Studies examining sociocultural and psychological factors underlying public masking amid the COVID-19 pandemic are therefore vital to identifying motivators , barriers , and disparities , and formulating behavior change strategies that encourage and sustain appropriate mask wearing .”
Part of the ‘ infodemic ’ related to COVID-19 is due in no small part to abundant research on SARS- CoV-2 and masks , but it is important to understand that mask science is different in healthcare settings than it is in community settings . As the authors note , “ Several COVID-19 observational studies across diverse community scenarios have suggested a benefit from masks in mitigating the transmission of SARS-CoV-2 . On the other hand , there are the RCTs , which are presumed to provide the highest quality data . However , RCTs can hardly capture the complexities related to viral transmission and public health interventions . Furthermore , large-scale mask RCTs related to SARS-CoV-2 are difficult to conduct given practical and ethical issues and the existence of alternative types of evidence .” They add , “ Whereas observational epidemiological studies are likely to overestimate masks ’ effects due to residual confounding , experimental epidemiological studies are likely to underestimate effect sizes due to both suboptimal adherence in the intervention group and contamination ( mask wearing ) in the control group . Therefore , the real effect size is likely between the estimates seen in those two types of study , with the maximum benefit of masking potentially resulting from the combination of source control and personal protection .”
At the heart of the discord is that “ While efficacy ( performance in controlled or ideal conditions ) and effectiveness ( performance in usual or real-world conditions ) are not synonymous , a large consensus and a growing body of literature have moved forward the uptake of community masking as part of comprehensive NPI bundles or ‘ policy packages ’ aimed at preventing infections caused by respiratory viruses including SARS-CoV-2 . Importantly , a fact undergirding community mask wearing during the pandemic is the risk of transmission , not only from symptomatic individuals , but also from pre-symptomatic and asymptomatic individuals . All in all , the intricate evidence base on the efficacy and effectiveness of masks explains the confusing messaging by public health officials about masks throughout 2020 and why mask policies flipped as scientists gathered data .”
Over the course of the pandemic , public health agencies have issued and then contradicted , and then retracted and re-issued guidance in an endless cycle , helping to fuel the aforementioned culture war around masking . This constantly changing guidance creates confusion and chaos and undermines trust .
“ All people undergo cognitive biases and use logical fallacies in their thinking processes and discourses ; lay people should be aware that even public health and virology ‘ experts ’ are prone to error and may be biased when giving professional advice or concepts ,” says Escandón . “ So , this explains one of the reasons why misleading advice or changing content across social media is often seen . The other big reason is the nature of data and knowledge . Science is not fixed and absolute . Science advances over time and changes constantly , and more importantly , policy changes when science is differentially interpreted and contextualized . So , the goalposts are intended to be always moving and different , and public health decisions will raise quite different viewpoints . If other crises or epidemics give the appearance of having much more fixed goalposts is because people are not paying enough attention or are not suffering on the same scale . Change is expected to happen in science and policy . Now , while this is true , I think things could have been done better and can still be done better . We could communicate clearer , incorporate context , and underscore the importance of nonstop education to embrace uncertainty and tolerate flip-flopping . If we communicate data in effective ways and provide useful advice to laypeople , while being consistent and most emotionally unbiased as possible , we ’ ll do better . This will decrease flip-flopping and prevent some subsequent harm – it won ’ t eliminate flip-flopping but it will definitely reduce it and therefore will contribute to preserve and build public trust . Public trust is lost when flip-flopping is not explained , and when media content is not consistent .”
The pandemic was an opportunity to revisit policy-making in response to outbreaks , and many jurisdictions leveraged this for the common good while others failed miserably , leading to high variability in mask policies , especially as the pandemic waned .
“ From a public health standpoint , mask advocacy has led to reflections over the way policies have been developed and communicated , and over the ideological distinction between applied and academic epidemiology ,” say Escandón , et al . ( 2021 ). “ Some scientists and academics have invoked the precautionary principle , not only to advocate changes in TBPs and to guide public health policies in general , but also to argue the case for universal masking . If the benefits of masks are to be considered ( i . e ., reduction of respiratory infectious disease transmission , mutual protection , positive prosocial signaling ), potential downsides should not be utterly disregarded . The latter include shortage of medical masks and FFRs for HCWs , cross-contamination due to inappropriate mask wearing , risk compensation or complacency toward other preventive measures , psychosocial effects , communication and learning difficulties , physiological effects , skin problems , headache , ocular dryness and irritation , and environmental pollution from mask waste . Of note , these lingering concerns are not reasons to refrain from community masking but are opportunities to maximize the benefits of masking , improve mask designs , and sharpen public health policies and messaging . The benefits of wearing masks outweigh the potential harms¸ especially when there exists widespread community transmission of SARS-CoV-2 .”
The authors explain that mask adherence depends on more than just discipline , but rather knowledge about the virus , risk perception , social acceptability of masks , perceived efficacy , trust in government and