The Health Information and Quality Authority (HIQA) has today published the advice it submitted to the National Public Health Emergency Team (NPHET) on face mask use to reduce the transmission of SARS-CoV-2.

COVID-19 is a fast-evolving pandemic. Measuring the effectiveness of a single public health measure, such as face mask use, is challenging as it is influenced by the other public health measures that have been adopted, adherence to the measures, the type of masks and the settings in which they are used.

HIQA examined a wide-ranging and multidimensional evidence base. The evidence summary on face mask use in the community was updated to include the most recent research. This evidence was interpreted in the context of research regarding the transmission of SARS-CoV-2 identified in a number of other HIQA evidence summaries and reviews.

Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, said: “We found that, collectively, the evidence points towards face mask use in the community reducing transmission of SARS-CoV-2.  There is no consistent evidence that face mask use leads to a false sense of security or reduced adherence to other public health measures. There are, however, reports of discomfort and skin irritation related to face mask use.”

Recommendations currently in place in Ireland for the general public reflect wider international public health guidance. In this update, HIQA found that some countries have recently taken their policy further, recommending face mask use in crowded outdoor settings due to the inability to maintain physical distance. HIQA advised that this should be considered for Ireland as well.

HIQA also noted that further research is required to understand and identify factors affecting adherence to face mask guidance to allow for enhanced and targeted communication strategies.

Dr Ryan said: ”Recommendations on face mask use must be accompanied by clear and concise communication which informs, empowers and supports the public to make decisions to protect themselves and others, particularly in settings and activities associated with higher risk of transmission.

It is important that face masks are used alongside other measures, including maintaining a safe physical distance, respiratory etiquette and hand washing in order to reduce the spread of infection and protect the most vulnerable in our society.”

HIQA’s advice to NPHET is accompanied by a rapid evidence update, published today, which follows its evidence summary on face mask use in the community published in August.

The documents published today are available from the link at the top of the page.
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Further information:
Marty Whelan, Head of Communications & Stakeholder Engagement
085 805 5202, mwhelan@hiqa.ie

Notes to Editor:

• HIQA has today published the following documents to inform NPHET’s response to COVID-19:
  • Advice to NPHET: Wearing of face masks in the community to reduce the transmission of SARS-CoV-2
  • A rapid evidence update on face mask use by healthy people in the community to reduce SARS-CoV-2 transmission
  • Protocol for rapid evidence update on face mask use by healthy people in the community to reduce SARS-CoV-2 transmission
• HIQA’s advice was informed by a rapid evidence update following HIQA’s previous evidence summary, published 21 August 2020, on the use of face masks in the community. The advice was also informed by some of HIQA’s other evidence summaries, which considered airborne transmission of SARS-CoV-2, relative importance of direct versus indirect droplet transmission for the spread of SARS-CoV-2 and activities or settings associated with higher risk of transmission of SARS-CoV-2.
• During the COVID-19 pandemic, the use of face masks by the general public has been recommended by an increasing number of countries, for an increasing number of activities. In Ireland, face masks are mandatory on public transport, in shops and other retail outlets, and recommended in situations where physical distancing may not be possible. Face masks are not required for children under 13 years of age (unless specifically advised by a healthcare provider).
• The rapid evidence update reviewed available research evidence from July 2020 onwards.
• The findings of this review are time sensitive; as the pandemic progresses, a different picture of the settings and situations for which face mask use is recommended may develop.
• HIQA’s COVID-19 EAG was convened for clinical and technical interpretation of the evidence provided and came to the collective consensus that the evidence base supports the ongoing use of face masks by the general public as a measure aimed at reducing the transmission of SARS-CoV-2 in the community.
• Communication campaigns in relation to face mask usage should focus on the following aspects:
  • with respect to children, clarification of the age from which face mask usage is required
  • characteristics of the settings and activities with high levels of SARS-CoV-2 transmission
  • concept of the continuum of risk, that is, that there is currently always some level of risk of SARS-CoV-2 transmission, and that this risk is greater in certain settings and circumstances, and for certain individuals
  • the possibility of aerosol transmission in certain scenarios, including high risk settings
  • the potential to mitigate risk through use of face masks, in addition to other public health measures, in settings where there is higher risk of transmission
  • importance of adherence to good practice guidelines in terms of appropriate levels of face coverage as well as mask selection, hygiene and disposal.
• Since September 2020, HIQA has provided evidence-based advice in response to requests from NPHET.
• HIQA’s advice to NPHET is informed by research evidence developed by HIQA’s COVID-19 Evidence Synthesis Team, with expert input from HIQA’s COVID-19 Expert Advisory Group.
  • The topics HIQA researches are outlined and prioritised by NPHET to ensure that they have rapid access to the best available evidence relevant to the SARS-CoV-2 outbreak.
• HIQA’s COVID-19 Evidence Synthesis Team produces a variety of outputs including rapid health technology assessments, scoping reports, rapid reviews of public health guidance, and evidence summaries, supplemented by an evidence-to-advice framework to guide the development of advice, where appropriate.
• HIQA’s COVID-19 Expert Advisory Group is a multidisciplinary group, comprising nominated representatives from the relevant clinical specialties and areas of expertise, methodology experts, and public representation.