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Showcase of a tailoring shop in Lower Saxony with masks: simple, cheap and effective means against infection
Photo:
Hauke-Christian Dittrich / dpa
People with masks in the supermarket, on public transport, in the restaurant - that was unimaginable in Germany at the beginning of 2020.
Some people still smiled at the people in Asian cities, some of whom wore masks as a matter of course in everyday life.
In the meantime, masks have become an integral part of everyday life in Germany too - many people want to wear them long-term to protect against illness.
Experts are also discussing whether masks should remain mandatory in the long term to protect against severe flu waves, for example in local public transport.
Politicians worldwide, on the other hand, are increasingly relying on relaxation of the mask issue.
A current study based on data from the beginning of the pandemic once again emphasizes the effectiveness of the simple measure.
In countries where masks are worn in public for cultural reasons or where this was supported by the government early in the pandemic, the number of corona deaths per capita rose by an average of around 16 percent every week in the first months of 2020, reports a research team in the American Journal of Tropical Medicine and Hygiene.
In countries that did not recommend masks, the average increase was around 62 percent per week.
Evaluated information from 200 countries
The research team had examined which factors explain the sometimes very different number of Covid 19 deaths per capita in different countries. To do this, it analyzed information from up to 200 countries that had, among other things, deposited data on Covid 19 mortality in publicly accessible databases on May 9, 2020. They compared these to a variety of factors that may have influenced the death rate.
These included, for example, the age of the population, the gender distribution, the outside temperature, urbanity and the frequency of obesity as well as the proportion of smokers in society. They also took into account how long the new coronavirus had already been detected in a country at the time of the analysis, and what countermeasures, apart from a mask requirement, had been introduced, such as lockdowns or large-scale tests that made it possible to identify and isolate infected people.
A higher death rate was independently associated with a higher degree of urbanization, i.e. a large number of people living together in fairly close quarters in cities, more people aged 60 or older in the population, or a higher prevalence of obesity.
In contrast, where international travel restrictions applied or cultural norms or measures favored the wearing of masks at the beginning of the outbreak, the team found a comparatively low death rate.
In Europe, only three countries opted for masks early on
In order to have the greatest possible effect, it was important that the wearing of masks was recommended as early as possible after the start of the pandemic or that it was used for cultural reasons anyway.
Because there were few infected people at the beginning of the pandemic, the masks apparently throttled the further spread.
Countries in which masks were recommended to the general population no later than 15 days after the first proven corona case performed best - mostly in Asia.
Where the measure was waived until April 16 or more than 60 days after the first corona case - this often affected western states - the average mortality was many times higher.
As a reminder: In Germany, masking was mandatory from April 16.
"Most countries in Europe and North America failed to introduce the wearing of masks in the early stages of their outbreaks," the study says.
In Europe, only the governments of three countries recommended that their people wear masks within 31 days of the outbreak in the country: Slovakia, the Czech Republic and Bosnia and Herzegovina.
One reason for this may have been that, among other things, the World Health Organization (WHO) had advised against wearing masks at the beginning of the pandemic.
Nonetheless, some countries, especially outside of Europe, used the measure.
In China, people were often wearing masks in public by the end of January.
In March, Kuwait, Nepal, Lithuania, the United Arab Emirates, Slovenia, Iran, Bulgaria, Ukraine, Austria, the Cayman Islands and Mauritius recommended the measure.
The sooner the better
24 countries recommended masks within the first 20 days of their outbreaks, according to the analysis.
On May 9, 2020, the average corona death rate in these states was 1.5 per million people.
For comparison: the median across all countries analyzed was 3.6 corona deaths per million people.
The research team reports that the trend has persisted until at least August 2020:
Among the 24 countries that initiated public mask wear within 20 days of the start of their outbreak, the average Covid-19 mortality on August 9 was 4.7 per million people.
In the additional 17 countries that recommended masks within 30 days of the outbreak began, the average mortality rate on August 9 was 26.6 per million people.
In contrast, corona per capita mortality in the United States, where mask wearing became a political issue in 2020, reached 502 corona deaths per million people.
However, it cannot be ruled out that factors that the experts did not take into account also influenced the result.
"The results speak in favor of the general wearing of masks in public to suppress the spread of the coronavirus," writes the research team.
"Given the low coronavirus mortality in Asian countries, where wearing masks in public was widespread at the start of the outbreak, it seems highly unlikely that masks are harmful."
A lack of evidence led to idleness
On Twitter, Trisha Greenhalgh, professor of health sciences in primary care at Oxford University, criticized that the lack of evidence of the effectiveness of masks had led many states to do nothing.
"New drugs and vaccines can have side effects that are worse than the disease itself," she writes. "It is therefore appropriate to ask for empirical evidence of the benefit-harm ratio before they are introduced." However, critics would have inappropriately applied the same rules to masks. "A piece of cloth over the face doesn't pose the same risks as a new drug or vaccine," she writes. But doing nothing could potentially cause great damage.
In Germany, there are currently discussions about an end to the mask requirement.
In England, protective measures against the corona virus have generally been voluntary since Monday.
In the Netherlands, too, the obligation to wear mouth and nose protection has largely been abolished, but it still applies where a distance of 1.5 meters cannot be maintained, for example on public transport.
"Currently, almost all countries recommend masks in overcrowded interiors," the authors of the work write.
Therefore, the countries no longer differ primarily in the given recommendation, but in the implementation.
