Bruno J Strasser, Thomas Schlich
Published: May 22, 2020
The shortage of face masks during the COVID-19 pandemic has become a symbol of the fragility of modern medicine and public health. Several explanations have been advanced for this situation, from a panicking public hoarding masks to the offshoring of manufacturing and the disruption of global trade. The history of medicine suggests another factor could be considered: the progressive replacement of reusable face masks by disposable ones since the 1960s. Medicine has been transformed by consumer culture—what Life Magazine enthusiastically named “Throwaway Living” in 1955. The history of the medical mask illuminates how this vulnerability was created.
It was mainly the use of the mask to cover the mouth and nose (and beard) during the Manchurian plague of 1910–11 and the influenza pandemic of 1918–19 that turned the face mask into a means of protecting medical workers and patients from infectious diseases outside of the operating room. During the 1918–19 influenza pandemic, wearing a mask became mandatory for police forces, medical workers, and even residents in some US cities, although its use was often controversial. Yet in cities like San Francisco, the decline in deaths from influenza was partly attributed to the mandatory mask-wearing policies. At this point, the rationale for wearing masks moved beyond their original use in the operating theatre: they now also protected the wearer against infection.
Medical researchers tested and compared the filtering efficiency of reusable masks with experiments involving the culture of bacteria nebulised though masks or spread by infectious volunteers wearing masks in an experimental chamber, as well as observational studies in clinical settings. They found that masks varied greatly in the extent to which they filtered bacteria. But when used properly, some masks were considered to offer protection from infection.
Reusable masks were once an essential part of the medical arsenal. However, the industrial production and further research and development of reusable masks was largely halted with the transition towards disposable masks in the 1960s. Disposable masks and respirators will certainly remain an essential part of medical personal protective equipment in the future, since some of them possess specific filtration qualities designed for health-care situations. To avoid a shortage of masks during the next pandemic, one should look beyond the creation of large stockpiles of disposable face masks and consider the risks of the throwaway consumer culture applied to life-saving devices. Perhaps one day it might again be possible to say about protective face masks what medical researchers wrote in 1918: “A mask may be repeatedly washed and used indefinitely.”
The Lancet – DOI: https://doi.org/10.1016/S0140-6736(20)31207-1