Facial Masking for Covid-19 | NEJM

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Correspondence from The New England Journal of Medicine — Facial Masking for Covid-19
To the Editor We caution against incorporating hypotheses about masks functioning as effective "variolation" — a notion that was advanced by Gandhi and Rutherford in the Journal (online September 8)1 — into public health messaging without considering the implications and nuances. The term "variolation" should be avoided because it is inaccurate with respect to coronaviruses, and it describes an obsolete and risky practice that was used for the iatrogenic inoculation of smallpox. There is insufficient evidence to support the claim that masks reduce the infectious dose of SARS-CoV-2 and the severity of Covid-19, much less that their use can induce protective immunity. Substantial knowledge gaps must be addressed before claims are made about the efficacy of face masks in reducing morbidity or eliciting immune responses. Masks are used primarily to reduce SARS-CoV-2 transmission rather than reduce the dose of infectious particles or mitigate the severity of Covid-19. The suggestion that masks offer an alternative to vaccination without evidence that the benefits outweigh the great risks implicitly encourages reckless behavior. With the lack of a vaccine, nonpharmaceutical interventions continue to be the best preventive tools.2,3 Transparent, contextualized messaging and embracing uncertainty are essential while science moves forward. Currently, there are too many research gaps to conclude that masks offer benefits beyond reducing transmission risk. We should not advocate for these benefits without fully comprehending the risks. Angela L. Rasmussen, Ph.D.

Columbia Mailman School of Public Health, New York, NY

[email protected] Kevin Escandón, M.D.

Universidad del Valle, Cali, Colombia Saskia V. Popescu, Ph.D.

George Mason University, Arlington, VA No potential conflict of interest relevant to this letter was reported. This letter was published on October 23, 2020, at NEJM.org. 3 References 1. Gandhi M, Rutherford GW. Facial masking for Covid-19 — potential for…
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