Why Is Wearing Face Masks Such A Vexed Question?

Raman Swamy

Just because a question sounds simple and straightforward, it doesn’t necessarily mean it has an uncomplicated answer.   In the coronavirus context, even the world's most knowledgeable infectious disease specialists have still not been able to conclusively say whether or not everybody ought to wear a face mask.

Till now the answer to that vexed question from governments and medical authorities has been a mix of 'yes',  'no',  'maybe' and 'not really'.  Now suddenly,  there's a prospect of a more categorical advisory -  the US government is all set to issue "new guidelines" on wearing of face masks. Till now the norm has been to keep it optional, but with an undertone of dissuading the general public from donning masks.  Like many other authorities, India’s Health Ministry too had issued an advisory more than two weeks ago - based on guidelines laid down by the World Health Organisation (WHO) - stating that there is no need for common citizens to wear face masks -  except in three circumstances:

1). If you have symptoms like fever, cough and difficulty in breathing;   2). If you are taking care of a COVID-19 infected person; or 3). If you are a health worker attending patients with respiratory problems.

As recently as March 31, WHO reiterated its guidelines with greater emphasis on the 'no' – telling people not to wear face masks unless a) they are sick with Covid-19 or b)  they are caring for someone who is sick. The executive director of the WHO’s Health Emergencies Program, Dr. Mike Ryan,  told a media briefing in Geneva (Switzerland) that:  "There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there's some evidence to suggest the opposite if masks are not properly worn or are not fitting properly".

He went on to explain the reason why use of masks is being advised against -  "If every citizen buys masks, it will cause a massive global shortage of masks.  We should remember that right now the people who need masks the most are those most at risk from infection --  the health workers who are exposed to the virus every second of every day. The thought of them not having masks is horrific."

That is the problem.   Those who need face masks the most are doctors, nurses, medical attendants and all the individuals engaged in treating or taking care of Covid-19 patients.   The top priority is to ensure that people on the frontline of combating the dreaded disease get adequate supply of masks.  The rest of the population should maintain ‘social distance’ from their fellow citizens and therefore they can do without covering their mouths and nostrils – unless they themselves are carriers or caregivers. 

In spite of this general rule of thumb which is being followed in most parts of the world,  the truth of the matter is that even the most experienced medical experts and pandemic scientists have been very frank in saying that they do not really understand much about how coronavirus spreads or what is the best way to avoid catching the contagion.  

Apart from the oft repeated advice -  “stay at home, wash your hands and keep social distance” -  nobody knows for certain the hows, whys and whats of the strange new plague that has brought the world to a standstill. 

That is why the American government has decided to issue a “new set of guidelines” on wearing of face masks.   An announcement is expected within a few days -  medical fraternities and governments across the globe are avidly waiting for the nature of the US view. 

On Thursday, President Trump’s team of public health advisers confirmed that they are debating the new guidance that would probably tell Americans that they can wear cloth masks to guard against virus transmission.  The indication is that the recommendation would not be mandatory.  It would be a matter of personal preference. 

However, there is another side to the issue that is nagging the experts.  The chief policy coordinator of the White House coronavirus task force put it like this -  “Our worry is that face coverings can give some individuals a false sense of protection.  That could be dangerous.  There is no scientific evidence that ordinary masks alone effectively prevent transmission”. In other words, citizens will be encouraged to use masks or face coverings whenever they step out onto the streets or shopping centres – but it should not lull people into a "false sense of security."  

The chief coordinator added:  “We don’t want people to get an artificial sense of protection because they’re behind a mask. Because if they’re touching things — remember your eyes are not in the mask — so if you’re touching things and then touching your eyes you're exposing yourself in the same way."

The very fact that a new advisory is going to be issued by the US government is arousing interest and curiosity.  This is because just a few weeks ago the US Surgeon General had categorically told ordinary citizens to stop buying masks.  The masks are in short supply and are urgently needed for health care workers, he had said. Moreover,  such masks are “NOT effective in preventing general public from catching Coronavirus", he had added emphatically. 

Evidently, something has changed.  Without some good reason the experts would not be now coming out with fresh guidances - presumably encouraging citizens to wear masks or face coverings when outside their  homes and in public places.

The specific language of the guidance has not been finalized.  But it is likely to apply to those living in parts of America that have been subject to a surge in the number of infected persons and fatalities, especially  California and New York.  The rest of the world will be waiting and watching.  So too will India’s Health Ministry.

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Apr 5, 2020

Raman Swamy

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