Avian Flu Diary: ECDC: Considerations For The Use of Face Masks In The Community in The Context of the SARS-CoV-2 Omicron VOC

#16,553

As we've discussed often over the past 16 years (see here, here, here, here, and here) - for all their hassles - the public wearing of face masks during a severe respiratory disease outbreak makes a lot of sense, can save lives, and help keep society open and running.

Last week, in MMWR: Relative Effectiveness Of Different Mask Types In Preventing COVID Infection, we looked at fresh evidence that - while fitted N95 respirators are best - that any mask beats no mask in a viral storm.

Face masks are not ideal, of course. They are uncomfortable for many to wear, can obscure one's speech and vision, and good ones aren't cheap. But when consistently worn in high risk areas, there is little doubt that they can substantially reduce your risk of infection from COVID, influenza, and many other respiratory illnesses.

While many are eager to ditch the mask, new waves of Omicron - and possibly new, more severe, variants - may intervene in the months and years ahead. Popular or not, masks are unlikely to go away completely any time soon.

Which brings us to a new technical document from the ECDC that updates what has been learned about the use of face masks by the public over the past year, and recommends that the practice be `considered' going forward, particularly in high risk situations.

First the ECDC new story, followed by a link and brief summary to the 7-page PDF report.

ECDC publishes updated considerations for use of face masks in the community
News
7 Feb 2022

ECDC publishes ‘Considerations for the use of face masks in the community in the context of the SARS-CoV-2 Omicron variant of concern’, a document which updates and complements ‘Using face masks in the community: first update - Effectiveness in reducing transmission of COVID-19’.

Wearing a face mask can help reduce the spread of COVID-19 in the community by reducing the release of respiratory droplets from asymptomatic / pre-symptomatic individuals or those with mild non-specific symptoms. The use of face masks for this purpose may be adopted to reduce the societal impact associated with absence from work or healthcare pressures due to infection, or to protect vulnerable individuals in particular settings.

The 2021 ECDC systematic review of the literature on the effectiveness of face masks in the community concluded that there was evidence of low to moderate certainty for the use of medical face masks providing a small to moderate protective effect against COVID-19 in the community, both in terms of personal protection and protection of others.

The results of studies published after the systematic review are consistent with this conclusion.

For outdoor settings: When the public health objective is to limit community transmission and physical distancing is not possible, wearing a face mask should be considered in crowded outdoor settings.

For indoor settings: In areas where the public health objective is to reduce ongoing community transmission of COVID-19, wearing a face mask should be considered as one of a range of possible measures in confined public spaces, such as stores, supermarkets, transportation hubs (e.g., ports, airports, train/coach stations) and in public transport.

In households: the use of a medical face mask or a respirator should be considered for people with symptoms of COVID-19 or confirmed COVID-19 and for the people who share their household, especially when isolation of the person with symptoms of or confirmed COVID-19 is not possible.

In care settings: face masks should be considered, to protect vulnerable people such as the elderly and people with underlying medical conditions. In this case, face masks can be recommended both for vulnerable people and for persons regularly interacting with this population.

Important considerations when using face masks

the appropriate use of face masks is important
the face mask should completely cover the face from the bridge of the nose down to the chin
the mask should be correctly adjusted on the bridge of the nose and to the face to minimise open space between the face and the mask
selecting the type of face mask should consider access, availability, and tolerability, in addition to effectiveness:
respirators are in general expected to be more effective than medical masks
community face coverings are expected to be less effective than medical face masks
people vulnerable to severe COVID-19 should consider wearing a respirator, if available and tolerated, including:
the elderly
those with underlying medical conditions
high-risk contacts of COVID-19 cases who cannot stay in quarantine for the full recommended quarantine period
COVID-19 cases who cannot isolate for the full recommended isolation period

The document also outlines what options for public health policy on face masks should be considered, taking into consideration the proportionality to other measures, the acceptability by the population, and the environmental impacts.

The Executive summary and link follow. I'll have a brief postscript after the break.

Considerations for the use of face masks in the community in the context of the SARS-CoV-2 Omicron variant of concern
Technical report
7 Feb 2022

This document provides an update to and complements the ECDC technical report on “Using face masks in the community: first update - Effectiveness in reducing transmission of COVID-19” published on 15 February 2021. The aim was to review whether the scientific evidence basis has changed since December 2020 and whether any changes are warranted given the emerging evidence on variants of concern (VOCs) and particularly the Omicron VOC. This document therefore builds on the evidence available in the literature and presents recommendations for public health measures. The use of face masks by healthcare workers for the prevention of COVID-19 is out of the scope of this document and is covered in the latest update to the technical report ‘Infection prevention and control and preparedness for COVID-19 in healthcare settings’, published on 9 February 2021.

Executive summary

Key messages

A public health policy for wearing a face mask in public spaces should be considered in areas with community transmission when the public health objective is to limit community transmission. An additional option is to focus on the use of face masks in specific settings to protect people vulnerable to severe COVID-19, such as the elderly and people with underlying medical conditions.
The appropriate use of face masks is important. The face mask should completely cover the face from the bridge of the nose down to the chin. The mask should be correctly adjusted on the bridge of the nose and to the face to minimise open space between the face and the mask.
When community face coverings are used, it is advisable to choose coverings that comply with available standards for filtration efficacy and breathability, e.g. CEN CWA 17553.
Respirators are expected to be more effective than medical masks, while community face coverings not manufactured according to the specifications in available guidelines for filtration efficacy and breathability are expected to be less effective than medical face masks. Selecting the type of face mask should take into account access, availability and tolerability, in addition to effectiveness.

Considerations for the use of face masks in the community in the context of the SARS-CoV-2 Omicron variant of concern

Open file in new window - EN - [PDF-456.75 KB]

If we get extremely lucky, then Omicron may be the last hurrah of this COVID pandemic, and the virus will take its place among the panoply of seasonal respiratory viruses next fall.