We ' The Doctors ' are men of science.  In this era of evidence base medicine,  anything to be accepted without scientific scrutiny is just plain quackery.

In these unprecedented times , when fear of unknown has taken precedence over confidence of known. Under this scare of impending doom , advisories of all types without any peer review,  without any randomized controlled trials are getting issued .

Also these so called  opinions are enforced by law agencies. ( Though we don't doubt the noble intentions behind them )

One such opinion which has made compulsory by Government of India is wearing of Mask by all citizens irrespective to their risk of exposure.

Let's analyze science behind......

 There are absolutely no Randomized Controlled Trials which justifies the use of Mask . What we have few small studies,  anecdotal reports that too of doubt ful scientific validity.

Famous epidemiologist , Dr Antono Lazzarino,  Dr Ben Killingley ( Infectious disease spl) , Dr Simian Clarke ( Clinical Microbiologist ) all from University College of London .... in various studies categorically casted aspersions on Mask utility .

2006 - 07 RCT in US College students in influenza season was a negative trial.

RCT done in Australia during the same period in influenza season again proved to be negative.

Largest study till date published in Lancet which reviewed 172 observational studies,  44 comparative studies involving 25 697 participants,  10 studies involving 2647 participants analysed the Data and recommended.. only social distancing greater than 1 m , frequent hand washing are only definitive and value of Face Mask only Modest.

Rightly so WHO and US center for CDC both unanimously recommended against wearing Mask by general public . Only HCW and in places where social distancing is not possible,  Mask has some use. ( Though later on in April month CDC withdrawn that recommendation... and advocates mask by everyone )

 We can still follow a guidelines despite weak scientific evidence if its without any risk . We can't comment the same regarding Mask.

1.Wearing a Mask makes exhaled air go into the eyes. This is uncomfortable and makes you touch eyes and in that risk of infecting yourself.

2.CO2 content of exhaled air increases in presence of mask,  this aggravates breathlessness and because of recycling air , increases viral load in lungs.

3.Direct evidence is there that Mask decreases innate immunity because of humid habitat where SARS - CoV - 2 remain active.

4. All above 3 , along with inappropriate use of mask , your quality of interaction,  giving false sense of security makes general statements about its use for all citizens may not be useful or may be potentially harmful.

While Driving, especially if u r driving alone , with Mask on , because of recycled air and its increased CO2 content leading to headache and eye discomfort.... definitely impairs your concentration and makes u prone for accidents.

CDC has equated Wearing Mask while driving alone with Driving while talking on phone., hence strictly warned people against mask while driving.

In conclusion,  current pandemic is very different from that of " parachutes for jumping out of aeroplanes "in which dynamics of harm and prevention are easy to define.,

but here making guidelines for wearing mask by everyone is not that straightforward and may be counterproductive. Positives and negatives are well equipoised.  Certainly it's not the time to act without evidence.

Regards

Dr amardeepgarg

Interventional cardiologist

Patiala