Face masks during the COVID-19 pandemic: Difference between revisions

[[File:Duta Besar Baru AS Sung Kim Serahkan Surat Kepercayaan Pada Presiden Jokowi (50515038461).jpg|thumb|US Ambassador to Indonesia [[Sung Kim]] accompanied by local officials at the [[Merdeka Palace|Presidential Palace]] wearing face masks amid the [[COVID-19 pandemic]]]]

Reviews of various kinds of scientific studies have concluded that masking is effective in protecting the individual against COVID-19.<ref name="Matuschek" /><ref name="Talic">{{cite journal |vauthors=Talic S, Shah S, Wild H, Gasevic D, Maharaj A, Ademi Z, Li X, Xu W, Mesa-Eguiagaray I, Rostron J, Theodoratou E, Zhang X, Motee A, Liew D, Ilic D |date=November 2021 |title=Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis |journal=BMJ |volume=375 |pages=e068302 |doi=10.1136/bmj-2021-068302 |pmid=34789505 |pmc=9423125 |s2cid=244271780 |quote=The results of additional studies that assessed mask wearing ... indicate a reduction in covid-19 incidence, SARS-CoV-2 transmission, and covid-19 mortality. Specifically, a natural experiment across 200 countries showed 45.7% fewer covid-19 related mortality in countries where mask-wearing was mandatory. Another natural experiment study in the US reported a 29% reduction in SARS-CoV-2 transmission (measured as the time-varying reproductive number Rt) (risk ratio 0.71, 95% confidence interval 0.58 to 0.75) in states where mask-wearing was mandatory. A comparative study in the Hong Kong Special Administrative Region reported a statistically significantly lower cumulative incidence of covid-19 associated with mask-wearing than in selected countries where mask-wearing was not mandatory.}}</ref><ref name=cdc-sci/> Various [[case–control study|case-control]] and population-based studies have also shown that increased levels of masking in a community reduces the spread of SARS-CoV-2,<ref name=Talic/><ref name=cdc-sci/> though there is a paucity of evidence from [[randomized controlled trial]]s (RCTs).<ref name=cochrane>{{cite journal | vauthors = Jefferson T, Dooley L, Ferroni E, Al-Ansary LA, van Driel ML, Bawazeer GA, Jones MA, Hoffmann TC, Clark J, Beller EM, Glasziou PP, Conly JM | title = Physical interventions to interrupt or reduce the spread of respiratory viruses | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD006207 | date = January 2023 | pmid = 36715243 | pmc = 9885521 | doi = 10.1002/14651858.CD006207.pub6 }}</ref><ref name=royalsoc>{{cite journal | url=https://doi.org/10.1098/rsta.2023.0133 | doi=10.1098/rsta.2023.0133 | title=Effectiveness of face masks for reducing transmission of SARS-CoV-2: A rapid systematic review | date=2023 | last1=Boulos | first1=Leah | last2=Curran | first2=Janet A. | last3=Gallant | first3=Allyson | last4=Wong | first4=Helen | last5=Johnson | first5=Catherine | last6=Delahunty-Pike | first6=Alannah | last7=Saxinger | first7=Lynora | last8=Chu | first8=Derek | last9=Comeau | first9=Jeannette | last10=Flynn | first10=Trudy | last11=Clegg | first11=Julie | last12=Dye | first12=Christopher | journal=Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences | volume=381 | issue=2257 | pmid=37611625 | pmc=10446908 | bibcode=2023RSPTA.38130133B }}</ref> Masks vary in how well they work,. withFitted [[N95 respirator|N95]]s andoutperform surgical masks outperforming cloth masks,<ref name=Ju/><ref butname=norespirator>{{cite evenjournal cloth| masks,doi=10.1186/1471-2458-13-811 | doi-access=free | title=Effectiveness of withcough theiretiquette variabilitymaneuvers in fabricdisrupting typethe andchain maskof fittransmission of infectious respiratory diseases | date=2013 | journal=BMC Public Health | volume=13 | page=811 | pmid=24010919 | pmc=3846148 | vauthors = Zayas G, provideChiang wearersMC, withWong substantialE, protectionMacDonald fromF, particlesLange carryingCF, COVID-19Senthilselvan A, King M }}</ref> while cloth masks provide marginal protection.<ref name=Ataei/><ref name="cloth_v_surgical">{{cite journal | title=Outward and inward protection efficiencies of different mask designs for different respiratory activities | date= February 2022 | vauthors = Koh XQ, Sng A, Chee JY, Sadovoy A, Luo P, Daniel D | journal=Journal of Aerosol Science | volume=160 | bibcode=2022JAerS.16005905K | doi=10.1016/j.jaerosci.2021.105905 }}</ref>

There are some other types of [[personal protective equipment]] (PPE), such as [[face shield]]s and medical [[goggles]], which are sometimes used in conjunction with face masks but were not recommended as a replacement.<ref>{{cite web|last=CDC|date=11 February 2020|title=Considerations for Wearing Masks|url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html|access-date=25 January 2021|website=Centers for Disease Control and Prevention}}</ref> Other kinds of PPE include gloves, aprons, gowns, shoe covers, and hair covers.<ref name=":3">{{cite journal | vauthors = Deepthi R, Masthi NR, Nirmala CJ, Manjula R, Vinothkumar S |title=Personal Protective Equipments (PPE) – Prerequisites, Rationale, and Challenges during COVID 19 Pandemic |journal=Indian Journal of Community Health |date=20 April 2020 |volume=32 |issue=2 (Supp) |pages=196–205 |doi=10.47203/IJCH.2020.v32i02SUPP.005|s2cid=225952423 |doi-access=free }}</ref>

The [[United States Environmental Protection Agency]] (EPA) Study published on 5 April 2021, showed extremely varied performance across cotton masks. The results of the EPA study found that "a three-layer knitted cotton mask blocked an average of 26.5 percent of particles in the chamber, while a washed, two-layer woven nylon mask with a filter insert and metal nose bridge blocked 79 percent of particles on average."<ref name=":4EPA-Researchers-Test-Effectiveness-of-Face-Masks-2021" /> Ultimately, the researchers found that fabric and fit are the two most vital factors when recommending masks to the public and further research is being conducted on variables such as facial hair and face shape on mask fit.<ref name=":4EPA-Researchers-Test-Effectiveness-of-Face-Masks-2021">{{cite web|url=https://www.epa.gov/sciencematters/epa-researchers-test-effectiveness-face-masks-disinfection-methods-against-covid-19|title = EPA Researchers Test Effectiveness of Face Masks, Disinfection Methods Against COVID-19|date = 5 April 2021}}</ref>

