Do Face Masks Work?

“Plus ça change, plus c’est la même chose” (the more things change, the more they continue to be the same thing, attributed to Jean-Baptiste Karr).

Introduction to an article from the Journal of the American Medical Association, January 12, 1918

In our current pandemic situation there has been lots of confusion, uncertainty and general ignorance on the subject of face masks and reduction of disease transmission. In the screen capture I show the introductory paragraphs of an article published over one century ago, just as the so-called “Spanish Flu” H1N1 pandemic was probably starting but not yet recognized.

Dr. Weaver reported on the significant reduction of spread of infection when the staff work gauze masks. His article states “The mask not only protects the healthy person from infection and from becoming a carrier, but also prevents a carrier from spreading infection to others.” Sounds familiar in the current media.

Another quote: “In recent years, so much emphasis has been laid on contact infection in contagious diseases that the possibility of infection through the air at short distances has been sometimes forgotten. Infection through the air for relatively short distances, that is, within a few feet of the patient (or carrier), is quite possible in case the specific agent is present in the secretions of the nose and throat when forcibly thrown out in small particles in forced expiratory efforts, as in coughing, crying or sneezing.

The article basically makes the point that handwashing is important, but it’s not the only thing to worry about. A lot of his article focuses on diphtheria transmission, which thankfully is largely unknown in the developed world due to immunization. But they were dealing with a lot of pathogens in those days, many of which could pneumonia. They also lacked antibiotics and other effective pharmaceutical treatments for most infections, leaving just supportive care as the main option.

With the SARS-CoV-2 virus we lack a vaccine and don’t yet have much in the way of pharmaceutical treatments either. At least we have oxygen therapy, which wasn’t widely available in 1918. Some things change, but some things still have strong echos in history.

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