Sweden’s approach to the coronavirus continues to stir controversy as Anders Tegnell, the country’s leading epidemiologist, said that there is no point in Swedish citizens following the World Health Organization’s advice, which is to wear face masks when social distancing is not possible. Tegnell said that there is no point in adopting this measure because Sweden’s number of COVID-19 infections is dropping sharply.

The Health Agency of Sweden says that since reaching a peak in late June, the infection rate has rapidly dropped despite an increase in testing over the period.

Sweden’s Unorthodox Approach to COVID-19

Since the start of the coronavirus pandemic, the Swedish Government has consistently refused to take its country into lockdown while many of its EU counterparts and the UK took the opposite direction. At one stage, the number of Swedish deaths exceeded those in the US and Brazil. On Tuesday 28th July, Sweden reported only two new deaths. The current death toll there stands at 5,743. This is a remarkable achievement for a nation that bucked the trend and kept its economy open as COVID-19 crippled the rest of Europe.

The Science Behind Face Masks is Unclear

As Sweden continues to recover from the coronavirus in its own way, was Tegnell right to argue that face masks should not be mandatory in his own country? The one reason why the face coverings debate remains unresolved is because there are a lot of contradictory arguments over their purpose and efficacy.

In the UK, the Scientific Advisory Group for Emergencies (SAGE) that is advising the British Government on its response to the coronavirus argues that the evidence of coverings preventing the spread of infection from one person to another is “marginal, but positive.”

This argument is supported by a study conducted by Cambridge and Greenwich universities which discovered that requiring everyone to wear a face mask would prevent a ‘second wave’ of coronavirus for 18 months.

Some Studies Show Face Masks are Effective

Nonetheless, Denis G. Rancourt, PhD, conducted a study into whether face masks work or not. He reviewed established knowledge about viral respiratory diseases, the mechanism of seasonal variation of excess deaths from pneumonia and influenza, and other factors.

He found that the “second wave” of an epidemic is not a result of ‘human sin’ regarding mask wearing and hand-shaking. Instead, it is a consequence of an air-dryness-driven many-fold increase in disease contagiousness among populations that have not yet gained immunity from a virus.

Furthermore, mask stoppage efficiency and host inhalation are only half of the equation because the minimal infectious dose (MID) must also be considered. If the MID surpassed by the virions carried in a single aerosol particle is able to evade mask-capture, then the mask is of no practical utility.

Do Face Masks Actually Work?

Rancourt states that because there is no sufficient scientific evidence on face masks, governments should not make policies that have a hypothetical potential to cause harm.

Radonovich et al (2019) conducted a study that investigated whether N95 respirators and medical masks prevent influenza among healthcare personnel. It also found that among 2,862 participants, 2,371 completed the study. Among outpatient health care personnel, N95 respirators versus medical masks as worn by volunteers in this experiment resulted in no substantial difference in the incidence of laboratory-confirmed influenza.

This was also supported by a 2020 Hong Kong study which came to the same conclusion, but also stated that improper use of these masks increases the chances of getting transmitted.

Sweden’s Approach is the Right One

People in many countries are being told that cloth masks are better than nothing, but in 2015 MacIntyre et al compared medical masks to cloth masks. They found that cloth masks are ineffective and can put people at a greater risk of catching a virus. Moisture retention, reuse of cloth masks and poor filtration may result in an increased risk of infection.

Considering Sweden has succeeded in curbing the rate of COVID-19 infections without the need to impose a lockdown so far, it would appear that Tegnell’s decision not to force Swedes to wear face masks is justified based on the scientific evidence currently available. There is no certainty that they do work and more countries would do well to follow Tegnell’s lead. It should be a matter of choice for people to wear a face covering. Sweden may well be the unsung hero of the coronavirus pandemic in years to come.