A surgical mask is a loose-fitting, [[Disposable product|disposable]] mask that creates a physical barrier separating the mouth and nose of the wearer from potential [[Contamination|contaminants]] in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle [[Respiratory droplets|droplets]], splashes, [[Spray (liquid drop)|sprays]], or splatter that may contain viruses and bacteria, keeping them from reaching the wearer's mouth and nose. Surgical masks may also help reduce exposure of others to the wearer's [[saliva]] and respiratory secretions.<ref name=":2US-Food-and-Drug-Administration-2020">{{cite web|url=http://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks|title=N95 Respirators and Surgical Masks (Face Masks)|date=11 March 2020|website=U.S. Food and Drug Administration|access-date=28 March 2020}} {{PD-inline}}</ref><ref>{{cite web |date=21 May 2020 |title=COVID-19 Q&A with Dr. Roy Kirkpatrick: Wearing masks |url=https://doppleronline.ca/huntsville/covid-19-qa-with-dr-roy-kirkpatrick-wearing-masks/ |url-status=live |archive-url=https://archive.today/20220313212300/https://doppleronline.ca/huntsville/covid-19-qa-with-dr-roy-kirkpatrick-wearing-masks/ |archive-date=13 March 2022 |access-date=13 March 2022 |website=Huntsville Doppler |language=en-CA }}</ref>

Certified medical masks are made of non-woven material, and they are mostly multi-layer. Filters may be made of [[microfibers]] with an electrostatic charge; that is, the fibers are [[electret]]s. An electret filter increases the chances that smaller particles will veer and hit a fiber, rather than going straight through (electrostatic capture).<ref name="PM03">{{cite web| vauthors = Wei NK |date=6 May 2019|title=What is PM0.3 and Why Is It Important?|url=https://smartairfilters.com/en/blog/what-is-pm0-3-why-important/|website=Smart Air Filters}}</ref><ref>{{cite patent|number=5496507|country=US|title=Method Of Charging Electret Filter Media}}</ref><ref name="Australia">{{cite web|date=February 2020|title=Properties of Different Types of Masks|url=http://cec.health.nsw.gov.au/__data/assets/pdf_file/0007/567394/Properties-of-different-types-of-masks.pdf|archive-url=https://web.archive.org/web/20200331144122/http://cec.health.nsw.gov.au/__data/assets/pdf_file/0007/567394/Properties-of-different-types-of-masks.pdf|url-status=dead|archive-date=31 March 2020|publisher=Government of New South Wales Clinical Excellence Commission}}</ref>{{better source needed|date=May 2020}}{{medcnmedical citation needed|date=May 2020}} While there is some development work on making electret filtering materials that can be washed and reused,<ref name="kaist">{{cite news| vauthors = Jung J |date=17 March 2020|title=KAIST Researchers Develop Highly Reusable Mask Filter| work=KoreaTechToday|url=https://www.koreatechtoday.com/kaist-researchers-develop-highly-reusable-mask-filter/}}</ref><!--<ref>{{cite web |title=N95 Respirators and Surgical Masks {{!}} {{!}} Blogs {{!}} CDC |url=https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/ |publisher=CDC }}</ref>--> current commercially produced electret filters are ruined by many forms of disinfection, including washing with soap and water or alcohol, which destroys the electric charge.<ref name=CDC_guidelines/> During the COVID-19 pandemic, public health authorities issued guidelines on [[Mechanical filter respirator#Disinfection and reuse|how to save, disinfect and reuse electret-filter masks]] without damaging the filtration efficiency.<ref name="CDC_guidelines">{{cite web |title=Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings |url=https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html |publisher=Centres for Disease Control and Prevention |date=27 March 2020|series=NIOSH Workplace Safety and Health Topic}}</ref><ref name="paperbag">{{cite web |title=Coronavirus Disease 2019 (COVID-19) |url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html |website=Centers for Disease Control and Prevention |date=11 February 2020}}</ref> Standard disposable surgical masks are not designed to be washed. Surgical masks may be labeled as surgical, isolation, dental, or medical procedure masks.<ref name=":2US-Food-and-Drug-Administration-2020" /> The material surgical masks are made from is much poorer at filtering very small particles (in the range of a tenth of a micrometer to a micrometer across) than that of filtering respirators (for example N95, FFP2) and the fit is much poorer.<ref name=":2US-Food-and-Drug-Administration-2020" /> Surgical masks are made of a non-woven fabric created using a [[melt blowing]] process.<ref>{{cite web|date=5 March 2020|title=Not Enough Face Masks Are Made In America To Deal With Coronavirus|url=https://www.npr.org/sections/health-shots/2020/03/05/811387424/face-masks-not-enough-are-made-in-america-to-deal-with-coronavirus|access-date=10 April 2020|publisher=NPR}}</ref><ref>{{cite web|date=1 April 2020|title=Chinese mask makers use loopholes to speed up regulatory approval|url=https://www.ft.com/content/09e13687-f7e1-485e-ba90-355959449c71|access-date=10 April 2020|website=Financial Times}}</ref> Random control studies of respiratory infections like [[influenza]] find little difference in protection between surgical masks and respirators (such as N95 or FFP masks).<ref>{{cite journal | vauthors = Long Y, Hu T, Liu L, Chen R, Guo Q, Yang L, Cheng Y, Huang J, Du L | title = Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis | journal = Journal of Evidence-Based Medicine | volume = 13 | issue = 2 | pages = 93–101 | date = May 2020 | pmid = 32167245 | pmc = 7228345 | doi = 10.1111/jebm.12381 }}</ref> However, the filtering performance of correctly worn N95/FFP2 type filtering respirators is clearly superior to surgical and to cloth masks<ref name="Filtration Efficiencies of Nanoscal"/> and for influenza, work by the UK Health and Safety executive<ref>{{cite web| vauthors = Gawn J |year=2008|title=Evaluating the protection afforded by surgical masks against influenza bioaerosols|url=https://www.hse.gov.uk/research/rrpdf/rr619.pdf|website=UK's Health and Safety Executive}}</ref> found that live virus penetrated all surgical masks tested but properly fitted respirators reduced the viral dose by a factor of at least a hundred.

