As members of the College of Family Physicians of Canada who are part of Masks4Canada (www.masks4canada.org), a community group of Canadian physicians, professionals, and citizens in support of masking in high-risk settings, we are writing to express our concerns with the public-facing article published in the July issue of Canadian Family Physician: “PEER simplified tool: mask use by the general public and by health care workers.”1
We are at a critical time in Canada’s fight against severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) and the surges that are emerging nationwide as economies reopen and interaction increases among the public. Clear and consistent messages are imperative around public masking. Public messaging must clearly articulate that cloth masking is an added layer of protection in addition to physical distancing and hand hygiene.
While we understand that this review of the current available evidence does indeed support the use of public masking in the first infographic, we are concerned that this article provides a confusing and unclear message for the public. We are surprised that such a nuanced evidence base regarding masking would have been made into a public-facing infographic, given the complexities of the emerging evidence base for source control for coronavirus. Many of our colleagues did not realize that these studies were not done with SARS-CoV-2, but with influenza viruses. Those who spoke with members of the public, family, or friends about the infographic found that a large number of the public concluded that this proved to them that cloth masking in public was not helpful.
The context of this evidence review must not be dismissed. We are in the midst of a pandemic of a novel virus that is showing concerning ongoing morbidity in addition to mortality. We do not have the luxury of waiting for randomized controlled trials to determine the magnitude of benefit that masking could provide for this novel virus. However, there are many other methodological studies with regard to masking during this pandemic that have shown a trend toward benefit. In weighing minimal potential harms against the potential of great benefit of masking while we learn to live with this virus, it is prudent to ensure that there is clear and consistent messaging on how masking should be added to the other public health measures.
We are requesting that the following changes be considered in your infographic to make it much more clear to the public that masking can help during this pandemic:
Please make clear in your title that the evidence is from studies on influenza viruses and not SARSCoV-2 (eg, “Masks regarding influenza for the general public”).
The last point under “What we do not know yet,” which says we do not know if it prevents coronavirus disease 2019 (COVID-19), can be misconstrued as well. It would be prudent to outline how SARS-CoV-2 might behave differently than influenza viruses, that masks in this pandemic are primarily for source control, and the mounting evidence regarding asymptomatic spread further supports the need for public masking.
Put distancing and hand hygiene in the same (larger) font size as masking. We suggest that this be the recommendation for the public: “Masking is one part of preventing infection. Do this along with 2-metre physical distancing and hand hygiene consistently for your best chance to prevent infection.”
Thank you for your urgent attention to this matter and for your careful consideration of these revision suggestions. This would help to improve on clear public health messaging regarding the relative benefits of masking during this pandemic, so that the public is compelled to improve their 3-pronged efforts to prevent further infections and transmission.
Footnotes
Competing interests
None declared
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Reference
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