Back in February, the coronavirus was a Chinese problem and the World Health Organisation (WHO) strongly opposed the use of face masks by the general public. Dr Michael Ryan, WHO’s executive director for emergencies, said, “Masks don’t necessarily protect you.” A month later, the experts still advised against wearing masks. England’s chief medical officer, Professor Chris Whitty, said, “Wearing a mask if you don’t have an infection reduces the risk almost not at all. So we do not advise that.”
There’s been a major shift in thinking since then. This month, the WHO changed its advice. “Governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in either confined or crowded environments,” WHO director general Dr Tedros Adhanom Ghebreyesus said.
STRONG EVIDENCE
At the start of May, the Covid-19 death rate in the US was 50 times more than Japan’s although Japanese subways and businesses remained open. Was it because the Japanese were wearing masks? Several recent studies have shown that masks indeed stop the virus from spreading.
American computer scientist De Kai published a research paper that says if 80% of people wear masks, the number of infections would fall by almost 92%. But if only 30-40% of the people wear them, “you get almost no beneficial effect at all,” he told Vanity Fair.
Last week, the University of Cambridge shared its own research that shows if everyone wears a mask outside home, the dreaded ‘second wave’ of the pandemic can be avoided. This means, a second round of lockdowns won’t be necessary, and both lives and livelihoods will be saved. Even if only half the population uses masks, the rate of infection can be slowed down, per the Cambridge study.
KEEP IT ON
New advice on mask use extends to the bedroom. According to a CNN report, Harvard doctors recommend wearing masks while having sex. “To better prevent infection during sex between partners who haven’t been isolating together, people should wear masks and avoid kissing.” Even if you and your partner have been living together, “one partner might’ve been exposed to the virus if they’ve left the shared home.” Well, someone’s got to go out for groceries.
LONG HISTORY
It’s odd that scientists spent months debating the efficacy of masks when more than a century of experience shows they prevent infection. The Lancet says Polish bacteriologist Carl Flugge demonstrated in the 1890s that respiratory droplets contain bacteria. In 1897, his collaborator and surgeon Johann Mikulicz started using ‘a piece of gauze tied by two strings to the cap, and sweeping across the face so as to cover the nose and mouth and beard’ during operations. By 1935, almost all surgeons wore face masks.
But common folk had also learnt to use them during pandemics. “During the Great Manchurian Plague of 1910-1911 ... face masks had been deemed effective,” says another CNN report. San Francisco made them compulsory during the 1918-20 Spanish flu pandemic. Violators were fined $5-100 and could face 10 days’ imprisonment. The Red Cross advertised: “Wear a mask and Save Your Life! A Mask is 99% Proof Against Influenza.” Authorities in France and Britain recommended face masks and the US led the world in their use.
The habit has survived in the East because of recurring outbreaks of “cholera, typhoid and other transmittable diseases, right up to SARS in 2003 and avian flu more recently.”
MASK OR SHIELD?
While masks are a time-tested barrier, they have some disadvantages. Wearing one for hours can be uncomfortable, especially if it is a close-fitting N95 mask. They can also cause miscommunication by hiding facial expressions. The part of your face below the bridge of the nose is crucial for visual cues, says an article in The Atlantic. “Whether you’re being genuine or sarcastic, for instance, stems from the shape of your mouth when you say it.” The hearingimpaired especially need to see the face of the person they are talking to.
Face shields, which have become popular in this pandemic, solve all three problems, and research at the University of Iowa shows they “reduce exposure to more than 90% of flu droplets from a cough.”
Shields have some other advantages as well. They stop respiratory droplets from reaching your eyes, and ensure you cannot touch your face with your hands. If you are a bank clerk or a salesperson, a shield is much more comfortable for daylong use. You can easily disinfect and reuse it, too.
However, some experts say shields are good for uninfected people, but if you are infected, a close-fitting mask is better at preventing your respiratory droplets from flying out.
IMAGE PROBLEM
While masks are clearly important for avoiding infection, getting people to use them is proving difficult. Recent reports in The Guardian and Washington Post mention businesses turning away customers who wear masks. There are instances of people deliberately coughing at mask users. And men seem more defiant than women. “A new survey of 2,459 people living in the US has found that men are less likely to don face masks because they believe wearing one is ‘shameful,’ ‘a sign of weakness,’ and ‘not cool’,” The Guardian reported last month. The same attitude prevailed at the time of the Spanish flu, CNN says: “At a boxing match in California, a photograph taken with a flashlight showed that 50% of the men in the audience weren’t wearing masks. Police enlarged the picture and used it to identify the mask-less.”
‘Masks better than distancing’
New York City made masks compulsory on April 17. Immediately, “the daily new infection rate fell by about 3% per day,” reports Reuters, citing a study published in The Proceedings of the National Academy of Sciences of the USA. Masks alone prevented 66,000 new infections in the next three weeks to May 9. In Northern Italy, compulsory mask-wearing prevented 78,000 infections between April 6 and May 9.
Since these areas already had physical-distancing, some scientists say wearing a mask is the most effective way to stop the virus, as it blocks the “atomisation and inhalation of virus-bearing aerosols (that) represents the dominant route for infection.”
They may be our best defence, but the World Health Organisation still insists masks are not sufficient by themselves. The Guardian quotes Dr Maria Van Kerkhove, WHO’s technical lead for Covid-19 response: “Masks must be part of a comprehensive strategy. They do not work alone. They must be used with a number of measures.” Otherwise, people wearing masks will be walking around with “a false sense of protection.”
