth it.
Though somewhat minor in scale, the fit of the mask, the number of particles that can enter, and the exhalation resistance factor, among some other minor differences, makes the N95 the choice of champions.
Trailer Bob says
Both…it’s a two way street.
Shy guy says
I hope our worthless Governor reds this,
IMYellowstone says
The slogan around Flagler: “Here you can choose your own poison; bleach, Ivermectin, hydroxychloroquine, or remdesivir”.
But for your own sake don’t wear a mask or take the vax and save your life or that of your neighbors. Masks don’t allow you to show off your anger. The thought of a Vax scares those scaredy-cats who are afraid of needles.
For those who plan on living much longer: wear your masks and get the vax.
NoInconvenienceHere says
When I read about this new virus in China back in late November 2019 (on some international medical message boards I follow), I knew this one was different. The tone was full of fear. The last time I read something with that much fear was the large-scale Ebola outbreak that had cases show up here in the US.
So, I bought rolls of N95 filters that you can cut and size to fit inside any mask. I bought masks with pockets. I bought hospital-grade wipes (Sonos). I bought nano-particle hand cleanser (All Day) and nose wipes (NanoBio Protect Nasal Antiseptic). I did all this in December (I have my Amazon history-LOL). I have yet to get anything. My allergies even reduced their potency.
My body thanks me it doesn’t have to take prescriptions meds or OTC yuck to feel better. I got my Moderna vax and my flu vax and all is well. I still use all the aforementioned items because I like not feeling like garbage. I like not getting god knows what from gross people. That’s more of an inconvenience to me than taking precautions. I usually have a cold or flu 3-4 times a year. Bronchitis too. Some type of stomach bug slips in there as well. Not one illness since December 2019. I’ve never been happier.
Danm50 says
Why do you think Doctors have worn masks for decades. BECAUSE THEY WORK. This is not new information .
tulip says
The saddest and most grim part of this mask issue and vaccine issue is that people who need urgent medical attention, surgery, cancer treatments and the like can’t get it because of the selfish and thoughtless unvaxed people who are are taking up the bed space in hospitals. Therefore, innocent people wind up suffering or dying because doctors and nurses are too busy with the covid patients who could’ve prevented themselves from getting covid in the first place. Because of this it leaves doctors and nurses in a lot of hospitals having to make decisions on who gets medical care and who doesn’t. That’s a terrible situation to be in for the doctors and horrifying to patients who need care and realize there is none to be had.
A.j says
Some just asked the question, why do you think Dr’s. wore masks for many years, it is because they work. Covid do not discriminate. Look all the Trump supporters who have died listening to him. He is still alive I wonder why. He got the shot. People need to stop listening to these lies and think for themselves. Trump and Fox News are not Dr’s. They are good liars.
Been There says
Trump told his supporters to get the vaccine at an August 23rd rally in Alabama and they booed him. These people subscribe to delusion and ignorant self-righteousness. They don’t care who says what unless it is what they have already formed an opinion of.
IMYellowstone says
Perhaps answering your question, “He is still alive I wonder why?”
The meds Trump took to shield himself from COVID: Dexamethasone, Remdesivir, Regeneron, Zinc, Vitamin D, Famotidine, Melatonin, and Aspirin.
Not hydroxychloroquine as he said he did!
Sherry says
Excuse me. . . the most effective medicine trump took was the “VACCINE”.
A.j says
I didn’t know Trump told his supporters in Ala. to get the shot. I guess covid gave him some common sense. He once said it was a Dem. hoax. After covid gave him a visit I didn’t hear him say covid was a Dem. hoax again. The reality is he’s alive and a lot of his supporters have died.