The story so far: From the start of the coronavirus disease (COVID-19), recommendations on use of masks have kept varying, country by country, depending on the virus’s trajectories. With SARS-CoV-2 growing exponentially in many parts of the world, countries such as India have begun to include newer recommendations on use of masks, including home-made face covers. The one point that remains unchanged is that medical masks should be reserved for health-care providers, persons with symptoms of COVID-19 or confirmed COVID-19, and their caregivers. Wearing a mask alone is never enough, but it is very important to wear one, all the same. Whether a mask gives complete protection from COVID-19 is still debatable. But top health authorities have always maintained that a mask alone does not suffice. Rather, it complements hand hygiene and physical distancing, both critical to prevent transmission of human-to-human COVID-19.
What is the stand of the World Health Organization (WHO)?
WHO, in its April 6-interim guidance on “Advice on the use of masks in the context of COVID-19” (https://bit.ly/2RunmQ5), notes that wide use of masks by healthy people in the community setting is not supported by current evidence and carries uncertainties and critical risks.
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It says: “In some countries, masks are worn in accordance with local customs or in accordance with advice by national authorities in the context of COVID-19. In these situations, best practices should be followed about how to wear, remove and dispose of them, and for hand hygiene after removal.”
WHO goes a step further and outlines factors for decision makers. They should consider the rationale and reason for mask use, vulnerability of person/population to develop severe disease, the setting in which the population lives in terms of population density, feasibility and type of mask.
Who should wear medical masks?
Almost all health authorities agree that medical masks — surgical masks and N95 respirators — should be reserved for health-care workers. WHO notes that the use of medical masks in the community may create a false sense of security, with a neglect of other essential measures (hand hygiene practices and physical distancing). The Union Ministry of Health and Family Welfare (MoHFW) has been maintaining that apart from health-care providers, persons with symptoms of cough, fever and difficulty in breathing and caregivers of persons with suspected symptoms of COVID-19 or confirmed COVID-19 should wear masks.
While patients should wear a medical mask as much as possible, changing it at least once a day, caregivers should wear the mask when in the same room as the affected person is.
Is it fine to wear homemade masks?
Do-it-yourself face covers is the latest buzz. Interestingly, the Office of the Principal Scientific Adviser to the Government of India has come out with a manual on homemade protective covers for face and mouth (https://bit.ly/3b4njlM). The do-it-yourself face cover is recommended for people living in densely populated areas across India.
The Atlanta-based Centers for Disease Control and Prevention has put out a recommendation too on the use of cloth face coverings (https://bit.ly/2Xw0eUX) especially in areas of significant community-based transmission. Citing recent studies that a significant portion of individuals with coronavirus lack symptoms and that even those who eventually develop symptoms can transmit the virus to others before showing symptoms, the CDC noted that this meant the virus can spread between people interacting in close proximity — speaking, coughing or sneezing. It has recommended cloth face coverings in public settings where other physical distancing measures are difficult to maintain.
The CDC, while emphasising the point that maintaining six-feet social distancing is critical to slow the spread of the virus, has additionally advised the use of simple cloth face coverings fashioned from household items or made at home from common materials at low cost.
Experts say staying at home is the best thing to do now. But if you have to step out, there is nothing wrong in wearing masks. The reason: one can never know if a person has symptoms. All that is needed in this situation is a cloth mask that could be made at home.
Specialists including V. Ramasubramanian, senior consultant, Infectious Diseases, Apollo Hospitals, are of the view that though there is no scientific rationale, it may probably help in both stopping transmission from infected people who are coughing as well as to protect ourselves to a certain extent. While these are not scientific recommendations, because of the evolution of the epidemic, we are looking at anything which may help and masks seem to be one of the visible factors which may help.
How should a mask be worn?
There are dos and don’ts for wearing masks too. Always wash your hands before wearing a mask. Do not touch the outer surface of the mask as much as possible. Once you wear a mask, do not adjust. If you do so, wash your hands.
If the mask is soiled or wet, or its integrity is broken, do not reuse it. Generally, you can wear a mask for up to three to four hours on an average.
The MoHFW has clear-cut dos and don’ts: Unfold the pleats of the masks and ensure that they are facing down. Place the mask over your nose, mouth and chin, and ensure there are no gaps on either side of the mask.
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Cloth covers should be washed after every use. Never reuse disposable masks, and used masks should be disposed of into closed bins after disinfecting them. Avoid touching the mask while using it. Remove it only with strings, always untie the string below and then the string above. After removing the mask, clean your hands with soap and water or use alcohol-based hand rub. Every member in a family should have a separate mask.