An [[N95 mask]] is a particulate-filtering facepiece [[respirator]] that meets the N95 [[NIOSH air filtration rating|air filtration rating]] of the US [[National Institute for Occupational Safety and Health]], meaning it filters at least 95 percent of 0.3&nbsp;μm [[airborne particles]], while not resistant to oil like the P95. It is the most common particulate-filtering facepiece respirator.<ref>{{cite web|url=https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1-a.html|title=NIOSH-Approved N95 Particulate Filtering Facepiece Respirators – A Suppliers List|date=19 March 2020| website=U.S. National Institute for Occupational Safety and Health|access-date=27 March 2020}}</ref> It is an example of a [[mechanical filter respirator]], which provides protection against [[particulates]], but not gases or [[vapor]]s.<ref>{{cite web| url=https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource3selection.html|title=Respirator Trusted-Source: Selection FAQs|date=12 March 2020|website=U.S. National Institute for Occupational Safety and Health|access-date=28 March 2020}}</ref> Like the middle layer of<ref name="Naveed">{{cite journal | vauthors = Naveed H, Scantling-Birch Y, Lee H, Nanavaty MA | title = Controversies regarding mask usage in ophthalmic units in the United Kingdom during the COVID-19 pandemic | journal = Eye | volume = 34 | issue = 7 | pages = 1172–1174 | date = July 2020 | pmid = 32327740 | pmc = 7179380 | doi = 10.1038/s41433-020-0892-2 | doi-access = free }}</ref> surgical masks, the N95 mask is made of four layers<ref name=scoping/> of melt-blown nonwoven polypropylene fabric.<ref name="VOADeliver">{{cite news| vauthors = Zie J |url=https://www.voanews.com/science-health/coronavirus-outbreak/world-depends-china-face-masks-can-country-deliver|title=World Depends on China for Face Masks But Can Country Deliver? |date=19 March 2020|publisher=[[Voice of America]]}}</ref><ref>{{cite news| vauthors = Feng E | url=https://www.npr.org/sections/goatsandsoda/2020/03/16/814929294/covid-19-has-caused-a-shortage-of-face-masks-but-theyre-surprisingly-hard-to-mak|title=COVID-19 Has Caused A Shortage Of Face Masks. But They're Surprisingly Hard To Make|date=16 March 2020|publisher=[[NPR]]}}</ref>{{medrs|date=May 2020}} The corresponding face mask used in the [[European Union]] is the [[FFP mask|FFP2 respirator]].<ref>{{cite web|url=https://multimedia.3m.com/mws/media/1791500O/comparison-ffp2-kn95-n95-filtering-facepiece-respirator-classes-tb.pdf|title=Comparison of FFP2, KN95, and N95 and Other Filtering Facepiece Respirator Classes|date=1 January 2020|website=3M Technical Data Bulletin|access-date=28 March 2020}}</ref><ref name=":12">{{cite web| url=https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/crisis-alternate-strategies.html|title=Strategies for Optimizing the Supply of N95 Respirators: Crisis/Alternate Strategies|date=17 March 2020|website=U.S. Centers for Disease Control and Prevention| access-date=28 March 2020}}</ref>

There is an increased risk for healthcare workers to become exposed to SARS-CoV-2 when they conduct [[aerosol-generating procedure]]s on COVID-19 patients, which is why it is argued that such situations may require enhanced personal protective equipment (i.e., higher than N95) such as PAPRs for healthcare workers.<ref name=how-agp>{{cite journal | vauthors = Howard BE | title = High-Risk Aerosol-Generating Procedures in COVID-19: Respiratory Protective Equipment Considerations | journal = Otolaryngology–Head and Neck Surgery | volume = 163 | issue = 1 | pages = 98–103 | date = July 2020 | pmid = 32396451 | doi = 10.1177/0194599820927335 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Mick P, Murphy R | title = Aerosol-generating otolaryngology procedures and the need for enhanced PPE during the COVID-19 pandemic: a literature review | journal = Journal of Otolaryngology - HeadOtolaryngology–Head & Neck Surgery | volume = 49 | issue = 1 | pages = 29 | date = May 2020 | pmid = 32393346 | pmc = 7212733 | doi = 10.1186/s40463-020-00424-7 | doi-access = free }}</ref>

Scientists have visualized droplet dispersal for [[Mechanical filter (respirator)#Exhalation valves|masks with exhalation valves]] and [[face shield]]s and concluded that they can be ineffective against COVID-19 spread (e.g., after a cough) and recommended alternatives.<ref>{{cite news |title=Face shields, masks with valves ineffective against COVID-19 spread: study |url=https://phys.org/news/2020-09-shields-masks-valves-ineffective-covid-.html |access-date=8 October 2020 |work=phys.org }}</ref><ref>{{cite journal | vauthors = Verma S, Dhanak M, Frankenfield J | title = Visualizing droplet dispersal for face shields and masks with exhalation valves | journal = Physics of Fluids | volume = 32 | issue = 9 | pages = 091701 | date = September 2020 | pmid = 32952381 | pmc = 7497716 | doi = 10.1063/5.0022968 | arxiv = 2008.00125 | doi-access = free | bibcode = 2020PhFl...32i1701V }}</ref> A later study showed that some (but not all) respirators with exhalation valves can perform as well as a surgical mask. However, a respirator ''without'' an exhalation valve should still be preferred.<ref name=new_exhale>{{cite journal | url=https://doi.org/10.1021/acs.estlett.2c00210 | doi=10.1021/acs.estlett.2c00210 | title=Performance of Valved Respirators to Reduce Emission of Respiratory Particles Generated by Speaking | date=2022 | last1=Hazard | first1=Jessica M. | last2=Cappa | first2=Christopher D. | journal=Environmental Science & Technology Letters | volume=9 | issue=6 | pages=557–560 | pmid=37552726 | bibcode=2022EnSTL...9..557H }}</ref>

Early in 2020, the [[Centers for Disease Control and Prevention|United States Centers for Disease Control and Prevention]] (CDC) said it did not recommend the use of face masks for the general public.<ref name=bi-clg>{{cite web | vauthors = López C |title=Celebrities like Gwyneth Paltrow and Kate Hudson were criticized for wearing face masks early in the pandemic. Here's what changed. |url=https://www.businessinsider.com/why-celebrities-were-criticized-for-wearing-masks-and-what-changed-2020-7 |website=Business Insider}}</ref><ref>{{cite web |title=Transcript for CDC Telebriefing: CDC Update on Novel Coronavirus |url=https://www.cdc.gov/media/releases/2020/t0212-cdc-telebriefing-transcript.html |website=Centers for Disease Control and Prevention |date=12 February 2020}}</ref> However, on 3{{nbsspaces}}April 2020, the CDC changed its advice to recommend that people wear cloth face coverings "in public settings when around people outside their household, especially when social distancing measures are difficult to maintain".<ref>{{cite web |title=Fact check: Medical discharge document includes outdated CDC guidance on face masks |url=https://www.reuters.com/article/uk-factcheck-outdated-masks/fact-check-medical-discharge-document-includes-outdated-cdc-guidance-on-face-masks-idUSKBN2441WN |work=Reuters |date=3 July 2020}}</ref><ref>{{cite journal | vauthors = Fisher KA, Barile JP, Guerin RJ, Vanden Esschert KL, Jeffers A, Tian LH, Garcia-Williams A, Gurbaxani B, Thompson WW, Prue CE | title = Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic - United States, April and May 2020 | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 69 | issue = 28 | pages = 933–937 | date = July 2020 | pmid = 32673303 | doi = 10.15585/mmwr.mm6928e3 | s2cid = 220606747 | doi-access = free }}</ref> In response to a media inquiry by [[National Public Radio]], the CDC said that this change in guidelines was due to the increasing and widespread transmission of the virus, citing studies published in February and March showing pre-symptomatic and asymptomatic transmission.<ref name="NPRMasks2">{{cite news | vauthors = Jingnan H |title=Why There Are So Many Different Guidelines For Face Masks For The Public| url=https://www.npr.org/sections/goatsandsoda/2020/04/10/829890635/why-there-so-many-different-guidelines-for-face-masks-for-the-public| publisher=NPR |date=10 April 2020}}</ref> In a subsequent interview and ''[[JAMA]]'' editorial, the CDC director [[Robert R. Redfield]] explained that the CDC's early guidance had been premised on an initial [[absence of evidence]] of disease transmission from pre- and asymptomatic individuals.<ref>{{cite web | vauthors = Mills R |title=CDC director: Face masks "our most powerful tool" to fight COVID-19 |url=https://www.krmg.com/news/local/cdc-director-face-masks-our-most-powerful-tool-fight-covid-19/D3OXVKUHWNAEVGT2Z4KEKASZXQ/ |website=102.3 KRMG |date=29 July 2020}}</ref><ref name=jama-umt>{{cite journal | vauthors = Brooks JT, Butler JC, Redfield RR | title = Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now | journal = JAMA | volume = 324 | issue = 7 | pages = 635–637 | date = August 2020 | pmid = 32663243 | pmc = 8607819 | doi = 10.1001/jama.2020.13107 | doi-access = free }}</ref><ref>{{cite web | vauthors = Henry TA |title=CDC's Dr. Redfield: This is why everyone should be wearing masks |url=https://www.ama-assn.org/delivering-care/public-health/cdc-s-dr-redfield-why-everyone-should-be-wearing-masks |website=American Medical Association |date=17 July 2020}}</ref>

