Experts Recommend Switching from Surgical Masks to Respirators in Healthcare Settings
A group of experts is advocating for a shift in the guidelines set by the World Health Organization, arguing that surgical face masks offer insufficient protection against flu-like illnesses, including Covid-19. They recommend that respirator-level masks be used in all direct healthcare interactions between doctors, nurses, and patients.
The letter sent to WHO chief Dr. Tedros Adhanom Ghebreyesus states there’s no longer a valid reason to use surgical masks, which are commonly found in hospitals worldwide, due to their lack of effectiveness against airborne pathogens. The authors also noted there’s even less justification for allowing healthcare workers to go without face coverings entirely.
During the peak of the pandemic, around 129 billion disposable face masks were reportedly used monthly across the globe by both the public and healthcare personnel, with surgical masks being the most prevalent option recommended by health authorities.
The experts argue that respirators, such as those meeting FFP2/3 standards in the UK or N95 standards in the US, should become standard in healthcare settings. As more evidence emerged throughout the pandemic, many countries started to advocate for these more effective masks.
The authors believe adopting their recommendations would lead to a decrease in infections among patients and healthcare professionals, as well as lower rates of sickness and burnout within the health workforce.
Prof. Adam Finkel from the University of Michigan, one of the authors of the letter, pointed out that surgical masks were primarily designed to prevent healthcare workers from contaminating patients during procedures, not to stop airborne pathogens. He compared surgical masks to typewriters, suggesting they’re outdated in the face of modern needs.
This advocacy stemmed from discussions at an online conference called Unpolitics, where evidence-based health policies were explored. The letter has gained support from nearly 50 senior clinicians and researchers, along with more than 2,000 public members, including patients considered clinically vulnerable.
While the recommendations are aimed at healthcare environments, some flexibility could exist, allowing establishments to choose not to require respirators based on local infection rates or room ventilation conditions.
Despite likely sparking controversy—especially given the cultural tensions around mask usage during the pandemic—the potential impact of these guidelines could be substantial. For instance, the conversation around mask-wearing shifted when NHS leaders suggested people with flu symptoms should wear masks in public.
The authors argued that WHO’s updates to guidelines recommending respirators could significantly influence global practices. They also proposed that the WHO could help improve access to respirators in less affluent countries by gradually reducing the production of surgical masks.
While Finkel acknowledged that surgical masks are “better than nothing,” they only block around 40% of Covid-sized particles, compared to approximately 95% by respirators. He likened the difference in risk to falling from a shorter wall versus a taller one; both scenarios carry risks, but the shorter fall is less likely to result in severe injury.
Criticism of the group’s perspective highlights the absence of randomized controlled trials to demonstrate that such physical measures effectively slow the spread of respiratory illnesses. Finkel and his co-authors contend that rigorous trials aren’t feasible since participants wouldn’t wear masks consistently throughout the day, exposing them to pathogens while unmasked.
Instead, they believe that laboratory results showing how effectively respirators filter airborne particles provide adequate evidence of their effectiveness.
Moreover, the letter calls for the WHO to revisit its earlier communications and clearly indicate to the public that Covid-19 spreads through airborne respiratory particles.
Prof. Trisha Greenhalgh from the University of Oxford, also a signatory, emphasized that respirators are designed to fit closely around the face and filter out airborne germs, unlike medical masks which tend to have a looser fit and significant leakage.
The letter has garnered support from a range of individuals, including prominent public health advocates and members of the World Health Network. In response to the letter, a WHO spokesperson remarked that it would need careful evaluation, noting the organization seeks input from a broad range of health and economic experts when formulating guidance for personal protective equipment for health workers. They also mentioned that they are currently re-evaluating WHO’s Infection Prevention and Control guidelines based on the latest scientific findings.
