COVID-19 Masking: Hundreds of Thousands of Russian Social Media Bots Have Tricked the Public

The conversation about permanently requiring universal masking in health care facilities must happen. Returning to normal is not an option since “normal” does not provide adequate safeguards. Mitigating exposure of high-risk patients to COVID-19 is of utmost importance, but so is preventing exposure to the human respiratory syncytial virus (RSV), influenza, and even the common cold.

On September 23, 2022, the CDC revised its masking guidance to allow hospitals to opt out of universal masking when community transmission levels were not “high.” Masking is still required for staff taking care of COVID-19 patients or patients having exposure within 10 days previously.

N95 masks should be used. According to the CDC, cloth masks block large particles (including droplets) and “in some cases filtering nearly 50% of fine particles less than 1 micron.” This level of mask effectiveness may help reduce the spread in the community but does not provide the needed level of personal protection to prevent infections with the Omicron variant. Omicron is highly infectious, and the viral dosage required for infection is presumably much lower than other variants. N95 masks are needed for optimal prevention of COVID-19 in health care personnel and patients. The public should also be strongly encouraged to adopt their usage.

Graham Snyder, MD, MS, et al recently reported survey results from 35 health care epidemiologists. Most (26) represented large multiple acute-care hospital systems. 90% responded that maintenance of masking requirements was essential to prevent influenza transmission, and 73% felt masking requirements were critical to preventing infections in staff and patients. However, less than 10% felt that staff and patients would favor this policy. Despite this, 97% reported that their facilities had no immediate plans to discontinue universal masking requirements. (Watch Snyder’s interview with ICT® about hospitals’ returning-to-work policies.)

Fake news and disinformation may significantly inhibit the adoption of masking by the public. The Washington Post reports that recently leaked national security documents indicate the Russians “boasted” that “less than 1%” of their sham social media profiles and bots have been caught. One of their propaganda campaigns spread the conspiracy theory that the United States was hiding the side effects of vaccines. A “network of hundreds of thousands of social media bots emulate(ed) users” and was intended to divide the West, and apparently was very successful. One could argue that this has led to a loss of confidence in public health authorities, adversely impacting adopting of COVID-19 mitigation strategies. This Post report bolsters a Reuters article which reported that according to a European Union document, the “Russian media have deployed a “significant disinformation campaign” against the West to worsen the coronavirus's impact, generating panic and sow distrust….”

Further adding to public confusion, the lead author of the recent Cochrane meta-analysis regarding the effectiveness of masking appeared to have spun the results in an interview with Maryanne Demasi, PhD, by stating, “There’s still no evidence that masks are effective during a pandemic” and that N95 masks make “no difference.” However, the Cochrane meta-analysis clearly stated, “The low to moderate certainty of evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect.“ In addition, the Editor-in-Chief of the Cochrane Library, Karla Soares-Weister, felt that many commentators of the meta-analysis have misrepresented and inaccurately interpreted the study as showing that “masks don’t work.”

Overall, the Cochrane meta-analysis was plagued by incorporating studies having poor and intermittent masking adherence, and all but 2 studied influenza-like illnesses, not COVID-19. The 2 studies which evaluated SARS-CoV-2 infections studied masking education and availability. Both studies had positive results, one reaching statistical significance.

Many other researchers have reported positive effects from masking, including one studying the Massachusetts School system, which reported that lifting of masking mandates accounted for 40% of the SARS-CoV-2 infections. In the British Medical Journal, Stella Talic, PhD, et al. reported a meta-analysis of six research studies that indicated that masking reduced the incidence of SARS-CoV-2 infections by almost 50%.
 
All of this is occurring as the United States is dealing with a surge in various infectious diseases. In addition, we are facing a growing XBB threat. The XBB.1.1.6 variant is causing a significant surge in India. This variant currently comprises 7.2% of the SARS-CoV-2 isolates in the United States and has almost doubled from the previous week. Because the United States experienced a significant number of XBB.1.5 cases, a large surge may not occur. However, this is not comforting for high-risk populations such as the elderly, obese, and immunocompromised.
 
Public masking, especially when sick, has been integral to Southeast Asian culture. This region has had a long history of dealing with epidemics and was the origin of SARS-1. As a hyper-traveling world society has emerged, dangerous pathogens spread almost instantaneously. The United States needs to adapt. As a first step, health care facilities should require universal masking to protect patients and staff.