Most countries in Europe introduced mandatory face mask rules for public places.<ref>{{cite web |title=Mandatory mask-wearing now the norm in Europe as COVID-19 cases rise |url=https://www.euronews.com/2020/07/24/coronavirus-mandatory-mask-wearing-becomes-the-norm-in-europe-as-cases-rise |website=euronews |date=24 July 2020}}</ref><ref name=voa-nor/> On 8{{nbsspaces}}April 2020, the [[European Centre for Disease Prevention and Control]] (ECDC) published its masking recommendations, saying that the "use of face masks in the community could be considered, especially when visiting busy, closed spaces".<ref>{{cite journal | vauthors = Vogel G |title='It's been so, so surreal.' Critics of Sweden's lax pandemic policies face fierce backlash |journal=Science |date=6 October 2020 |doi=10.1126/science.abf1247|s2cid=225148153 }}</ref><ref name=ecdc-apr>{{cite web |title=Using face masks in the community - Reducing COVID-19 transmission from potentially asymptomatic or pre-symptomatic people through the use of face masks |url=https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission |website=European Centre for Disease Prevention and Control |date=8 April 2020|archive-url= https://web.archive.org/web/20200408134120/https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission |archive-date=8 April 2020 }}</ref> On 15 February 2021, ECDC updated the recommendation stating, "Although the evidence for the use of medical face masks in the community to prevent COVID-19 is limited, face masks should be considered as a non-pharmaceutical intervention in combination with other measures as part of efforts to control the COVID-19 pandemic."<ref>{{cite web |title=Using face masks in the community: first update - Effectiveness in reducing transmission of COVID-19 |date=15 February 2021 |publisher=European Centre for Disease Prevention and Control |url=https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission|archive-url=https://web.archive.org/web/20210217020753/https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission |archive-date=17 February 2021 }}</ref>

Sweden was notable as a country where face masks were not recommended to the general public and the [[State epidemiologist (Sweden)|State Epidemiologist of Sweden]], [[Anders Tegnell]], was an opponent to face masks among the general population, although he stated that face masks might be suitable in workplaces where people are one to two meters from each other for more than fifteen minutes, something which some Swedish and foreign media have interpreted as a recommendation.<ref>{{cite web|title=Tegnells vändning: Lämpligt med munskydd (om man är nära varandra)|url=https://www.breakit.se/artikel/27100|access-date=13 May 2021|website=Breakit|language=sv}}</ref><ref>{{cite web| vauthors = Lönnroth V |date=25 November 2020|title=Tegnell: Då ska du bära munskydd på jobbet|url=http://www.gp.se/1.37607725|access-date=13 May 2021|website=Göteborgs-Posten|language=sv}}</ref> This position was slightly reversed when [[Prime Minister of Sweden]], [[Stefan Löfven]], announced that they were recommending face masks on 18 December 2020.<ref>{{cite web |title=Sweden does U-turn on face masks to fight virus |url=https://www.france24.com/en/live-news/20201218-sweden-does-u-turn-on-face-masks-to-fight-virus |publisher=France 24 |date=18 December 2020}}</ref> The [[Public Health Agency of Sweden]] later clarified on their website that the recommendation would include citizens born before 2004 to wear masks during rush hour on public transportation throughout the country from 7{{nbsspaces}}January 2021 onward.<ref name=fol-7jan>{{cite web |title=Munskydd i kollektivtrafiken från den 7 januari |url=https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2020/december/munskydd-i-kollektivtrafiken-fran-den-7-januari/ |website=Folkhalsomyndigheten |date=30 December 2020 |access-date=18 January 2021 |archive-date=9 November 2021 |archive-url=https://web.archive.org/web/20211109212033/https://www.folkhalsomyndigheten.se/nyheter-och-press/nyhetsarkiv/2020/december/munskydd-i-kollektivtrafiken-fran-den-7-januari/ |url-status=dead }}</ref> On 20 December 2020, two days after the announcement was made, Prime Minister Löfven was [[paparazzi]]ed in a shopping mall in central Stockholm without wearing a face mask.<ref>{{cite web|url=https://www.aftonbladet.se/nyheter/a/pAd1xj/statsminister-lofven-besokte-galleria-fyra-dagar-fore-jul|title = Statsminister Löfven besökte galleria fyra dagar före jul| date=29 December 2020 }}</ref> By 22 January 2021, the [[Storstockholms Lokaltrafik|Stockholm Public Transport]] estimated that about half of all passengers on trains and buses wore face masks during rush hour.<ref>{{cite news|url=https://www.svt.se/nyheter/lokalt/stockholm/sl-ungefar-50-procent-bar-munsykdd-under-rusningstid|title=Hälften av resenärerna använder munskydd under rusningstid enligt SL|newspaper=SVT Nyheter|date=22 January 2021 | vauthors = Razooq N }}</ref> Among those who chose not to follow the recommendation were Johan Carlson, the Director-General of the Public Health Agency, and Anders Tegnell, the state epidemiologist.<ref>{{cite news|url=https://www.svt.se/nyheter/lokalt/uppsala/johan-carlson-akte-kollektivtrafik-utan-munskydd|title=FHM:s generaldirektör åkte kollektivtrafik utan munskydd: "Genant"|newspaper=SVT Nyheter|date=28 January 2021 | vauthors = Pan E, Lindberg J |language=sv}}</ref><ref>{{cite web|url=https://nyheter24.se/nyheter/inrikes/952572-har-aker-anders-tegnell-tag-i-rusningstrafik-utan-munskydd|title=Nyheter24 avslöjar: Här åker Anders Tegnell tåg i rusningstrafik – utan munskydd|date=4 February 2021}}</ref>

