[The Lancet Respiratory Medicine] Rational use of face masks in the COVID-19 pandemic

The Lancet Respiratory Medicine, 20 Mar 2020

Shuo Feng, Chen Shen, Nan Xia, Wei Song, Mengzhen Fan, Benjamin J Cowling

Highlights

• It would be reasonable to suggest vulnerable individuals avoid crowded areas and use surgical face masks rationally when exposed to high-risk areas.
• As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks.
• The use of masks increases substantially once local epidemics begin, including the use of N95 respirators (without any other protective equipment) in community settings.
• Health authorities should optimise face mask distribution to prioritise the needs of frontline health-care workers and the most vulnerable populations in communities who are more susceptible to infection and mortality if infected, including older adults (particularly those older than 65 years) and people with underlying health conditions.
• Improper use of face masks, such as not changing disposable masks, could jeopardise the protective effect and even increase the risk of infection.
• The contrast between face mask use as hygienic practice (ie, in many Asian countries) or as something only people who are unwell do (ie, in European and North American countries) has induced stigmatisation and racial aggravations, for which further public education is needed.
• Perhaps it would also be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission.
• Vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available.
• Universal use of face masks could be considered if supplies permit.
• Urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged.

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