COMMENT LETTERS
The Practice of Wearing Thereafter, we educated the public to wear masks as a
practice of respiratory hygiene. Although evidence is
Surgical Masks during the limited for their effectiveness in preventing transmis-
COVID-19 Pandemic sion of severe acute respiratory syndrome coronavirus
2, either for source control or to reduce exposure, the
wearing of masks by healthy persons may prevent
Cho-Han Chiang, Cho-Hung Chiang,
potential asymptomatic or presymptomatic transmis-
Cho-Hsien Chiang, Yee-Chun Chen
sion (3). This marginal reduction in transmission may
Author affiliations: National Taiwan University College of Medicine, produce substantial results, particularly when it is
Taipei, Taiwan (Cho-Han Chiang, Y.-C. Chen); Fu-Jen Catholic implemented early. Taiwan had the foresight to create
University, Taipei (Cho-Hung Chiang); Chung Shan Medical a large stockpile of medical and surgical masks; other
University, Taichung, Taiwan (Cho-Hsien Chiang); National Taiwan countries or regions might now consider doing so as
University Hospital, Taipei (Y.-C. Chen) part of future pandemic plans (3).
DOI: https://doi.org/10.3201/eid2608.201498
About the Author
To the Editor: We read with interest the meta- Mr. Chiang is a medical student at National Taiwan
analysis conducted by Xiao et al. (1) that found no University. His primary research interests are
significant reduction in influenza transmission with epidemiology and prevention of communicable diseases.
the use of surgical masks in the community, based
on 10 randomized controlled trials. Nevertheless,
References
mechanistic studies found that surgical masks could 1. Xiao J, Shiu EYC, Gao H, Wong JY, Fong MW, Ryu S,
prevent transmission of human coronavirus and in- et al. Nonpharmaceutical measures for pandemic influenza
fluenza virus infections if worn by infected persons in nonhealthcare settings—personal protective and
(2). The authors pointed out the limitations of their environmental measures. Emerg Infect Dis. 2020;26:967–75.
https://doi.org/10.3201/eid2605.190994
study: small sample size and suboptimal adherence 2. Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ,
in the mask-wearer group (1). Recommendations on Hau BJP, et al. Respiratory virus shedding in exhaled breath
masks in the community vary across countries during and efficacy of face masks. Nat Med. 2020 Apr 3 [Epub ahead
the coronavirus disease (COVID-19) pandemic (3); of print]. https://doi.org/10.1038/s41591-020-0843-2
3. Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ.
studies have reported mixed results (2,4,5). Rational use of face masks in the COVID-19 pandemic.
Epidemiologic data may provide an alternative Lancet Resp Med. In press 2020. https://doi.org/10.1016/
insight. As of April 3, 2020, Taiwan recorded 348 S2213-2600(20)30134-X
COVID-19 cases (1.46/100,000 population), of which 4. Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ,
Wong YJ, et al. COVID-19 and the risk to health care
48 (13.8%) were local cases. Singapore recorded workers: a case report. Ann Intern Med. 2020 Mar 16 [Epub
1,114 cases (19.07/100,000 population), of which 572 ahead of print]. https://doi.org/10.7326/L20-0175
(51.3%) were local cases. Taiwan and Singapore both 5. Bae S, Kim MC, Kim JY, Cha HH, Lim JS, Jung J, et al.
employed stringent measures. Taiwan recommended Effectiveness of surgical and cotton masks in blocking
SARS–CoV-2: a controlled comparison in 4 patients.
the use of masks early in the pandemic. In contrast, Ann Intern Med. 2020 Apr 6 [Epub ahead of print].
Singapore did not recommend the use of masks until https://doi.org/10.7326/M20-1342
April 3 and initiated its Stay Home policy on April 7.
Before the 2003 severe acute respiratory syndrome Address for correspondence: Yee-Chun Chen, Department
coronavirus epidemic in Taiwan, only persons with of Internal Medicine, National Taiwan University Hospital
open tuberculosis wore masks in public. During the No. 7 Chung-Shan South Rd, Taipei, Taiwan; email:
epidemic, wearing a mask in public was stigmatized. [email protected]
1962 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 26, No. 8, August 2020