Masks are not of equal efficacy. While N95 masks outperform surgical masks in filtration, healthcare worker population studies have not shown a significant difference between the two, as of June 2021.<ref name=Ju>{{rcite journal |Ju}} N95vauthors and= surgicalJu masksJT, bothBoisvert designedLN, forZuo singleYY use,| cantitle be= decontaminatedFace atmasks aagainst lossCOVID-19: toStandards, maskefficacy, integritytesting and filtrationdecontamination methods efficacy.{{r|Ju}} Bothjournal N95= andAdvances surgicalin outperformColloid clothand masks,Interface whichScience the| generalvolume public= has292 used| basedpages on= their102435 greater| availabilitydate during= maskJune supply2021 shortages.{{r|Ju}} Clothpmid and= fabric33971389 masks| havepmc protected= wearers8084286 from| COVID-19,doi with= some10.1016/j.cis.2021.102435 variability,{{r|Ataei}}</ref> suchA aslater fabricstudy type,performed layerin count2024, andhowever, maskcriticized fitthe methodology of such studies due to substantial healthcare worker compliance problems.<ref name=longreview>{{cite journal | vauthors url=https://doi.org/10.1128/cmr.00124-23 Sharma| SK, Mishra M, Mudgal SKdoi=10.1128/cmr.00124-23 | title =Masks Efficacyand ofrespirators cloth face mask infor prevention of novel coronavirus infectionrespiratory transmissioninfections: A systematicstate reviewof andthe meta-analysisscience |review journal| date=2024 Journal| oflast1=Greenhalgh Education| andfirst1=Trisha Health| Promotionlast2=MacIntyre | volume first2=C. 9Raina | pages last3= 192Baker |year first3=Michael 2020G. | pmidlast4=Bhattacharjee | first4= 33015206Shovon | pmc last5= 7497125Chughtai | doi first5=Abrar 10.4103/jehpA.jehp_533_20 | doi-access last6=Fisman free| }}</ref>first6=David Cloth| maskslast7=Kunasekaran are| insufficientfirst7=Mohana for| healthcarelast8=Kvalsvig workers| andfirst8=Amanda not| recommended,last9=Lupton according| tofirst9=Deborah two| randomized controlledlast10=Oliver trials.{{r|Ataei}} Severalfirst10=Matt observational| studies,last11=Tawfiq including| fourfirst11=Essa reviewed| inlast12=Ungrin a| 2020 ''[[Thefirst12=Mark Lancet|Lancet]]'' meta-analysis,last13=Vipond have| foundfirst13=Joe that| masksjournal=Clinical offerMicrobiology statisticallyReviews significant| protectionvolume=37 from| infection,issue=2 although| thepages=e0012423 level| ofpmid=38775460 protection| variespmc=11326136 according| topmc-embargo-date=May the22, mask2025 type| and settinghdl=1959.<ref4/102268 name=lan-chu}}</ref>

Clinical evidence of mask efficacy in COVID-19 transmission was limited and had become a subject of scientific debate by May 2021.{{r|Nanda}} Clinical studies had not evaluated the efficacy of cloth masks in COVID-19 transmission by the end of 2021.{{r|Ataei}} Evaluation of cloth mask efficacy is further complicated by the wide variation in fabric and fit, among other factors.{{r|Ju}} Concerning the precedent of mask efficacy in limiting transmission of respiratory viral illnesses other than COVID, a clinical trial meta-analysis in May 2021 showed no significant evidence of efficacy, though the authors noted the evidence to be poor quality and subject to confounding factors like consistent mask usage adherence.<ref name=Nanda>{{cite journal | vauthors = Nanda A, Hung I, Kwong A, Man VC, Roy P, Davies L, Douek M | title = Efficacy of surgical masks or cloth masks in the prevention of viral transmission: Systematic review, meta-analysis, and proposal for future trial | journal = Journal of Evidence-Based Medicine | volume = 14 | issue = 2 | pages = 97–111 | date = May 2021 | pmid = 33565274 | pmc = 8014575 | doi = 10.1111/jebm.12424 }}</ref>

A [[scientific review]] of research about the overall efficacy of face masks in terms of [[product design]] (such as thermal comfort and flow resistance) and ways of usage found that [[fluid dynamics]] and fabrication techniques have a significant impact on performance. According to the review, studies showed that cotton and surgical masks had a microorganism filtration efficiency of 86.4% and 99.9% respectively, while the surgical mask was three times more effective in blocking transmission than the cotton mask and could lead to a decrease of the [[effective reproduction number]] to below{{nbsspaces}}1{{snd}}which could halt epidemic spread in a region where 70% of residents use them consistently in public.<ref>{{cite news |title=Face masks slow spread of COVID-19; types of masks, length of use matter |url=https://phys.org/news/2020-11-masks-covid-length.html |access-date=9 December 2020 |work=phys.org }}</ref><ref>{{cite journal | vauthors = Kumar S, Lee HP | title = The perspective of fluid flow behavior of respiratory droplets and aerosols through the facemasks in context of SARS-CoV-2 | journal = Physics of Fluids | volume = 32 | issue = 11 | pages = 111301 | date = November 2020 | pmid = 33281434 | pmc = 7713871 | doi = 10.1063/5.0029767 | arxiv = 2010.06385 | bibcode = 2020PhFl...32k1301K }}</ref>

