The Mandatory Mask

There has been a lot of debate about whether face masks are effective, when you should wear them and whether or not they will be mandatory in public. I believe we are headed towards temporary enforcement of mandatory face masks, not only in businesses, but also in public spaces.

One of the most informative articles describing the future of COVID-19 measures was called "The Hammer and the Dance" published on March 19th by Tomas Pueyo:

This article foretold what was coming for countries facing COVID-19. It has been an accurate forecast of what we need to do to combat COVID-19. If you have 30 minutes I recommend at least taking a glance at it.

In the article, several transmission prevention measures are listed in order based on the cost of each prevention measure.

There are several ways to reduce the transmission rate with varying costs and effectiveness. Unfortunately in many countries it has been necessary to implement prevention measures with the highest costs.

During this time (and still now), many public agencies were communicating that face masks were not necessary for the general public. The WHO’s official advice was "if you are healthy, you only need to wear a mask if you are taking care of a person with suspected [COVID-19] infection." In Canada, where I live, the advice was "Putting a mask on an asymptomatic person is not beneficial, obviously, if you're not infected,".

There is a big problem with this logic. We have known for a long time that there are large numbers of asymptomatic cases of COVID-19 (as early as late January: https://www.publichealthontario.ca/-/media/documents/ncov/what-we-know-jan-30-2020.pdf?la=en).

If you don’t know you are infected, how would know to wear a mask?

Experience

Experience takes the thinking out of action.

Asian countries have more experience with virus outbreaks due to the more common occurrence in that geography in recent history. For many years now it has been common to see photos taken in Asian countries with a spattering people wearing face masks. Some people have assumed it is only because of more prevalent air pollution. However, pollution is not the only reason and, now almost certainly, it’s not the dominant reason.

The general populations in countries (particularly China, South Korea and Japan) have more first-hand experience dealing with virus epidemics than we do in North America and Europe. They have faced several epidemics in the last 20 years including the 2002 SARS outbreak and the 2006 bird flu.

Children attend ballet lessons wearing masks to protect themselves from severe acute respiratory syndrome, or SARS, in Hong Kong, in 2003. (Vincent Yu / Associated Press)(https://www.latimes.com/california/story/2020-02-18/sars-coronavirus-china-epidemic)

This experience and preparedness has allowed countries such as South Korea to avoid a large scale spread of the virus with low-cost repercussions on its people and economy. South Korea showed that the cornerstones of a virus response are at the top of the table shown above and, additionally, the use of face masks. The summary is that a combination of the following is needed:

·        Wide-scale testing to identify cases

·        Isolation of active cases

·        Reduction of transmission rate for undiscovered cases

In North America, we have been fortunate to have avoided major virus outbreaks. We don’t have the collective experience to understand what the most important actions are during the outbreak. Unfortunately we are now learning from our own firsthand experience.

Personal Protective Equipment (PPE) is not a new idea. In workplaces PPE is commonly used to mitigate safety hazards. Face masks are a form of PPE that mitigates the safety risks of the day.

Do face masks help?

They definitely do help as they prevent you from infecting other people and they prevent other people from infecting you.

When Dr. Tam, Canada’s Chief Public Health Officer, explained why the general public didn’t need masks she provided some rationale for the Canadian Government’s stand in this video: https://www.cbc.ca/player/play/1717905987907 (recorded March 25th)

The key arguments were:

1)     We want to protect our frontline healthcare workers. Our mask supply needed to be prioritized for healthcare workers.

2)     If you wear a mask you will take bigger risks.

3)     If you wear a mask you touch your face more.

Rationale number 2 is silly. This would be similar to arguing that seatbelts reduce safety by encouraging unsafe driving.

Rationale 3 is reasonable however could be solved with education. We need we need to provide education and training on proper use of face masks (such as ensuring you wash your hands before putting a face mask on or taking it off). Confidence and behavior can be changed through education. With proper education, face masks can’t do more harm than the help they offer. However, they are certainly not a solution on without this education. Finally, it is better to risk someone infecting themselves by touching their face taking a mask off than it would be to allow them to infect several people through not wearing a mask at all.

If you’re still not convinced, if face masks don’t lower transmission rate, why do healthcare workers need them?

Supply and Distribution Control

If masks help and are a low cost way of preventing transmission, why has there been unclear guidance on using them?

The reason for mixed messaging is that our government couldn’t afford a mask shortage for healthcare workers and we didn’t have enough supply or distribution control over masks.

What would happen if we ran out of masks for healthcare workers? It would be a disaster for obvious reasons. Workers who can’t protect themselves will walk off the job because they would be forced to make a choice between their own safety and their patients. 

Off-shoring manufacturing and core competency works fine until the whole world needs the same thing that you need. In this situation Canada doesn’t have enough local manufacturers of face masks to supply its own inhabitants.

In a crisis of this nature, we can’t rely on the generosity of other countries to supply us with the same equipment they sorely need. As an example, there was a short-lived disagreement as a shipment of masks to Canada was held at the USA border. I don’t blame other countries because they need to supplies just as much as we do.

Mandatory Masks

As governments are planning the economic re-opening, I believe we are headed towards a world where we will see masks become mandatory in public (for temporary periods of time). Face masks are a low cost and effective way to lower the transmission rate. Wearing face masks in public is a better solution than many of the social distancing measures we are currently taking.

TL;DR: wear a face mask when you're out in public, wash your hands before touching your face.

If you can’t find a mask to buy, you can make your own following the instructions below.

How to make your own face mask: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

You can also sterilize them for re-use. I would suggest researching how to sterilize your masks for re-use based on the type of mask you have.