Aerosol transmission and mask guidance in Spain during COVID-19: An analysis of institutional health communication, 2020–2025

Abstract

Research background: Institutional health communication during public health emergencies shapes risk understanding, protective behaviour, and public trust. During the COVID-19 pandemic, mask recommendations had direct implications for protection against aerosol transmission, for which scientific evidence increasingly consolidated between 2020 and 2021. High-filtration respirators (FFP2/N95) provide substantially better protection than surgical or hygienic masks, yet official guidance in Spain consistently prioritised the latter.

Purpose: To examine how the Spanish Ministry of Health communicated about mask use between January 2020 and December 2025.

Methodology: A documentary content analysis was conducted on 2,060 press releases and 143 institutional campaign materials.

Findings: Low-filtration masks were referenced substantially more frequently than high-filtration respirators across both sources. Aerosol transmission was not mentioned in any campaign material. A marked dissociation emerged in 2021: the highest proportion of high-filtration references in press releases (58.3%) coincided with a vaccination campaign in which all protagonists wore surgical masks. Influenza campaign materials did not include any reference to high-filtration protection in any annual cycle.

Practical implications: These findings document a systematic pattern of limited visibility of high-filtration protection across the communication formats analysed, with important implications for pandemic preparedness and public health messaging.

Originality / value: This study offers a novel, longitudinal analysis of Spanish health communication that reveals a persistent omission of high-filtration respirators despite evolving evidence on aerosol transmission. It bridges institutional messaging and scientific consensus with direct implications for pandemic risk communication.