Leserbrief zum Beitrag: Kappstein I. Mund-Nasen-Schutz in der Öffentlichkeit: Keine Hinweise für eine Wirksamkeit Krankenhaushygiene up2date 2020; 15: 279–297

Sehr geehrte Frau Kappstein,

mit Interesse habe ich Ihre Übersichtsarbeit „Mund-Nasen-Schutz in der Öffentlichkeit: Keine Hinweise für eine Wirksamkeit“ im aktuellen Heft 3 von „Krankenhaushygiene up2date“ vom September 2020 [1] gelesen. Ich kenne Ihre begründeten Auseinandersetzungen mit Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) am Robert Koch-Institut [2], schätze Ihren Sachverstand [3] und Ihr kritisches Hinterfragen von Empfehlungen. Auch unter Berücksichtigung des mangelnden expliziten Wissens zu SARS-CoV-2 im Frühjahr dieses Jahres und des schnellen Zuwachses im Laufe des vergangenen halben Jahres bin ich über einige Ihrer Statements irritiert und mit Ihren Schlussfolgerungen nicht einverstanden und will begründen, warum.

Publication History

Article published online:
27 October 2020

• Literatur

• 1 Kappstein I. Mund-Nasen-Schutz in der Öffentlichkeit: Keine Hinweise für eine Wirksamkeit. Krankenhaushygiene up2date 2020; 15: 279-297
• 2 Kappstein I. Empfehlungen der „Richtlinie“ – Was mache ich anders?. Krankenhaushygiene up2date 2009; 4: 9-294
• 3 Kappstein I. Nosokomiale Infektionen. Prävention – Labordiagnostik – antimikrobielle Therapie. Stuttgart: Georg Thieme Verlag; 2009
• 4 Leung NHL, Chu DKW, Shiu EYC. et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nature Med 2020; 26: 676-680
• 5 World Health Organization. Non-pharmaceutical public health measures for mitigating the risk and impact of epidemic and pandemic influenza. 2019 Verfügbar unter (Zugriff 05.10.20): https://apps.who.int/iris/bitstream/handle/10665/329438/9789241516839-eng.pdf?ua=1
• 6 World Health Organization‎. Advice on the use of masks in the context of COVID-19. Interim guidance. 2020 Verfügbar unter (Zugriff 05.10.20): https://apps.who.int/iris/bitstream/handle/10665/331693/WHO-2019-nCov-IPC_Masks-2020.3-eng.pdf?sequence=1&isAllowed=y
• 7 World Health Organization. Advice on the use of masks in the context of COVID-19. Interim guidance. 05.06.2020 Verfügbar unter (Zugriff 05.10.20): https://apps.who.int/iris/bitstream/handle/10665/331693/WHO-2019-nCov-IPC_Masks-2020.3-eng.pdf?sequence=1&isAllowed=y
• 8 European Centre for Disease Prevention and Control (ECDC). Using face masks in the community. Reducing COVID-19 transmission from potentially asymptomatic or pre-symptomatic people through the use of face masks. 08.04.2020 Verfügbar unter (Zugriff 05.10.20): https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-use-face-masks-community.pdf
• 9 Centers for Disease Control and Prevention (CDC). Use of Masks to Help Slow the Spread of COVID-19. 28.06.2020 https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
• 10 Robert Koch-Institut – RKI. Mund-Nasen-Bedeckung im öffentlichen Raum als weitere Komponente zur Reduktion der Übertragungen von COVID-19. Epid Bull 2020; 19: 3-5
• 11 Guyatt GH, Oxman AD, Vist GE. et al. Rating quality of evidence and strength of recommendations. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924
• 12 World Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions. Scientific Brief. 2020 Verfügbar unter (Zugriff am 05.10.20): https://www.who.int/news-room/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions
• 13 Bundesinstitut für Arzneimittel und Medizinprodukte. Hinweise des BfArM zur Verwendung von selbst hergestellten Masken (sog. „Community-Masken“), medizinischem Mund-Nasen-Schutz (MNS) sowie filtrierenden Halbmasken (FFP2 und FFP3) im Zusammenhang mit dem Coronavirus (SARS-CoV-2/Covid-19). Verfügbar unter (Zugriff am 05.10.20): https://www.bfarm.de/SharedDocs/Risikoinformationen/Medizinprodukte/DE/schutzmasken.html
