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An analysis of policy decisions to combat SARS-CoV-2 transmission: comparing the available evidence and policies of public face masking to social distancing

As the COVID-19 pandemic spread throughout the world in early 2020, many country leaders endorsed social distancing policies to reduce transmission. Public face masking policies, however, were only endorsed by a few countries in eastern Asia until recently. Herein, we review the theory and evidence behind public face masking and social distancing. We find a complete absence of adequate randomized trials for social distancing and only a few for public masking, but similar levels of evidence that both interventions could work to reduce the spread of the SARS-CoV-2 virus. Given the similar levels of evidence, it is strange that social distancing was promoted in the absence of public face masking policies, particularly so with the detrimental emotional, social, and economic side effects that social distancing entails. In the future, possible interventions to combat pandemic illness should be evaluated against the entire body of evidence rather than upon the absence or presence of adequate randomized trials.