After PM Narendra Modi announced a national lockdown and I moved from New Delhi to my village in Haryana, I noticed one stark difference: there was hardly anyone who was without a mask here - from ragpickers to those driving SUVs - everyone is wearing one, even if it means wrapping a bandana around their faces.
In New Delhi, that wasn’t the case. And Covid-19 had already been spreading in the national capital while there were no cases in my hometown district.
It seemed that people in the countryside hadn’t been exposed to expert advice that ‘masks don’t work’, like the folks in big cities had been.
The World Health Organisation (WHO), which has come under severe criticism for being soft on China’s transgressions with respect to handling Covid-19, has maintained from the beginning that masks are not effective in preventing Coronavirus spread.
“If you do not have any respiratory symptoms, such as fever, cough, or runny nose, you do not need to wear a medical mask. When used alone, masks can give you a false feeling of protection and can even be a source of infection when not used correctly,” the WHO tweeted just five days back.
Many government organisations across the world, including the United States Surgeon General’s office and prestigious Centre for Disease Control, have reiterated this, exhorting the masses not to hoard masks, for they are ‘useless’ and only those health workers who are taking care of Covid-19 patients should be wearing them.
On 17 March, India’s Ministry of Health and Family Welfare issued an advisory saying that everyone needn’t wear a mask. “Only wear a mask if you have symptoms like fever, cough and difficulty in breathing; You are caring for a COVID-19 infected or suspected person; You are a health worker attending to patients with respiratory problems,” the ministry said.
I asked a roadside vendor in my hometown why he was wearing a mask when “experts” said they were ineffective in preventing the spread of Covid-19. “Fayde ka pata nahi but ghata kya hai?,” he shot back. (I don’t know about the benefits but what’s the harm in wearing it?)
An illiterate has a far better understanding of risk than the experts at the WHO or the bureaucrats at the Ministry of Health. The former has common sense to evaluate that, in a global pandemic, wearing a mask is better than not wearing it.
Many are now openly challenging the WHO’s assertion that there are no upsides to wearing a mask.
There are various scientific studies which prove the importance of masks. While I will mention those here, even without those references, isn’t it established that a person infected with the novel Coronavirus can be asymptomatic for days and continue to spread the virus unknowingly by talking to people, putting his near and dear ones at risk of infection?
Isn’t it established that the transmission rate for the novel Coronavirus (a person's ability to infect others) is very high?
Now, if everyone wore a mask, wouldn’t those who are infected but are symptomatic, infect less number of people? They would. So, masks are very critical in reducing the rate of transmission and we know that the whole world is trying to flatten the curve (i.e. reduce the transmission rate).
It’s really common sense, then, to wear a mask and one needn't wait for WHO to correct its mistake.
Prof Yuen Kowk-Yung, a professor at Hong Kong University who leads research into infectious diseases and was instrumental in containing the spread of the SARS in Hong Kong in 2003, recommends everyone to “Wear a mask to protect not only yourself but also others, because if you are infected but asymptomatic, you could still stop the spread by wearing a mask.”
This is akin to how social distancing works. Imagine if WHO said that only those who are Covid-19 patients need to do social distancing and not others. That would be terrible advice. But if everyone is asked to maintain social distance including those with no infection (or better put in lockdown), the rate of transmission will come crashing down.
Thus, making it mandatory for everyone to wear masks, like social distancing, is not about protecting individuals from infection but the whole society from getting it.
There is a reason why everyone (including the WHO) is emphasising on increasing testing for Covid-19 affected countries (especially those in community transmission) because mass testing helps identify even asymptomatic patients early, isolate or quarantine them, and help reduce the transmission rate. Masks help achieve exactly this, but at a fraction of cost.
Sui Huang, a molecular and cell biologist at the Institute of System Biology, explains in this post on Medium why everyone should wear masks. “Given that the upper respiratory tract is the major site for SARS-Cov-2 entry into human tissues, wearing simple face masks, which exert a barrier function that blocks those big projectile droplets that land in the nose or throat, may substantially reduce the production rate, to an extent that may be comparable to social distancing and washing hands. This would then double the effect of mitigation in ‘flattening the curve’,” he reasons.
Now, the scientific evidence:
A study in 2013 examined homemade masks as an alternative to commercial face masks. It evaluated several household materials for the capacity to block bacterial and viral aerosols and concluded that “a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.”
A study conducted to estimate the effectiveness of different types of protective equipment in reducing the rate of infection in an influenza outbreak found that a “50 per cent compliance in donning the device resulted in a significant (at least 50 per cent prevalence and 20 per cent cumulative incidence) reduction in risk for fitted and unfitted N95 respirators, high-filtration surgical masks, and both low-filtration and high-filtration pediatric masks and an 80 per cent compliance rate essentially eliminated the influenza outbreak.”