• 14 Goldmann E. Exaggerated risk of transmission of COVID-19 by fomites. Lancet 2020; DOI: 10.1016/S1473-3099(20)30561-2.
• 15 Ferguson NM, Laydon D, Nedjati-Gilani G. et al. Impact of nonpharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. 2020; DOI: 10.25561/77482.
• 16 Greenhalgh T, Schmid MB, Czypionka T. et al. Face masks for the public during the covid-19 crisis. BMJ 2020; 369: 1435 DOI: 10.1136/bmj.m1435.
• 17 Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission – The Time Is Now. JAMA 2020; DOI: 10.1001/jama.2020.13107.
• 18 Thagard P. How Scientist Explain Disease. Princeton, New Jersey: Princeton University Press; 1999
• 19 Silverman WA. Where is the evidence? Debates in modern medicine. New York: Oxford University Press; 1998
• 20 Derry GN. What science is and how it works. Princeton, New Jersey: Princeton University Press; 1999
• 21 Eikenberry SE, Mancuso M, Iboi E. et al. To mask or not to mask: Modelling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infectious Disease Modelling 2020; 5: 293-308
• 22 Chu DK, Akl EA, Duda S. et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; DOI: 10.1016/S0140-6736(20)31142-9.
• 23 Prem K, Liu Y, Russell TW. et al. The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study. Lancet Public Health 2020; DOI: 10.1016/S2468-2667(20)30073-6.
• 24 Islam N, Sharp SJ, Chowell G. et al. Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries. BMJ 2020; 370: m2743 DOI: 10.1136/bmj.m2743.
• 25 Jones NR, Qureshi ZU, Temple RJ. et al. Two metres or one: what is the evidence for physical distancing in covid-19?. BMJ 2020; 370: m3223 DOI: 10.1136/bmj.m3223.
• 26 Lyu W, Wehby GL. Community use of face masks and COVID-19: Evidence from a natural experiment of state mandates in the US. Health Affairs 2020; 39: 1419-1425 DOI: 10.1377/hlthaff.2020.00818.
• 27 Kähler CJ, Hain R. Fundamental protective mechanisms of face masks against droplet infections. J Aerosol Sci 2020; 105617 DOI: 10.1016/j.jaerosci.2020.105617.
• 28 Leung NHL, Chu DKW, Shiu EYC. et al. Respiratory virus shedding in exhaled breath and efficacy of facemasks. Nat Med 2020; 26: 676-680
• 29 Bahl P, Bhattacharjee S, de Silva C. et al. Face coverings and mask to minimise droplet dispersion and aerosolisation: a video case study. Thorax 2020; 75: 1024-1025 DOI: 10.1136/thoraxjnl-2020-215748.
• 30 Konda A, Prakash A, Moss GA. et al. Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano 2020; 14 DOI: 10.1021/acsnano.0c03252.
• 31 Morbidity and Mortality Weekly Report. Absence of apparent transmission of SARS-CoV-2 from two stylists after exposure at a hair salon with a universal face covering policy – Springfield, Missouri. 2020 https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6928e2-H.pdf (Zugriff 05.10.20)
• 32 Howick J. The Philosophy of Evidence-Based Medicine. Wiley-Blackwell: BMJ Books; 2011
• 33 Tao X, Garron T, Agrawal AS. et al. Characterization and Demonstration of the value of a lethal mouse model of Middle East Respiratory Syndrome coronavirus infection and disease. J Virol 2016; 90: 57-67
• 34 Memoli MJ, Czajkowski L, Reed S. et al. Validation of the wild-type influenza A human challenge model H1N1pdMIST: an A(H1N1)pdm09 dose-finding investigational new drug study. Clin Infect Dis 2015; 60: 693-702
• 35 Buitrago-Garcia D, Egli-Gany D, Counotte MJ. et al. The role of asymptomatic SARS-CoV-2 infections: rapid living systematic review and meta-analysis. medRxiv 2020; DOI: 10.1101/2020.04.25.20079103.
