Firstpost Podcast: Should healthy people use masks as protection against coronavirus? Public health expert Aiswarya Rao explains

For the rest of the lockdown, get yourself busy either making a mask for yourself, your family or your local community of non-healthcare service providers.

Aiswarya Rao April 06, 2020 18:11:12 IST
Firstpost Podcast: Should healthy people use masks as protection against coronavirus? Public health expert Aiswarya Rao explains

Since the coronavirus pandemic was first reported in China in December 2019, health experts have debated on whether ordinary people should use masks for protection against the infection. The World Health Organisation has recommended that healthy people should use masks only if they are taking care of someone suspected of being a novel coronavirus patient.

Authorities in some countries had initially recommended that healthy people should not wear masks, pointing out that they create shortages for healthcare workers, who need them the most. However, many are now offering different advice. For example, the United States' Centers for Disease Control and Prevention (CDC) has modified its earlier recommendation, and now says that the general population should wear non-medical masks made of fabric.

In India, both ordinary people and healthcare professionals are presently scrambling to buy masks. In this context, it is important to understand whether masks are effective against COVID-19.

In this episode, Dr Aiswarya offers advice on whether people should wear masks to secure themselves against COVID-19. You can listen to the full episode here. Here is the full transcript of the interview:

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Sixty-five days in, there have been contrasting views from authorities on the need to wear a mask at all. In this episode, Dr Aiswarya explains where the debate came from, and what one really needs to do now.

Firstpost Podcast Should healthy people use masks as protection against coronavirus Public health expert Aiswarya Rao explains

Representational image. PTI

Today is the 65th day since the first case of Coronavirus was detected in India. Today is also the 12th day of lockdown to contain the march of the virus in our nation. Nearly 206 countries of the world have reported the infection, that’s almost all countries of the world, except perhaps North Korea. While we are grappling with effective and urgent ways to halt and reverse the epidemic, something as simple as the use of face masks has the world divided into two schools – until recently. I am Dr. Aiswarya Rao, a Paediatrician and Public Health Consultant, and today I am going to look at the various flip-flops that public health officials have made with regard to the use of masks by the general population.

On 29th February, the US Surgeon General, Dr Jerome Adams, issued an advisory asking people not to buy masks. He said that they are not effective in preventing general public from catching the coronavirus. This advice came because he explained that if people buy masks, then they won’t be available for healthcare providers who are caring for sick patients and it puts them and communities at risk.

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But 2 days back the CDC and the US Surgeon General have had to review their position on wearing the face mask. The CDC now recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission. He went on to explain that emerging data suggests facial coverings help you from spreading the virus if you're an asymptomatic carrier – a person who lack symptoms and don’t know whether you have it.

This recommendation underlines the concept that wearing a mask is harm reduction, and it is risk reduction. It helps slow the spread of the virus especially if there is community transmission.

Dr. Jerome Adams then made a DIY video tutorial on how to make a face mask with common household items such as an old used T Shirt, within 45 seconds.

On the other hand, World Health Organisation officials still stood by their advice on the general use of face masks by the general population. They do not recommend the use of face masks unless someone is sick with COVID 19 or caring for someone who was sick. Less than 5 days back, Dr. Mike Ryan, Executive director of WHO health emergencies program said at a media briefing that there is no potential benefit from the wearing of masks by the general population. However, yesterday he said WHO supports any decision a country comes to on its own, based on the context in which they're dealing and the resources that they have at their disposal. The WHO official advised that the use of masks, both homemade or cloth masks, at community level may help in an overall, comprehensive response to this disease,"

WHO made this guarded recommendation in the light of the significant global shortage of Personal Protection Equipment including masks, gloves, gowns and face shields. Therefore, prioritising the use of masks for those who need it the most, which would be frontline health care workers was essential.

Meanwhile in India, yesterday the Ministry of Health and Family Welfare, GoI, has issued a detailed advisory and manual on homemade protective cover for the face and mouth. This advisory seems to suggest that everyone should wear a face mask to protect the community at large without explicitly saying that. The manual has extremely detailed instructions with clear pictures of how to make re-usable pleated face masks at home. They have given 2 tutorials – one tutorial uses a sewing machine, and another without a sewing machine. This second tutorial is the same one that was demonstrated by the US Surgeon General. These guidelines were issued by the office of the principal scientific advisor, GOI. Throughout the manual they do not use the word face mask but call it a re-usable face cover. I think that is important and well thought out for our country context. The manual goes on give instructions on how to clean and sanitise the face covers every day and how to store the clean face covers. They recommend that everyone has two face covers so you can wear one, while the other is washed and dried. The ministry has given very practical tips and options on cleaning the face covers – one option is to wash the face cover with salt and warm water and dry it in hot sun for 5 hours. The next option is to put in in a pressure cooker and pressure boil it for 10 minutes. If you don’t have a pressure cooker, then boil it in hot water for 15 minutes. And the last option is to wash and clean with soap and water and apply heat for up to 5 minutes with an iron.

A meta-analysis of several studies published in the Medline and the Cochrane register which were conducted during the SARS outbreak in 2003, concluded that washing hands more than 10 times daily was 55 percent effective in stopping virus transmission. This is regarding health care workers with exposure to the virus. Interestingly they also found that wearing a mask was actually more effective — at about 68 percent. Wearing gloves offered about the same amount of protection as frequent handwashing, and combining all measures — hand-washing, masks, gloves and a protective gown — increased the effectiveness of the protection to 91 percent.

Such data is not available for the effectiveness of using the mask or the face cover- whatever you may choose to call it – in general population, especially if they show no signs or symptoms of the infection.

But all scientists agree on one thing and that is …Anything is better and it’s not about you…Its about harm reduction. If you get infected, you infect others. The face cover prevents droplets from flying out and contaminating the air and objects around you. And remember to always use a face and mouth cover in conjunction with all the other healthy habits that prevent COVID 19 – such a staying at home, always maintain physical distance from others both inside the house and outside, wash your hands, avoid touching your eyes, nose or mouth, and seek medical care early if you show symptoms.

The message is loud and clear. Don’t buy a mask if you can help it. Leave those for the health care workers and those with the infection, who need them more. Make your own mask. It may not be as effective as an N95 mask, but it is more effective than nothing. Never leave home without it. In the words of the Eric Garcetti, the mayor of Los Angeles, “covering your face is like casting a vote for the pandemic to end”.

So, for the rest of the lockdown, get yourself busy either making a mask for yourself, your family or your local community of non-healthcare service providers.

This is Dr. Aiswarya Rao signing off. And I will see you with my next podcast on the evolving coronavirus outbreak in India soon.

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