WHO: Masks Inadequate – Respirators Needed for Better Protection

The standard of care in healthcare may be on the verge of a significant shift. A growing chorus of experts is challenging the World Health Organization’s long-held guidance on face masks, arguing that surgical masks offer inadequate protection against airborne illnesses like influenza and COVID-19. This isn’t simply a debate about comfort or cost; it’s a fundamental reassessment of how we protect both healthcare workers and patients, particularly as new and potentially more dangerous pathogens emerge.

For years, surgical masks have been the ubiquitous face covering in hospitals and clinics worldwide. Their widespread adoption was driven by availability and cost, but also by a prevailing understanding of how respiratory viruses spread. However, as the COVID-19 pandemic unfolded, mounting evidence revealed the critical role of airborne transmission – particles suspended in the air that can travel beyond the immediate vicinity of an infected person. This realization prompted some countries to recommend higher-grade masks, but a global standard shift never materialized. The current call for change stems from a growing frustration that the WHO has been slow to fully acknowledge and act upon this evidence. Professor Adam Finkel, a former chief regulatory official at the US Occupational Safety and Health Administration, frames the situation starkly: surgical masks are “obsolete” in the context of airborne pathogen protection, akin to using a typewriter in the age of computers.

The implications of this potential shift are far-reaching. Beyond the immediate benefits of reduced infection rates for healthcare workers and patients – and a corresponding decrease in burnout and absenteeism – a move to universal respirator use could necessitate a significant overhaul of global PPE supply chains. The WHO’s procurement infrastructure would need to prioritize respirators, and production of surgical masks might need to be scaled down. This transition wouldn’t be without challenges, particularly for lower-income countries where access to respirators is already limited. The letter to the WHO acknowledges this, suggesting potential “off-ramps” based on local infection rates and ventilation systems, but emphasizes the need for a baseline standard of respirator use.

The Forward Look

The next few months will be critical. The WHO has acknowledged the letter and stated it will be undergoing “careful review.” However, the organization’s history of cautious responses to emerging scientific evidence raises questions about the speed and extent of any potential changes. Expect a period of intense debate, potentially fueled by the politicization of mask-wearing that characterized the early stages of the pandemic. Kemi Badenoch’s recent comments, expressing “trauma” from mask-wearing, highlight the lingering cultural resistance to even basic preventative measures.

More importantly, watch for the WHO to address the criticism regarding its initial downplaying of airborne transmission. A clear and unambiguous statement acknowledging this route of infection is crucial for building public trust and justifying a shift towards respirators. Furthermore, the ongoing development of the WHO’s pandemic accord – a legally binding agreement aimed at improving global preparedness for future outbreaks – could provide a framework for implementing and enforcing updated PPE guidelines. If the WHO doesn’t act decisively, expect continued pressure from the scientific community and potentially, independent initiatives to promote respirator use in healthcare settings. The debate isn’t just about masks; it’s about whether global health policy will prioritize evidence-based practices over outdated norms and political considerations.

The WHO has been criticised for being slow to describe Covid-19 as spreading via “airborne” particles and the letter also calls for it to revisit earlier statements and “unambiguously inform the public that it spreads via airborne respiratory particles”.

Prof Trisha Greenhalgh of the University of Oxford, whose research is cited extensively in the letter and is one of its signatories, said: “A germ that does not get inside someone cannot make them sick. By sealing against the face, respirators force airflow to pass through them, filtering out the airborne germs. Respirators are designed to fit closely around the face and meet high filtration standards. Medical masks, in contrast, fit loosely and leak extensively.”

The letter’s supporters include members of the World Health Network, prominent US epidemiologist Eric Feigl-Ding, and Guardian columnist George Monbiot.

A WHO spokesperson said the letter required “careful review”. They said the organisation consulted widely with experts from different health and economic contexts when producing guidance on personal protective equipment for health workers, adding: “We are currently reviewing WHO’s Infection Prevention and Control guidelines for epidemic and pandemic-prone acute respiratory infections, based on the latest scientific evidence to ensure protection of health workers.”