At the beginning of the [[COVID-19 pandemic in the United States|COVID-19 outbreak in the United States]], the U.S.'s [[Strategic National Stockpile]] contained just twelve million N95 respirators, far fewer than estimates of the amount required.<ref name="Khazan">{{cite magazine | vauthors = Khazan O |date=10 April 2020 |title=Why We're Running Out of Masks |url=https://www.theatlantic.com/health/archive/2020/04/why-were-running-out-of-masks-in-the-coronavirus-crisis/609757/ |magazine=The Atlantic}}</ref> Millions of N95s and other supplies were purchased from 2005 to 2007 using congressional supplemental funding, but 85&nbsp;million N95s were distributed to combat the [[2009 swine flu pandemic]], and Congress did not make the necessary appropriations to replenish stocks.<ref name=Khazan/> The Stockpile's primary focus has also primarily been on [[biodefense]] (defense against a terrorist or [[weapon of mass destruction]] attack) and response to natural disaster, with the infectious disease a secondary focus.<ref name=Khazan/> By 1{{nbsspaces}}April 2020, the Stockpile was nearly emptied of protective gear.<ref name="washingtonpost7148009252">{{cite news| vauthors=Miroff N| date=1 April 2020| url=https://www.washingtonpost.com/national/coronavirus-protective-gear-stockpile-depleted/2020/04/01/44d6592a-741f-11ea-ae50-7148009252e3_story.html| title=Protective gear in the national stockpile is nearly depleted, DHS officials say| newspaper=The Washington Post |url-status=live|archive-url=https://web.archive.org/web/20200401225900/https://www.washingtonpost.com/national/coronavirus-protective-gear-stockpile-depleted/2020/04/01/44d6592a-741f-11ea-ae50-7148009252e3_story.html| archive-date=1 April 2020| url-access=subscription}}</ref> In January and February 2020, U.S. manufacturers, with the encouragement of the Trump administration, shipped millions of face masks and other personal protective equipment to the PRC, a decision that subsequently prompted criticism given the mask shortage that the U.S. faced during the pandemic.<ref>{{cite news |title=U.S. sent millions of face masks to China early this year, ignoring pandemic warning signs |language=en-US |newspaper=The Washington Post |url=https://www.washingtonpost.com/health/us-sent-millions-of-face-masks-to-china-early-this-year-ignoring-pandemic-warning-signs/2020/04/18/aaccf54a-7ff5-11ea-8013-1b6da0e4a2b7_story.html |access-date=1 November 2022 |issn=0190-8286}}</ref>

In France, [[2009 swine flu pandemic|2009 H1N1]]-related spending rose to €382{{nbsspaces}}million, mainly on supplies and vaccines, which was later criticized.<ref name=":19Public-Senat-2020" /><ref name=":20BFMTV" /> It was decided in 2011 to not replenish its stocks and rely more on supply from China and [[Just-in-time manufacturing|just-in-time logistics]].<ref name=":19Public-Senat-2020" /> In 2010, its stock included a billion surgical masks and 600&nbsp;million FFP2 masks; in early 2020, it was 150&nbsp;million and zero respectively.<ref name=":19Public-Senat-2020" /> While stocks were progressively reduced, a 2013 rationale stated the aim to reduce costs of acquisition and storage, now distributing this effort to all private enterprises as an optional best practice to ensure their workers' protection.<ref name=":19Public-Senat-2020" /> This was especially relevant to FFP2 masks, more costly to acquire and store.<ref name=":19Public-Senat-2020" /><ref>{{cite web|url=https://www.lefigaro.fr/sciences/quand-l-etat-stratege-a-renonce-a-renouveler-ses-stocks-de-masques-20200319|title=Quand l'État stratège a renoncé à renouveler ses stocks de masques | vauthors = Roy S, Barotte N |date=19 March 2020|website=Le Figaro| language=fr| access-date=6 April 2020}}</ref> As the [[COVID-19 pandemic in France]] took an increasing toll on medical supplies, masks and PPE supplies ran low, causing national outrage. France needed forty million masks per week, according to French president [[Emmanuel Macron]].<ref name=":25Radio-France-Internationale-2020">{{cite web|url=http://www.rfi.fr/en/international/20200331-macron-40-million-masks-covid-19|title=France to produce 40 million face masks by end of April for domestic battle against Covid-19|date=31 March 2020|publisher=Radio France Internationale|access-date=6 April 2020}}</ref> France instructed its few remaining mask-producing factories to work 24/7 shifts and to ramp up national production to forty million masks per month.<ref name=":25Radio-France-Internationale-2020" /> French lawmakers opened an inquiry on the past management of these strategic stocks.<ref>{{cite web| url=http://www.rfi.fr/en/france/20200401-where-billion-masks-french-coronavirus-committee-asks|title=Covid-19: French lawmakers to investigate where one and a half billion masks sent|date=1 April 2020|publisher=Radio France Internationale|access-date=6 April 2020}}</ref> The mask shortage has been called a {{Lang|fr|"scandal d'État"}} (State scandal).<ref>{{cite web| url=https://www.franceinter.fr/societe/penurie-de-masques-les-raisons-d-un-scandale-d-etat |title=Pénurie de masques : les raisons d'un "scandale d'État" |publisher=Franceinter.fr |date=n.d.|access-date=6 April 2020}}</ref> Thousands of French individuals and companies teamed up during the outbreak to form a decentralized network of [[Fab lab]]s and ad-hoc retooled production facilities, producing more than a million [[face shield]]s, masks and other kinds of PPE during the height of the pandemic.<ref>{{cite web|title=National Case Study: France's Maker Response Against COVID-19|url=https://opensourcemedicalsupplies.org/national-maker-response-case-studies/france/|access-date=18 March 2021|website=Open Source Medical Supplies}}</ref>

N95 and FFP masks were in short supply and high demand during the [[COVID-19 pandemic]].<ref>{{cite news| vauthors = Johnson M |url=https://thehill.com/policy/healthcare/public-global-health/489782-feds-have-15-million-expired-n95-masks-in-storage|title=Feds have 1.5 million expired N95 masks in storage despite CDC clearing them for use on COVID-19: report|date=26 March 2020|work=The Hill|access-date=12 April 2020}}</ref><ref name=":19Public-Senat-2020" /> Production of N95 masks was limited due to constraints on the supply of [[nonwoven polypropylene]] fabric (which is used as the primary filter), as well as the cessation of exports from China.<ref name="VOADeliver" /><ref>{{cite news| vauthors = Evan M, Hufford A |url=https://www.wsj.com/articles/coronavirus-pressures-supply-chain-for-protective-masks-11583552527|title=Critical Component of Protective Masks in Short Supply – The epidemic has driven up demand for material in N95 filters; 'everyone thinks there is this magic factory somewhere'|date=7 March 2020|newspaper=[[The Wall Street Journal]]}}</ref> China controls fifty percent of global production of masks, and facing its own coronavirus epidemic, dedicated all its production for domestic use, only allowing exports through government-allocated humanitarian assistance.<ref name="VOADeliver" />

The [[Strategic National Stockpile]] had not been refilled following the [[H1N1 pandemic]],<ref>{{cite web|url=https://www.pbs.org/wgbh/frontline/article/depleted-national-stockpile-contributed-to-covid-ppe-shortage/|title=Depleted National Stockpile Contributed to COVID PPE Shortage: ‘You'You Can’tCan't Be Prepared If You’reYou're Not Funded to Be Prepared’Prepared'|first=Patrice|last=Taddonio|publisher=PBS Frontline|date=2020-10-06}}</ref> which quickly led to respirator and other PPE shortages.<ref>{{cite webnews|url=https://www.washingtonpost.com/national/coronavirus-protective-gear-stockpile-depleted/2020/04/01/44d6592a-741f-11ea-ae50-7148009252e3_story.html|title=Protective gear in national stockpile is nearly depleted, DHS officials say|first=Nick|last=Miroff|publishernewspaper=The Washington Post|date=2020-04-02}}</ref>

