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COVID-19 and Masks

Wearing face masks in group settings independently reduces (4,5,6,10,11) but does not eliminate (1,7) the risk of transmitting SARS-CoV-2. Other possible variables influencing the odds of transmission include presence or absence of mask mandates (6), degree of compliance with mask mandates or requests (10), prevalence of the virus in the community, number of attendees, number of unvaccinated attendees, number of infected attendees, locally dominant variant of the virus, spacing, ventilation, and duration of exposure. There is experimental evidence from a study in nonhuman primates (3) that the exposure dose of SARS-CoV-2 independently influences what happens next along a continuum ranging from no disease to death. Wearing a mask can provide valuable benefit to self and others even when it fails to protect completely.

"Personal freedom" has been raised as an issue in mask wearing (12), especially in the context of mandates. Masks have acquired a new symbolism (8) in the pandemic. Prevalence of mask wearing has varied among U.S. states (8) as well as among other countries (9). "Freedom" is just a cover for the real issue, which is identity politics (2), given that mandates unrelated to COVID-19 traditionally have been accepted without drama. In some subcultures, wearing a mask in public looks weak (8). Any government mandate for highly visible attire that conflicts with a person's self-identity and how they wish to be seen by others (8) is likely to be greeted with hostility--and understandably so. The demonstrable value of masking for preventing this particular disease has been compromised by those who have made it a political issue. This kind of damage is hard to undo.


  1. Akhtar J et al. Can face masks offer protection from airborne sneeze and cough droplets in close-up, face-to-face human interactions?—A quantitative study. Phys Fluids (1994). 2020 Dec 1; 32(12):127112. doi: 1063/5.0035072

  2. Collins RN, Mandel DR, Schjywiola SS. Political Identity Over Personal Impact: Early U.S. Reactions to the COVID-19 Pandemic. Front Psychol.2021; 12: 607639. Published online 2021 Mar 23. doi: 3389/fpsyg.2021.607639

  3. Dabisch PA et al. Seroconversion and fever are dose-pependent in a nonhuman primate model of inhalational COVID-19. PLoS Pathog 2021 Aug 23;17(8):e1009865. doi: 10.1371/journal.ppat.1009865.Online ahead of print.

  4. de Labry-Lima AO et al. The use of masks to protect against respiratory infections: An umbrella review. Enferm Infecc Microbiol Clin (Engl Ed) 2021 Aug 24;S2529-993X(21)00157-X doi: 10.1016/j.eimce.2021.08.002. Online ahead of print.

  5. Howard J et al. An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A.2021 Jan 26; 118(4): e2014564118. Published online 2021 Jan 11. doi: 1073/pnas.2014564118

  6. Joo H e al. Decline in COVID-19 Hospitalization Growth Rates Associated with Statewide Mask Mandates - 10 States, March-October 2020. MMWR 2021 Feb 12;70(6):212-216. doi: 10.15585/mmwr.mm7006e2.

  7. Jung J et al. Frequent Occurrence of SARS-CoV-2 Transmission among Non-close Contacts Exposed to COVID-19 Patients. Korean Med Sci 2021 Aug 23;36(33):e233. doi: 10.3346/jkms.2021.36.e233.

  8. Kemmelmeier M, Jami WA. Mask Wearing as Cultural Behavior: An Investigation Across 45 U.S. States During the COVID-19 Pandemic. Front Psychol.2021; 12: 648692. Published online 2021 Jul 21. doi: 3389/fpsyg.2021.648692

  9. Martinelli L et al. Face Masks During the COVID-19 Pandemic: A Simple Protection Tool With Many Meanings. Front Public Health.2020; 8: 606635. Published online 2021 Jan 13. doi: 3389/fpubh.2020.606635

  10. Nguyen M. Mask Mandates and COVID-19 Related Symptoms in the US. Clinicoecon Outcomes Res.2021; 13: 757–766. Published online 2021 Aug 16. doi: 2147/CEOR.S326728

  11. Tran TQ et al. Efficacy of face masks against respiratory infectious diseases: a systematic review and network analysis of randomized-controlled trials. J Breath Res 2021 Aug 18. doi: 10.1088/1752-7163/ac1ea5. Online ahead of print.

  12. Vázquez E, Chobdee J, Nasrollahzadeh N, Cheney A. Personal Freedom and Social Responsibility in Slowing the Spread of COVID-19: A Rapid Qualitative Study. Health Educ Behav.2021 Aug 20 : 10901981211033241. Published online 2021 Aug 20. doi: 1177/10901981211033241

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