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Face masks to prevent the next pandemic?

“I couldn’t wear one – it would be too embarrassing.”

When I asked some friends about using face masks to prevent flu, they all laughed. And then they said that they would not wear them. “I am not sure they would really work.” “I don’t tend to get bad colds.” “People might think that I was a doctor – or a surgeon”, “I couldn’t wear one – it would be too embarrassing!”

I only asked four people so this is hardly a scientific study – but it set me thinking about face masks and ‘flu.  And when thinking things through, a good place to start is with the evidence. In the case of respiratory infections, there is some evidence that “facemasks and facemasks plus hand hygiene may prevent infection in community settings, subject to early use and compliance.” 1

But there are barriers to people wearing face masks. Sim and colleagues have delved into these barriers in an insightful review of the use of facemasks to prevent respiratory infection. (2)

They found a range of barriers. Some people found masks uncomfortable; some forgot to wear them every day; some found them impractical – wondering how they would eat or drink when wearing masks.

Sometimes the masks didn’t fit or fell off; sometimes they became damp and uncomfortable; sometimes children didn’t like their parents wearing face masks.

Masks also didn’t seem to suit certain groups of patients – such as those with chronic lung disease or with rhinorrhoea. Or children.

Some people also found them embarrassing.

I suspect that this embarrassment would continue to be a barrier even if the other problems were overcome – that is, even if we had masks that were comfortable and a good fit and easy to put on and take off.

How can we overcome the embarrassment? A multi-pronged approach will be needed but the underlying strategy will need to be about convincing people that wearing a mask is not only socially acceptable but desirable. This will take time. To draw an analogy, it took a good number of years to convince people to wear a seatbelt. But today wearing a seatbelt is second nature to most people.

In the future it may be similar when it comes to wearing a face mask during a ‘flu outbreak.

1. MacIntyre CR, Chughtai AA. Facemasks for the prevention of infection
in healthcare and community settings. BMJ. 2015 Apr 9;350:h694.
2. Sim SW, Moey KS, Tan NC.The use of facemasks to prevent
respiratory infection: a literature review in the context of the Health Belief
Model. Singapore Med J. 2014 Mar;55(3):160-7.

This opinion piece was authored by BMJ Clinical Director, Dr Kieran Walsh. The purpose of this document is to educate and to inform. The content of this document does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the author's. BMJ does not endorse any views or recommendations expressed in this document. Readers should also be aware that professionals in the field may have different opinions. Users of this document hereby agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

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