As the coronavirus (COVID-19) continues to spread, having now infected over 110,000 people in 110 countries, opinions of whether face masks are necessary for everyone is still hotly debated.
In China and in other countries like Japan, face masks are a common sight with people using it for when they feel unwell or as a measure against pollution.
However, other parts of the world including Europe and America, authorities only encourage the use of masks for ill people who are out in public.
Inkstone news did a review of the nine countries with the highest infection rates of COVID-19 and found that only three of those countries recommend the usage of masks even for people without respiratory symptoms as measure to curb the spread of the virus.
China recommends both healthy and sick people to use masks at all times while South Korea and Japan encourage sick people to use masks at all times and for healthy people to use it in crowded places.
Meanwhile, national health authorities in Italy, Iran, France, Spain, Germany, and the United States recommend that only sick people use masks, noted Inkstone.
Experts urge the use of masks for all to curb asymptomatic transmission of the virus
Given the spread of the virus outside of China, the article notes that some experts have recommended authorities around the world to rethink the usage of masks.
Referring to an article published in a medical journal, Lancet, on 3 March, it was noted that researchers argue that COVID-19 has “defied conventional containment strategy”. This can be seen as some patients in the early stages of infection show little to no symptoms while being infectious.
“People wear masks to protect themselves in close person-to-person contacts, but unintentionally, they are protecting each other through source control,” said Chi Chiu Leung, Tai Hing Lam, and Kar Keung Cheng in the article.
Another point in considering the usage of masks is the fact that there have been many people who have contracted the virus but do no exhibit symptoms like cough and fever.
In China, major cities have enforced a rule on wearing masks in public, even going so far as to detain people who attempted to use public transport without a mask.
Speaking to Inkstone, Dr DJ Hamblin-Brown, vice-president of medical affairs at United Family Healthcare in Beijing, said that China has recognised the need to control the spread of COVID-19 by asymptomatic patients.
While a non-peer reviewed study found that the incubation period for the coronavirus could be as long as 24 days, other experts and researchers have estimated that most infected people will develop symptoms about five days after infection.
This means that someone could be carrying the virus but remain asymptomatic, meaning they might go undetected and continue living their daily lives, infecting others along the way.
In many countries, asymptomatic transmissions have been recorded. In Singapore, one example is that of a British businessman who contracted the virus in Singapore and spread it to others when he went on a skiing trip in France before heading back home to the United Kingdom. All the way, the man was asymptomatic. However, 13 infections were traced back to him.
Researchers and WHO diverge on mask usage recommendations
Now, as a cautionary measure, the World Health Organisation (WHO) has suggested that the only ones who should be donning masks are people with respiratory symptoms. The organisation also urges caution to reduce the risk of infection, such as limiting touching your face.
However, a microbiologist at the University of Hong Kong, Professor Yuen Kwok-yun, argued for broader use of the masks.
The professor, who is also an advisor to the city’s COVID-19 taskforce, told Chinese state media Caixin that “wearing a mask not only protects yourself but also protects others in case you are an asymptomatic patient”.
When queried by Inkstone about this take on the issue, WHO said that they are aware that asymptomatic patients could pass on the virus, adding that there is still much that they don’t know about the virus. The WHO spokesperson added that the organisation is closely monitoring new data.
How effective are masks anyway?
So, on the question of whether masks are as effective in preventing respiratory diseases, studies from around the world prove that it is.
In a 2014 study in Japan of over 10,000 students, it was shown that face masks do reduce the risk of catching the flu.
A 2016 analysis of 25 studies conducted between 1999 to 2014 on the usage of face masks during the Muslim pilgrimage, commonly known as hajj (haji), concluded that masks could provide “significant protectiveness” from respiratory infections.
In the current situation with COVID-19, some experts have noted even if the pathogen is small enough to penetrate, the masks could effectively block droplets of virus-carrying saliva and thus reduce the risk of infection.
Illustrating that infection is an accumulative process, 82-year-old virologist Changshou Hang from the Chinese Centre for Disease Control and Prevention said that a person could be infected if they inhale a large dose of viral droplets at once.
He explained, “If you are wearing a face mask, viral droplets can still get to you, but it will be in much less dosage.”
The question of mask usage is also a cultural one
Given the opinions of various experts on the usefulness of masks in protecting the wearer and those around them, the other aspect that is considered is the culture surrounding mask usage.
Keiji Fukuda, a director at the school of public health at the University of Hong Kong, told Inkstone that it is common to see people wearing masks in Asia where it is culturally accepted. However, many countries in the west “simply do not believe promoting healthy people to wear masks is useful”.
This dichotomy is illustrated in an example of a Canadian in Tokyo who was baffled when seeing how common surgical masks were in Tokyo back in 2014.
The man wrote to an advice columnist in the Japan Times that where he comes from, only health professionals wear masks, and even then, only when they are on the job.
In the aforementioned Lancet article, the authors suggested that the cultural pressure to use masks could help curb further spread of COVID-19 by asymptomatic patients.
They said, “If everyone puts on a mask in public places, it would help to remove stigmatization that has hitherto discouraged masking of symptomatic patients in many place.”
Managing the global shortage of masks
If we go by the recommendations of researchers and health experts for all people to use masks, then the question arises whether there is enough masks to go around.
So far, health authorities, including in Singapore, have recommended that healthy people do not need to wear masks. The common reasoning given is to protect the supply of masks for those who really need them, such as frontline healthcare workers and sick people.
This is a legitimate concern given that the WHO has estimated a 100 fold increase in demand for face masks since the outbreak began. This has led to a global shortage which the organisation warned could place healthcare workers at risk. This is also a concern that was noted in the Lancet article.
However, some experts have noted that other face-coverings could be used in place of masks if the latter are unavailable.
Dr Brown from United Family Healthcare said, “Masks are not magic. They are just a bit of cloth covering the face.”
He explained that a handkerchief or scarf could be used in place of a mask to prevent droplet spread, adding that these should be washed daily and not be handled when in use.
In fact, South Korea’s Ministry of Food and Drug Safety even revised its guidelines on face masks last week (4 March), recommending the reuse of cotton or disposable masks as a temporary measure.
Dr Brown also cautioned the public against hoarding heavy-duty masks such as the N95 variety as those should be reserved for healthcare workers.