Cottage industries and volunteer groups also emerged, manufacturing cloth masks for localized use. They used various patterns, including some with a bend-to-fit nosepiece insert. Individual hospitals developed and requested a library of specific patterns.<ref>{{cite news | vauthors = Enrich D, Abrams R, Kurutz S |title=A Sewing Army, Making Masks for America |url=https://www.nytimes.com/2020/03/25/business/coronavirus-masks-sewers.html |work=The New York Times |date=25 March 2020}}</ref><ref>{{cite news |vauthors=Levy J |title=Need for masks spawns cottage industry |url=https://www.rep-am.com/local/localnews/2020/05/04/need-for-masks-spawns-cottage-industry/ |work=Republican-American |location=Waterbury, CT |publisher=Republican American |date=4 May 2020 |access-date=7 May 2020 |quote=Production of face masks is becoming a cottage industry of sorts with some hybrid operations that both donate and sell the sought-after coverings. |archive-date=2 November 2020 |archive-url=https://web.archive.org/web/20201102205622/https://www.rep-am.com/local/localnews/2020/05/04/need-for-masks-spawns-cottage-industry/ |url-status=dead}}</ref><ref>{{cite news |vauthors=Bhanoo S |date=1 April 2020 |title=Which DIY mask pattern should you use? Even experts can't pick one to recommend. |url=https://www.washingtonpost.com/lifestyle/wellness/masks-diy-coronavirus/2020/04/01/20830f5e-7420-11ea-85cb-8670579b863d_story.html |newspaper=The Washington Post}}</ref><ref>{{cite web |title=Master Maskmaking Guide |url=https://www.makemasks2020.org/mask-making-guide |website=Makemasks |quote=well-known patterns such as the Deaconess, A.B. mask (For a nurse, by a nurse), We Can Sew It, the Cynthia, and the Erin{{nbsspaces}}... Full Pattern Library |access-date=9 May 2020 |url-status=dead |archive-date=14 August 2020 |archive-url=https://web.archive.org/web/20200814073342/https://www.makemasks2020.org/mask-making-guide}}</ref>

Between April and June 2020, sellers on [[Etsy]] sold 29&nbsp;million cloth face masks worth an estimated $364{{nbsspaces}}million. Approximately four million people (about seven percent of buyers) visited the website ''just'' to buy masks.<ref>{{cite news| vauthors = Kavilanz P |date=7 August 2020|title=Etsy's on fire as reusable face mask sales surge|publisher=[[CNN]]|url=https://www.cnn.com/2020/08/07/business/etsy-face-mask-market/index.html|access-date=25 August 2020}}</ref>

Similar concerns over difficulty in communicating have been expressed by those who may depend on dogs for [[Assistance dog|therapeutic]] or [[Dog#As pets|social]]{{Broken anchor|date=2024-06-15|bot=User:Cewbot/log/20201008/configuration|target_link=Dog#As pets|reason= The anchor (As pets) [[Special:Diff/1035168707|has been deleted]].}} reasons, as the animals depend on body language such as facial expressions.<ref>{{cite news|url=https://www.yourdog.co.uk/the-your-dog-blog/five-easy-steps-to-get-your-dog-used-to-face-masks|title=Five easy steps to get your dog used to face masks| vauthors = Wright S |date=9 June 2020|work=Your Dog Magazine|access-date=24 July 2020}}</ref> Conversely, people who are exempt from wearing masks on medical grounds or due to a disability, fear they will be [[Disability hate crime|subjected to abuse]] for not wearing a mask, even if they are legally exempt from doing so.<ref name=mtr-dis/> For instance, in the United Kingdom, the charity [[Disability Rights UK]] received numerous reports about people being confronted on trains and buses.<ref name=mtr-dis>{{cite news|url=https://metro.co.uk/2020/07/24/people-disabilities-fear-abuse-not-wearing-face-masks-public-13032131/|title=People with disabilities fear abuse for not wearing face masks in public| vauthors = Courtney-Guy S |date=24 July 2020|work=[[Metro (UK newspaper)|Metro]]|access-date=24 July 2020}}</ref> Health organizations such as the [[American Lung Association]] commented that, even though there may be people who will seek an exemption, the individual's concerns needs to be weighed against the societal needs to limit the spread of the virus.<ref name=abc-med/><ref>{{cite web |title=American College of Chest Physicians, American Lung Association, American Thoracic Society and COPD Foundation Statement on Importance of Patients with Chronic Lung Disease Wearing Facial Coverings |url=https://www.lung.org/media/press-releases/accp-ala-ats-copd-foundation-urge-masks-for-all |website=American Lung Association |date=16 July 2020}}</ref> However, anti-maskers have called upon bogus claims about legal or medical exemptions in their refusal to wear masks.<ref name=abc-med>{{cite web | vauthors = Dwyer D |title=Few medical reasons for not wearing a face mask |url=https://abcnews.go.com/Politics/medical-reasons-wearing-face-mask/story?id=72020929 |website=ABC News |date=30 July 2020}}</ref> They have, for instance, claimed that the [[Americans with Disabilities Act]] (designed to prohibit discrimination based on disabilities) allows exemption from mask requirements, but the [[United States Department of Justice]] responded that the act "does not provide a blanket exemption to people with disabilities from complying with legitimate safety requirements necessary for safe operations".<ref>{{cite web | vauthors = Brown M |title=Fact check: ADA does not provide blanket exemption from face mask requirements |url=https://www.usatoday.com/story/news/factcheck/2020/07/15/fact-check-ada-disability-rights-and-face-mask-requirements/5391830002/ |website=USA Today |date=16 July 2020}}</ref>

By 2023, most jurisdictions had ended their mask mandates.<ref name="royalsoc">{{rcite journal |royalsoc url=https://doi.org/10.1098/rsta.2023.0133 | doi=10.1098/rsta.2023.0133 | title=Effectiveness of face masks for reducing transmission of SARS-CoV-2: A rapid systematic review | date=2023 | last1=Boulos | first1=Leah | last2=Curran | first2=Janet A. | last3=Gallant | first3=Allyson | last4=Wong | first4=Helen | last5=Johnson | first5=Catherine | last6=Delahunty-Pike | first6=Alannah | last7=Saxinger | first7=Lynora | last8=Chu | first8=Derek | last9=Comeau | first9=Jeannette | last10=Flynn | first10=Trudy | last11=Clegg | first11=Julie | last12=Dye | first12=Christopher | journal=Philosophical Transactions of the Royal Society A: Mathematical, Physical and Engineering Sciences | volume=381 | issue=2257 | pmid=37611625 | pmc=10446908 | bibcode=2023RSPTA.38130133B }}</ref> By May 2023, people in most countries largely stopped wearing masks.<ref>{{cite news |last1=Rigby |first1=Jennifer |last2=Satija |first2=Bhanvi |title=WHO declares end to COVID global health emergency |url=https://www.reuters.com/business/healthcare-pharmaceuticals/covid-is-no-longer-global-health-emergency-who-2023-05-05/ |access-date=9 May 2023 |work=Reuters |date=8 May 2023 |language=en}}</ref>