Covid-19 is caused by the novel Coronavirus which is similar to SARS. A study conducted during community transmission of SARS in Beijing found that consistently wearing a mask in public was associated with a 70 per cent reduction in the risk of catching SARS.
Additionally, the authors of the paper noted that most people in the community wore simple surgical masks, not N95 respirators.
“Theoretically, N95 respirators might be a better choice if you are taking care of someone with Covid-19. When used properly in a medical setting, N95 respirators were more effective against SARS than surgical masks in three different studies,” they noted.
However, when moved out of a hospital setting and into everyday life, those differences could even out. If we look at the data on influenza, reviews typically conclude that N95 respirators are not significantly more effective than surgical masks.
One study on the Influenza virus aerosols exited from the mouth concluded that, “Overall, masks produced a 3.4 fold (95 per cent CI 1.8 to 6.3) reduction in viral aerosol shedding”.
A group of scientists at Cambridge tested the effectiveness of homemade masks compared to surgical masks in blocking 0.02 micron Bacteriophage MS2 particles, which are several times smaller than the coronavirus and found that while surgical mask blocked 89 per cent, masks made of Vacuum cleaning bag blocked 85 per cent, Dish Towel 73 per cent and even a 100 per cent cotton T-shirt blocked 50 per cent particles.
Jeremy Howard, distinguished research scientist at the University of San Francisco, is among hundreds of Twitter users who are running a “Mask for all” campaign.
His research institute, fast.ai, has listed 34 scientific papers which show that even basic masks can be effective in reducing virus transmission.
Peter Kolchinksy, a virologist and biotech investor, explains why masks are important even in this Covid-19 pandemic. “Public should know covid exposure dose matters. We have to conserve masks for healthcare workers, but masks can help anyone, reducing amount of virus released (even by breathing) or taken in. Immune system is more effective if infection starts w/ low dose. (Sic),” he tweeted.
Keeping the exposure dose to a minimum means that the virus has to divide many more times before getting to high levels...but the immune system starts responding and, therefore, can flatten the curve, keeping the peak viral load lower, so it does less damage (fewer symptoms) [sic],” he added in a follow up tweet.
Now, the experience of those countries which have succeeded to an extent in controlling the contagion.
Dr. Pak-Leung Ho, head of Centre for infection at the University of Hong Kong, has highlighted universal mask-wearing as one of the reasons why widespread outbreak didn't occur.
George Gao, director-general of the Chinese Center for Disease Control and Prevention (CDC), says that not wearing masks in the fight against this pandemic is a ‘big mistake’.
“This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or pre-symptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others,” Gao says.
Taiwan, another country which has succeeded in containing Covid-19, has laid great emphasis on mass mask usage. Its Prime Minister, Tsai Ing-wen, proudly announced on Twitter that her country can manufacture 10 million masks a day. It’s more than a week since it decided to export 100,000 per day to the US.
Faced with actual evidence and results of masses wearing masks in Asia, western countries are also rethinking their positions on masks.
German medical officials who, like everyone else, were denying the importance of masks, are also advising people to wear masks in public to stop the spread of contagion.
Austria, which now has almost 10,000 cases of Covid-19, has decided to make basic face masks compulsory in supermarkets and “the aim in the medium-term was for people to wear them in public more generally as well.”
US Food and Drug administration classifies surgical masks as medical devices so firms have to take various permissions and tolerate regulatory cholesterol to manufacture them and deliver to the market and the process can take months.
So, no new firms could launch their products overnight to meet the surging demand. Some tough restrictions were removed only three days back.
Many textile companies across the world are already churning out lakhs of masks in their factories. In the US, even Apple Inc. - a tech behemoth, donated 90 lakh masks for healthcare workers. In India, the textiles ministry is actively involved in getting lakhs of masks manufactured along with personal protection equipment.
In some countries, people are themselves making their own masks at home. On social media, #Mask4All campaign is gaining steam and helping people with DIY (do-it-yourself) tips on how to make or sew their own masks at home.
The Czech Republic went from zero mask usage to 100 per cent in a matter of days without any government help. Citizens made their own masks en masse. Masks are seen everywhere. Even politicians going to the Parliament are sporting them. Ditto in Slovakia, where the President’s pictures of her donning masks matching in colour with her dress have gone viral.
The point is everyone is slowly taking to the idea of wearing a mask whether they are infected or not. It is effective. It works. And you should wear it too. Ignore the WHO or advisories from Ministries of Health that tell you otherwise.
Arihant Pawariya is Senior Editor, Swarajya.
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