Non- medical masks as precautionary measure

As the lockdown restrictions are easing in some parts of the world, and our monitor of cases gets more and more relaxed, we may get a false sense of relief. However, this couldn't be farther from the truth as cases are on a rise in India and in many parts of the world, while experts are predicting a second wave which could prove to be more chaotic and fatal than the first.

In such times, it is important that we take precautions to prevent the spread of the disease as much as possible, and on of the most important pre- caution we have been asked to take is the use of face masks. Initially, this led to a panic buying of masks and a dangerous shortage of masks for healthcare workers, but as we ease into this new way of life, people have started opting for alternatives like handmade cloth masks.

In this article, we will try and understand the importance of masks, suggestions by leading experts, as well as, how to accommodate the increasing demand of masks.

According to WHO, wearing medical masks can 'prevent the spread of infectious droplets from an infected person to someone else and potential contamination of the environment by these droplets.'

However, there is little evidence that wearing a medical mask among healthy individuals or those who came in contact with infected persons is a useful preventive measure.

Also, they believe that wearing masks may 'create a false sense of security' and cause them to neglect other essential measures like hand hygiene practices and social distancing. It may also cause them to touch their faces more, under their masks and eyes which may further spread the infection instead of preventing it.

Their general advice is that medical masks and respirators should be reserved for Healthcare workers (top priority), Infected persons, People with comorbidities (Cardiovascular diseases, Diabetes mellitus, and older people)

In my opinion, essential service providers, other than healthcare workers, such as delivery man, should also be prioritized, provided the production of medical masks is sufficient to accommodate them.

While WHO suggests that encouraging healthy people to wear masks (medical or non- medical) potentially reduces exposure risk from an infected person during the "pre- symptomatic" period, there are certain risks that must be considered such as 'self- contamination by touching and reusing contaminated masks', potential breathing difficulties', 'false sense of security', 'diversion of mask supplies and consequent shortage of mask for health care workers', and 'diversion of resources from effective public health measures, such as hand hygiene'.

Now, what are some possible methods to avoid the above risks?

We can educate people through mass media on the proper management of masks (below) and provide easy make- at- home techniques to create non- medical masks at home so that people are not tempted to re-use contaminated masks'

Masks should only be worn by people who have to leave their homes (in the case of people who stay at home), therefore, if they have breathing difficulties, they should not be leaving their homes (asking another family member to carry out the errand) or they can use a thinner material and maintain 1m distance from other people while outside as preventive measures.

Also, in the FAQ section, it seems that most people have breathing difficulties while exercising and wearing a mask. Doctors have advised that they may exercise outside without a mask safely, as long as they care to maintain distance and not touch any contaminated surfaces (use gloves/ minimize contact as much as possible)

An important guideline by CDC (Centres for Disease Control and Prevention): 'Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.'

This can only be prevented through proper education of the public again through mass media and constant reminders.

Non- medical alternatives should be widely available for the masses and they should be discouraged to but medical masks unless they have comorbidities or are infected. The most important thing is strong communication with the public on what the guidelines are and why is it important to adhere to them.

As of now, WHO is collaborating with other research partners on assessing the effectiveness of non- medical masks. As of now, they do not discourage countries from advising their general public from using non- medical masks as a preventive measure.

In countries where citizens have been encouraged to wear masks on a day- to- day basis when they are in public places, a positive outcome has been observed. In East and South- East Asia, for instance, people are strongly encouraged to wear masks while ill as they have been quick to learn from the SARS virus outbreak which affected several regions there.

A Cochrane Review found strong evidence that wearing masks in public consistently was associated with a 70% reduction in the risk of catching SARS. While we do not have any conclusive studies about this with regards to the Coronavirus, there are other reasons why wearing a mask, be it non-medical, can be effective at such a time.

Wearing a mask could act as a behavioural nudge and a visual reminder of the dangers of the virus. Inculcating this habit could also lead to following other hygienic and social distancing practices consistently. Asymptomatic cases and mild account for nearly 80% of positive cases and wearing masks in public can lower the risk of transmission from asymptomatic, undetected 'silent killer' of the disease.

The general consensus is there is not much evidence to say that homemade face masks can prevent incoming germs for sure, however, they do help reduce the spread of infection to a certain extent if an infected person wears them, especially during the 'pre- symptomatic' period. However, most experts advice wearing a non- medical mask is better than having nothing covering your face.