• 36 Buitrago-Garcia D, Egli-Gany D, Counotte MJ. et al. Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: A living systematic review and meta-analysis. PLoS Med 2020; DOI: 10.1371/journal.pmed.1003346.
• 37 Oran DP, Topol EJ. Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review. Ann Intern Med 2020; DOI: 10.7326/M20-3012.
• 38 Gandhi M, Beyrer C, Goosby E. Masks do more than protect others during COVID-19: reducing the inoculum of SARS-CoV-2 to protect the wearer. J Gen Intern Med 2020; DOI: 10.1007/s11606-020-06067-8.
• 39 Gandhi M, Rutherford GW. Facial Masking for Covid-19 – Potential for “Variolation” as We Await a Vaccine. N Engl J Med 2020; DOI: 10.1056/NEJMp2026913.
• 40 Zhanga R, Lib Y, Zhang AL. et al. Identifying airborne transmission as the dominant route for the spread of COVID-19. PNAS 2020; 117: 14857-14863
• 41 Lednicky JA, Lauzardo M, Fan ZH. et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. medRxi 2020; DOI: 10.1101/2020.08.03.20167395.
• 42 Rose G. Strategy of prevention: lessons from cardiovascular disease. BMJ 1981; 282: 1847-1851
• 43 Rose G. Sick individuals and sick populations. Int J Epidemiol 1985; 14: 32-38
• 44 Eckel RH, Jakicic JM, Ard JD. et al. ACC/AHA Guideline on Lifestyle Management to Reduce Cardiovascular Risk. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129: S49-S73
• 45 Cholesterol Treatment Trialists (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials. Lancet 2010; 376: 1670-1681
• 46 Hartzband P, Gropman J. Where am I in the numbers?. Hartzband P, Gropman J. Your Medical Mind. How to Decide What Is Right for You. London: Penguin Books; 2011: 9-29
• 47 Lenzer J. Majority of panellist on controversial new cholesterol guideline have current or recent ties to drug manufactures. BMJ 2013; 347: f6989
• 48 Jureidini J, McHenry LB. The Illusion of Evidence-Based Medicine. Exposing the crisis of credibility in clinical research. Adelaide, South Australia: Wakefield Press; 2020
• 49 Mega ER. COVID has killed more than one million people. How many more will die?. Nature 2020; DOI: 10.1038/d41586-020-02762-y.
• 50 Institute of Health Metrics and Evaluation (IHME). COVID-10 Projections. Verfügbar unter (Zugriff 06.10.20): https://covid19.healthdata.org/global?view=daily-deaths&tab=trend
• 51 Greenhalgh T, Howick J, Maskrey N. et al. Evidence based medicine: a movement in crisis?. BMJ 2014; 348: g3725
• 52 Allison TA, Oh A, Harrison KL. Extreme Vulnerability of Home CareWorkers During the COVID-19 Pandemic – A Call to Action. JAMA Intern Med 2020; DOI: 10.1001/jamainternmed.2020.3937.
• 53 Janssens U, Schlitt A, Hein A. et al. SARS-CoV-2 Infektion bei Mitarbeiterinnen und Mitarbeitern im Gesundheitswesen – Bedeutung der RT-PCR Testung. AWMF online 2020; DOI: 10.1111/pai.13265.
• 54 Read R. A choir decided to go ahead with rehearsal. Now dozens of members have COVID-19 and two are dead. Los Angeles Times. 29.03.2020 Verfügbar unter (Zugriff 06.10.20): https://www.msn.com/en-us/news/us/a-choir-decided-to-go-ahead-with-rehearsal-now-dozens-of-members-have-covid-19-and-two-are-dead/ar-BB11T9wB
• 55 European Commission. The precautionary principle: decision-making under uncertainty. 2017 Verfügbar unter (Zugriff 06.10.20): https://ec.europa.eu/environment/integration/research/newsalert/pdf/precautionary_principle_decision_making_under_uncertainty_FB18_en.pdf
• 56 Reis J, Spencer PS. Decision making under uncertainty in environmental health policy: new approches. Environ Health Prev Med 2019; 24: 57
• 57 Gostin LO, Cohen IG, Koplan JP. Universal masking in the United States – The role of mandates, health education, and the CDC. JAMA 2020; DOI: 10.1001/jama.2020.15271.