Bengaluru: Are masks crucial in the global public fight against the coronavirus pandemic? This question is now being considered across the world, with increasing emphasis on utilising the protection masks may offer.
In an interview with the journal Science, Chinese Center for Disease Control and Prevention (CDC) director-general George Gao said last week, “The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks.”
On Sunday, Washington Post published a perspective by AI researcher Jeremy Howard saying that DIY masks could help flatten the curve, as shown in the Czech Republic, and that regular citizens should be wearing one everyday for respiratory hygiene.
The reason behind the discussion gaining more ground is that the data is evolving in real-time.
The Czech result
The Czech Republic government has reported a drastic reduction in growth of new numbers and a noticeable flattening of the curve over the past few days. Many, including residents, attribute this improvement to mandatory mask usage.
Abhijeet Borkar, astrophysicist at the Astronomical Institute of the Czech Academy of Sciences in Prague told ThePrint over email, “On March 18, the Govt made it mandatory to use masks or other forms of face covering. People have made their own homemade masks that are multi-coloured with intricate designs or punk or cute themed.”
People take it seriously, he added. “In last 15 days, there hasn’t been a single person I saw outside who wasn’t wearing a mask.”
Additionally, a study published in the medical journal Lancet this month declared, “As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks.”
What do masks do?
Studies have shown that using a DIY (do it yourself) mask made of cotton tee shirts would be “better than no protection” against influenza viruses. While wearing a mask doesn’t offer a foolproof protection, it could likely prevent many cases of infection if used properly.
They are also essential for healthcare workers, who come in contact with so many symptomatic and asymptomatic people. But medical masks are at a shortage everywhere — a predictable outcome which caused the authorities to request citizens to stop buying masks in the first place.
Masks could still help people not showing symptoms from spreading the disease. The primary reason for authorities, the World Health Organization, scientists, epidemiologists, and doctors to urge people not to buy and use masks is because their shortage at healthcare facilities is highly risky to public health — sick healthcare workers would leave no one to take care of anyone.
Unless used in a specified manner, masks don’t add much for healthy people who might not come in contact with the infected. Where they play a role is in the containment of infection when it comes to a person who’s actually infected.
Wearing a mask in a proper manner can help keep cough droplets in when coughing, sneezing, or even speaking. Since Covid-19 spreads almost exclusively in this manner, masks are most essential for the infected.
In the Science interview, Gao stressed, “This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”
As a preventive measure, a mask cannot be standalone. An Oxford study found that “masks are only one component of a complex intervention which must also include eye protection, gowns, behavioural measures to support proper doffing and donning, and general infection control measures”.
The Czech Republic situation echoes the same. The country got its first three confirmed cases on 1 March. On 12 March, the government declared an emergency for the first time in several centuries, closed its borders and announced a countrywide curfew. On 18 March, it made masks compulsory. The measures were first supposed to be in place until 24 March but were then extended to 1 April and subsequently to 12 April.
“Three things helped keep numbers low and reduce spread: 1. Closing borders quickly and early. 2. Immediate decision within two days from closing just a few shops to closing everything down, and forbidding public gathering of more than 5 people. 3. Wearing masks,” said Borkar.
“The government then made it tighter — a phase India already is in — and necessarily so: “Outside of necessary work and family, no more than two people are allowed to meet together,” added Borkar.
Another way the masks help flatten the curve is by preventing the spread of regular flu or cold to ease the burden on the hospital system. The seasonal flu outbreak this time has also been curtailed, said Borkar.
DIY and cloth masks
Amid a shortage of surgical masks, DIY cloth masks made of cotton tee shirts are growing in popularity. But these can be effective only as a short-term solution, especially for the healthy who don’t come in contact with the infected. They are not the safest if an infected patient is in close contact, or if the infected patient is wearing one.
Randomised trials of cloth masks compared with surgical masks show that cloth masks allow 97 per cent penetration by particles while medical masks allow a still high 44 per cent. The study also found that moisture and reuse increase the chances of infection.
Further, moisture also increases the chances of contamination.
In the Post opinion, Howard wrote, “It’s true that masks can become contaminated. But better a mask gets contaminated than the person who is wearing it. It is not hard to wash or dispose of a mask at the end of the day and then wash hands thoroughly to prevent a contaminated mask from spreading infection.”
But Covid-19 is a respiratory disease. If a mask worn over the nose or mouth is contaminated, the person will most definitely get contaminated too. Additionally, touching the face while pulling the mask up and down through the day can also increase the risk of infection.
Despite scientific evidence being sparse and inconsistent across studies, including suggestions that N95 is not effective in curtailing influenza-related viruses, the numbers seem significant enough to matter in a small country like Czech Republic.
Many experts have made valid arguments for masks, but their availability, method, and priority of usage remains critical when attempting to control epidemics.
‘If we wear masks, infections less likely’
While masks might not have been necessary during the early days of the outbreak, as the disease spreads rapidly through society, it becomes important to take even the most minimal of protection.
If the Czech model is anything to go by, going to places with risk of exposure to others, while wearing even a basic kerchief around the nose and mouth, could offer some aid.
“If we all wear masks, people unknowingly infected with the coronavirus would be less likely to spread it,” said Howard, and this is objectively true. Even minimal protection could make a significant change in numbers compared to no protection against the spread of the novel coronavirus.
Not everyone needs to purchase a mask right away even if they start using masks right away. Any mask, including the DIY rubber band-paper towels and cotton ones, are fine for a few hours as long as they’re used and sterilised properly.
“I have been using a running mask for winter when I’m outside, because I gave away my N95 to my friend’s wife who’s a nurse,” said Borkar.
The office of Principal Scientific Adviser to the Government has issued a manual on homemade masks to curb the spread of the virus. The announcement said that the masks are 70 per cent effective and are to be used in combination with other measures.
These homemade masks are made of old cotton cloth sewed in place and are reusable, with detailed instructions on how to clean them everyday.
However, surgical masks should still be made available to healthcare workers and the sick above everyone else. For others, cloth or other DIY masks can offer some form of basic protection, but could come in handy especially for those who are infected but asymptomatic.