Two studies on the value of face coverings

Widespread facemask use could shrink the 'R' number and prevent a second COVID-19 wave

University of Cambridge

Population-wide use of facemasks keeps the coronavirus 'reproduction number' under 1.0, and prevents further waves of the virus when combined with lockdowns, a modelling study from the universities of Cambridge and Greenwich suggests.

The research suggests that lockdowns alone will not stop the resurgence of SARS-CoV-2, and that even homemade masks with limited effectiveness can dramatically reduce transmission rates if worn by enough people, regardless of whether they show symptoms.

The researchers call for information campaigns across wealthy and developing nations alike that appeal to our altruistic side: "my facemask protects you, your facemask protects me." 


The findings are published in the Proceedings of the Royal Society A.

"Our analyses support the immediate and universal adoption of facemasks by the public," said lead author, Dr Richard Stutt, part of a team that usually models the spread of crop diseases at Cambridge's Department of Plant Sciences.

"If widespread facemask use by the public is combined with physical distancing and some lockdown, it may offer an acceptable way of managing the pandemic and re-opening economic activity long before there is a working vaccine."

Dr Renata Retkute, coauthor and Cambridge team member, said: "The UK government can help by issuing clear instructions on how to make and safely use homemade masks."

"We have little to lose from the widespread adoption of facemasks, but the gains could be significant."

The new coronavirus is transmitted through airborne droplets loaded with SARS-CoV-2 particles that get exhaled by infectious people, particularly when talking, coughing or sneezing.

For the latest study, Cambridge researchers worked to link the dynamics of spread between individuals with population-level models, to assess different scenarios of facemask adoption combined with periods of lockdown.

The modelling included stages of infection and transmission via surfaces as well as air. Researchers also considered negative aspects of mask use, such as increased face touching.

The reproduction or 'R' number -- the number of people an infected individual passes the virus onto -- needs to stay below 1.0 for the pandemic to slow.

The study found that if people wear masks whenever they are in public it is twice as effective at reducing 'R' than if masks are only worn after symptoms appear.

In all modelling scenarios, routine facemask use by 50% or more of the population reduced COVID-19 spread to an R less than 1.0, flattening future disease waves and allowing less-stringent lockdowns.

Viral spread reduced further as more people adopted masks when in public. 100% mask adoption combined with on/off lockdowns prevented any further disease resurgence for the 18 months required for a possible vaccine.

The models suggest that -- while the sooner the better -- a policy of total facemask adoption can still prevent a second wave even if it isn't instigated until 120 days after an epidemic begins (defined as the first 100 cases).

The team investigated the varying effectiveness of facemasks. Previous research shows that even homemade masks made from cotton t-shirts or dishcloths can prove 90% effective at preventing transmission.

The study suggests that an entire population wearing masks of just 75% effectiveness can bring a very high 'R' number of 4.0 -- the UK was close to this before lockdown -- all the way down to under 1.0, even without aid of lockdowns.

In fact, masks that only capture a mere 50% of exhaled droplets would still provide a "population-level benefit," even if they quadrupled the wearer's own contamination risk through frequent face touching and mask adjustment (a highly unlikely scenario).

The researchers point out that crude homemade masks primarily reduce disease spread by catching the wearer's own virus particles, breathed directly into fabric, whereas inhaled air is often sucked in around the exposed sides of the mask.

"There is a common perception that wearing a facemask means you consider others a danger," said Professor John Colvin, coauthor from the University of Greenwich. "In fact, by wearing a mask you are primarily protecting others from yourself."

"Cultural and even political issues may stop people wearing facemasks, so the message needs to be clear: my mask protects you, your mask protects me."

"In the UK, the approach to facemasks should go further than just public transport. The most effective way to restart daily life is to encourage everyone to wear some kind of mask whenever they are in public," Colvin said.

Prof Chris Gilligan, coauthor from Cambridge's Epidemiology and Modelling Group in the Department of Plant Sciences, added: "These messages will be vital if the disease takes hold in the developing world, where large numbers of people are resource poor, but homemade masks are a cheap and effective technology."

Face masks critical in preventing spread of COVID-19

Study found that wearing a face mask stopped person-to-person spread of the virus

Texas A&M University

A study by a team of researchers led by a Texas A&M University professor has found that not wearing a face mask dramatically increases a person's chances of being infected by the COVID-19 virus.

Renyi Zhang, Texas A&M Distinguished Professor of Atmospheric Sciences and the Harold J. Haynes Chair in the College of Geosciences, and colleagues from the University of Texas, the University of California-San Diego and the California Institute of Technology have had their work published in the current issue of PNAS (Proceedings of the National Academy of Sciences).

The team examined the chances of COVID-19 infection and how the virus is easily passed from person to person. From trends and mitigation procedures in China, Italy and New York City, the researchers found that using a face mask reduced the number of infections by more than 78,000 in Italy from April 6-May 9 and by over 66,000 in New York City from April 17-May 9.

"Our results clearly show that airborne transmission via respiratory aerosols represents the dominant route for the spread of COVID-19," Zhang said. 

"By analyzing the pandemic trends without face-covering using the statistical method and by projecting the trend, we calculated that over 66,000 infections were prevented by using a face mask in little over a month in New York City. We conclude that wearing a face mask in public corresponds to the most effective means to prevent inter-human transmission.

"This inexpensive practice, in conjunction with social distancing and other procedures, is the most likely opportunity to stop the COVID-19 pandemic. Our work also highlights that sound science is essential in decision-making for the current and future public health pandemics."

One of the paper's co-authors, Mario Molina, is a professor at the University of California-San Diego and a co-recipient of the 1995 Nobel Prize in Chemistry for his role in understanding the threat to the Earth's ozone layer of human-made halocarbon gases.

"Our study establishes very clearly that using a face mask is not only useful to prevent infected coughing droplets from reaching uninfected persons, but is also crucial for these uninfected persons to avoid breathing the minute atmospheric particles (aerosols) that infected people emit when talking and that can remain in the atmosphere tens of minutes and can travel tens of feet," Molina said.

Zhang said that many people in China have worn face masks for years, mainly because of the bad air quality of the country.

"So people there are sort of used to this," he said. "Mandated face-covering helped China in containing the COVID-19 outbreak."

Zhang said the results should send a clear message to people worldwide -- wearing a face mask is essential in fighting the virus.

"Our work suggests that the failure in containing the propagation of COVID-19 pandemic worldwide is largely attributed to the unrecognized importance of airborne virus transmission," he said. "Social-distancing and washing our hands must continue, but that's not sufficient enough protection. Wearing a face mask as well as practicing good hand hygiene and social distancing will greatly reduce the chances of anyone contracting the COVID-19 virus."

The study was funded by the Robert A. Welch Foundation.