John Bream, MD
Founder, Bream Medical

What are they saying about masks?

With an increase in COVID-19 cases coinciding with the return to school, great debate has reemerged about the role of masking in combating the spread of respiratory viruses.  While everyone certainly has a strong opinion on the subject, now is a good time to revisit this topic – and what the evidence says.

A lot of attention has turned to a recent Cochrane review (below), and in particular, its conclusion that “Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence).”

Certainly, this article was used by people who do not support wearing a mask to bolster their viewpoint.  People who are pro-masking may point to the low-to-moderate certainty of the evidence and the limitations of trying to measure the cumulative en masse effect of community masking.

So, what does Dr. Bream think about this review?

In general, I think the review is accurate. 

We now know that COVID-19 is an aerosolized virus, and that surgical and cloth masks do not block the transmission of aerosols well (if any).  Additionally, given that any chance to succeed for masking would require near-universal compliance, and the fact that many people do not wear their mask appropriately or repeatedly manipulate it (toddlers), I agree there is likely to be little to no benefit of community masking for COVID-19.  

Additionally, there is no scientific reason to wear a mask in your house if someone within your house tests positive.  

However, based upon the very low rates of influenza during periods of increased masking, I do think that masking has some benefit upon respiratory viruses that are spread by droplets – such as the flu.  Additionally, given that I cared for thousands of patients in the emergency department during the throes of Covid, performed high-risk procedures on them, and did not contract Covid until my wife brought it home from a conference in Dallas, I think there is a role for high-quality masks such as KN95, N95, etc, in healthcare settings, especially for high-risk procedures.  If I was doing a procedure such as intubation on a Covid positive patient in the ER, I’d don an N95.  

Otherwise, you’ll always see my face in the emergency room or in my clinics.

Bream Medical is an all-inclusive, non-corporate practice that provides urgent care, primary care, and direct primary care services in Salisbury, Edenton, and Stokesdale, NC, and provides telemedicine consultation anywhere in North Carolina.  We provide excellent healthcare by prioritizing patient care – not profits.  To learn more about Bream Medical, visit or call 704.216.1263 (Salisbury), or 252.482.3350 (Edenton).

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