Mandatory mask
If everyone continues to wear a face mask as is required, we’ll be closer to bringing the number of new Covid-19 cases down to zero for good.
AS we all know, wearing face masks in public spaces is now mandatory in Malaysia.
This is a great policy that is going to keep us all much safer from the SARS-CoV-2 virus that causes Covid-19, not to mention all other airborne viruses that can make us sick.
Given the amount of misinformation and confusing statements from international health bodies, particularly regarding the use of face masks, we are quite lucky that efforts to curb the spread of Covid-19 in Malaysia is generally going well.
But the road to the end of this pandemic is far from over, so now is not the time to be complacent about wearing your face masks in public.
Evidence is piling up that face masks do help prevent the spread of Covid-19, especially when you are in close proximity to an infected person without symptoms, i.e. who is asymptomatic.
Thus, the more consistent we are in wearing face masks, the better.
By and large, countries that implemented a stricter maskwearing policy have fared better – a study that examined Covid-19 death rates across 198 countries, found that those with government policies that favoured mask-wearing had lower death rates.
Show me the proof
One convincing body of scientific evidence is from lab research on respiratory droplets and the ability of various types of face masks to block them out.
One study used speeded-up video to observe the droplets.
They found that hundreds of droplets between 20 to 500µm in size were produced just by uttering a simple phrase.
However, nearly all of the droplets were blocked when the mouth was covered by a damp washcloth.
Another experiment involved patients with influenza or the common cold.
They found that wearing a surgical face mask significantly reduced the amount of these respiratory viruses transmitted in droplets and aerosols.
But real-world scenarios are where we can witness the strongest evidence that face masks are really effective.
A recent study published in the journal Health Affairs, compared the growth rate of Covid-19 before and after face masks became required in 15 American states and the District of Columbia.
The required face mask use was found to be directly responsible for a slowdown in the daily Covid-19 growth rate, which became more significant over time.
In the first five days after a face mask mandate, the daily growth rate slowed by 0.9 percentage points.
At the three-week mark, the daily growth rate had slowed by up to two percentage points.
Face mask FAQs
Here are four frequently asked questions (FAQs) about face masks, and their answers: > Does the type of face mask I wear matter?
The short and concise answer to this question is yes.
By wearing the right type of face mask, you minimise your risk as much as possible (See Double the layers on p2).
But there are other considerations to take into account, such as supply of face masks, comfort, utility, etc.
Healthcare professionals are always required to don surgical face masks at work, while office workers have the additional option of buying reusable cloth masks with a pocket for replaceable filters.
Since the pandemic started, we’ve seen many other types of face mask designs as well.
However, not all are meant for daily use or are effective in keeping away viruses.
The Japanese Pitta mask, which is made from a spongy-looking polyurethane material, is smart and stylish, but has been found to be ineffective against tiny airborne particles.
There are also face masks with air valves attached, but these only protect the wearer from outside particles.
When the wearer exhales, they are still emitting unfiltered particles that escape into the air, putting those around them at risk of infection if they are infected with the SARS-CoV-2 virus.
As for N95 respirators, they are only necessary in medical situations such as intubation.
That being said, a general rule of thumb is that some coverage is still better than none at all.
Even if a face mask is not 100% effective, you are still preventing some risk by covering your nose and mouth.
> Is wearing a mask meant to protect myself or to protect others?
The best benefit of a face mask is to prevent people who have Covid-19 from passing it to other people.
If you are not infected, you still benefit from wearing a face mask as it is effective as “source control”.
The US Food and Drug Administration (FDA) defines source control as “preventing the transmission of infection through a person’s respiratory secretions, which are produced when speaking, coughing or sneezing”.
Face masks can prevent larger expelled droplets from evaporating into smaller droplets that can travel farther.
> What percentage of the population needs to wear face masks in order to significantly reduce transmission?
Ideally, it should be 100%, but that seems unlikely to be achievable due to various factors.
In one simulation, researchers predicted that 80% of the population wearing face masks would help to reduce the spread just as effectively as a strict lockdown.
In Malaysia, we have been able to avoid large numbers of casualties because most people voluntarily wore face masks in public, practised physical distancing (previously called social distancing) and other preventive measures.
> Do I still need to wear a face mask if I’m already practising physical distancing?
The three golden rules of this pandemic to help keep Covid-19 at bay are: wash your hands, watch your distance and wear a mask.
Compared to wearing a face mask, cleaning your mobile phone or washing your groceries for example, are just distractors.
There isn’t much evidence that contaminated surfaces, i.e. fomites, are a major source of SARS-CoV-2 viral transmission, but there is plenty of evidence for transmission through inhaled droplets.
Even if you are practising physical distancing, you should still wear a face mask when you go out, even if it is just for a short walk around the neighbourhood.
Best practices
Face masks are most likely to lessen the spread of Covid-19 when they are widely used by people in public settings.
Face masks should always be worn in public, especially around people who don’t live in your household, and when other physical-distancing measures are difficult to maintain.
Remember to always wash your hands with soap and water before touching a face mask.
Ensure that a face mask does not have any holes or tears before putting it on.
Always determine which side is the top and which is the front of the mask first, so that you wear it properly and do not need to adjust it after putting it on.
If the face mask has ear loops, hold the mask by the loops and put the loops around each ear.
If the face mask has ties, bring it to your nose and secure the ties around your head before adjusting the nose wire.
If the face mask has bands, hold the mask to your nose and pull the bottom strap over your head so that it rests at the nape of your neck and the top strap over the crown of your head.
Once in position, secure the mask over your mouth and chin.
When removing your face mask, do not touch the front of the mask. Remove it using the loops or ties.
If you do touch the front of the mask, wash or sanitise your hands immediately afterwards.
If you run out of face masks or forget to bring one along with you, a bandanna or towel can act as a temporary substitute.
The only people who should not wear a face mask are children under the age of two, anyone with trouble breathing or anyone with disabilities who may endanger themselves by wearing a face mask.
These people should instead avoid going out as much as possible in order to help minimise their risk of getting infected.
Face masks are a critical preventive measure and are absolutely necessary when physical distancing is difficult.
As we are not out of the woods yet when it comes to this pandemic, we should still be diligent about wearing our face masks.
If a face mask is unavailable or cannot be used, take other measures to reduce the risk of Covid19 infection, such as physical distancing, frequent handwashing and cleaning frequently-touched surfaces.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com. my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.