To mask or not to mask, that is the question

Face masks have emerged as a matter of controversy

In the US, there is a raging debate about whether masks are helpful in preventing transmission of Covid-19 or if its just a useless exercise, unlikely to help with prevention. For the longest time, the centers for disease control (CDC) contended that face mask should only be used by those known to have symptoms of respiratory sickness - coughing, sneezing etc, out of a sense of public service. Only recently and under tremendous political pressure, did the CDC put out a recommendation for wearing face masks by everyone in public places.

On the face of it, the argument to selectively use makes a lot of sense - after all, viruses are so small that no coarse material like cotton or paper fabric would be able to prevent virus penetration.  But that misses the point of prevention, which is all about relative risk reduction not absolute risk reduction.  In relative risk reduction, a group of measures, when used together, reduce the risk to a manageable level.  

We have already been practicing relative risk reduction measures such as,

• avoidance of crowded places - i.e. social distancing, 

• avoidance of social contact - i.e. no hugging and kissing even within our social circle, 

• improved personal hygiene - i.e. regular washing of hands, and disinfecting of common areas, and

• reduced exposure to socially exchanged materials such as currency

In this context, where social distancing is unavoidable, such as in subways, buses and transit areas, use of even cotton masks can help reduce the relative risk, by absorbing any droplets that might have been released in the air by an infected person. As long as the exposure is transitory, coarse material masks can be very helpful.  

But if you are using a mask, I have two recommendations for you: 

• if it’s a home made cotton mask, please throw the mask into washing after every use. Or if you have a disposable one, throw it away after one use or at least put it away for a few days to a week, so that any virus that might have made it to your mask, may be destroyed. One only increases the chance of infection by using hands to remove and put back on a mask that might have absorbed droplets contaminated with the virus.  

• wash your hands after removing the mask.  If the mask was contaminated, it will likely contaminate your hand as you try to remove it.  Washing hands reduces this risk of contamination

But, is this an adequate protection for a healthcare worker? Probably not, for a healthcare worker working in a crowded environment needs absolute risk reduction, which can only happen when one uses a mask capable of holding back viruses, such as the N95 mask.  But if there are no more N95 masks, any mask will help reduce the relative risk, but the absolute risk is still high. So, data or no data, using masks is a commonsense measure that one should consider if one were to find themselves temporarily unable to avoid crowded places.  

There are a few other measures to consider to reduce our exposure to the risk of infection by corona virus. If you found yourself in a crowded situation, washing hands upon returning home or work, is always a good idea.  But perhaps a better idea is changing clothes, or even taking a bath. Another is to wash with soap, those things that might have been come in contact with other individuals, including fruits and vegetables. Those things that cannot be washed, such as paper products, put them away for 4-5 days - anecdotal information seems to suggest that the virus could survive on common materials for up to 72 hrs.

Let us do our part by using face masks in the public.