Although authorities, especially in Asia, have been recommending people to wear face masks in public, in many other parts of the world, conflicting advice has caused much confusion among the general population.<ref name=cnn-amhb>{{cite web | vauthors = Griffiths J |title=Asia may have been right about coronavirus and face masks, and the rest of the world is coming around |url=https://edition.cnn.com/2020/04/01/asia/coronavirus-mask-messaging-intl-hnk/index.html |publisher=CNN| date=2 April 2020}}</ref> Several governments and institutions, such as in the United States, initially dismissed the use of face masks by the general population, often with misleading or incomplete information about the usefulness of masks.<ref name="thenational.scot">{{cite web | vauthors = Watterson A |title=Through all the misinformation, what is the truth of wearing face masks? |url= https://www.thenational.scot/news/18385472.misinformation-truth-wearing-face-masks/ |website=The National |date=17 April 2020}}</ref><ref name="vanityfair.com">{{cite magazine | vauthors = Frank TA |title="I Was Looking at Them in the Wrong Way": Mask Misinformation and the Failure of the Elites |url=https://www.vanityfair.com/news/2020/04/mask-misinformation-and-the-failure-of-the-elites |magazine=Vanity Fair |date=8 April 2020}}</ref><ref name=npr-wta>{{cite web | vauthors = Huo J |title=Why There Are So Many Different Guidelines For Face Masks For The Public |url=https://www.npr.org/sections/goatsandsoda/2020/04/10/829890635/why-there-so-many-different-guidelines-for-face-masks-for-the-public |publisher=NPR |date=10 April 2020}}</ref> Commentators have attributed the anti-mask messaging to efforts to manage the mask shortages, as governments did not act quickly enough, remarking that the claims go beyond the science or were simply lies.<ref name=npr-wta/><ref>{{cite web |title=Coronavirus: Abrupt reversals on face mask policy raise new questions |url=https://www.france24.com/en/20200405-coronavirus-abrupt-reversal-on-mask-policy-in-france-and-the-us-raises-new-questions |publisher=France 24 |date=5 April 2020}}</ref><ref>{{cite web | vauthors = Walther M |title=The noble lie about masks and coronavirus should never have been told |url=https://theweek.com/articles/906647/noble-lie-about-masks-coronavirus-should-never-have-been-told |website=The Week |date=4 April 2020}}</ref><ref name="nytimes.com">{{cite web | vauthors = Tufekci Z |title=Why Telling People They Don't Need Masks Backfired |url=https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html |website=The New York Times |date=17 March 2020}}</ref> On 12 June 2020, [[Anthony Fauci]], a key member of the [[White House]] coronavirus task force, confirmed that the American public were not told to wear masks from the beginning due to the shortages of masks and explained that masks do actually work.<ref>{{cite web | vauthors = Jankowicz M |title=Fauci said US government held off promoting face masks because it knew shortages were so bad that even doctors couldn't get enough |url=https://www.businessinsider.com/fauci-mask-advice-was-because-doctors-shortages-from-the-start-2020-6 |website=Business Insider |date=15 June 2020}}</ref><ref>{{cite web | vauthors = Ross K |title=Dr. Fauci Explains Why Public Wasn't Told to Wear Masks When COVID-19 Pandemic Began |url=https://www.thestreet.com/video/dr-fauci-masks-changing-directive-coronavirus |website=TheStreet |date=12 June 2020}}</ref><ref>{{cite web | vauthors = Kelley A |title=Fauci: why the public wasn't told to wear masks when the coronavirus pandemic began |url=https://thehill.com/changing-america/well-being/prevention-cures/502890-fauci-why-the-public-wasnt-told-to-wear-masks |website=The Hill |date=16 June 2020}}</ref><ref>{{cite web | vauthors = McArdle M |title=Fauci Confirms Public-Health Experts Downplayed Efficacy of Masks to Ensure They Would Be Available to Health-care Workers |url=https://www.nationalreview.com/news/fauci-confirms-public-health-experts-downplayed-efficacy-of-masks-to-ensure-they-would-be-available-to-healthcare-workers/ |website=National Review |date=16 June 2020}}</ref><ref>{{cite web | vauthors = Novak M |title=Dr. Fauci Made the Coronavirus Pandemic Worse by Lying About Masks |url=https://gizmodo.com/dr-fauci-made-the-coronavirus-pandemic-worse-by-lying-1844050358 |website=Gizmodo |date=17 June 2020}}</ref>{{citationexcessive overkillcitations inline|date=June 2021}}

The city of [[Vilnius]] in Lithuania held a "Mask Fashion Week" in May 2020, which was promoted with billboards (with no catwalks or displays) around the city featuring local people including Mayor Remigijus Simasius wearing face masks.<ref>{{cite web | vauthors = Sytas A |title=Lithuanian capital holds 'Mask Fashion Week' amid coronavirus pandemic |url=https://uk.reuters.com/article/health-coronavirus-lithuania-mask-fashio/lithuanian-capital-holds-mask-fashion-week-amid-coronavirus-pandemic-idINKBN22H260 |archive-url=https://web.archive.org/web/20201001064243/https://uk.reuters.com/article/health-coronavirus-lithuania-mask-fashio/lithuanian-capital-holds-mask-fashion-week-amid-coronavirus-pandemic-idINKBN22H260 |url-status=dead |archive-date=1 October 2020 |work=Reuters |date=6 May 2020}}</ref>

<ref name=":19Public-Senat-2020">{{cite web|url=https://www.publicsenat.fr/article/politique/penurie-de-masques-une-responsabilite-partagee-par-les-gouvernements-successifs|title=Pénurie de masques : une responsabilité partagée par les gouvernements|date=23 March 2020|website=Public Senat|language=fr|access-date=6 April 2020}}</ref>

<ref name=":20BFMTV">{{cite web|url=https://www.bfmtv.com/sante/penurie-de-masques-pourquoi-la-france-avait-decide-de-ne-pas-renouveler-ses-stocks-il-y-a-neuf-ans-1878500.html|title=Pénurie de masques: pourquoi la France avait décidé de ne pas renouveler ses stocks il y a neuf ans|last=BFMTV|publisher=BFMTV|language=fr|access-date=6 April 2020}}</ref>