In an apparent “U-turn” from the Government’s previous stance on medical masks, Prime Minister Lee Hsien Loong on Fri (3 Apr) announced that the authorities will “no longer discourage people from wearing masks”.
Mr Lee in a televised address today said that the Government’s reason for advising the general public to only wear such masks if they are unwell was based on “scientific advice and guidelines” from the World Health Organization (WHO).
Additionally, there were no instances of community spread of the novel coronavirus (COVID-19) in Singapore initially, he noted.
“It was very unlikely for you to run into anyone with COVID-19 on the street, much less be infected by them,” said Mr Lee.
“Nevertheless, the Government gave each household four surgical masks, to use in case you got sick, and to give people peace of mind,” he added.
Presently, however, Mr Lee said that the Government is concerned about “some cases out there community going undetected” even if there are few of them.
“We also now have evidence that an infected person can show no symptoms, and yet still pass on the virus to others,” he said, adding: “This is why the WHO is reviewing the issue of face masks, and so is the US CDC.”
“Therefore we will no longer discourage people from wearing masks,” said Mr Lee.
A federal official who asked to remain anonymous told The Washington Post as reported on Tue (31 Mar) that officials at the Centers for Disease Control and Prevention are currently reviewing their advisory on masks.
While the official said that the CDC guidance will stress that the general public should not use medical masks — including surgical and N95 masks — to avoid further shortage of masks for frontline healthcare workers, another official said that the proposed revised recommendation may include utilising using do-it-yourself cloth coverings.
Such DIY masks may reduce the risk of transmission from the person wearing them to others around them if the person has been infected with the virus.
The New York Times reported the US CDC Director Robert Redfield as saying on 31 Mar that the Centre’s guidance on mask-wearing “was being critically re-reviewed, to see if there’s potential additional value for individuals that are infected or individuals that may be asymptomatically infected”.
WHO is also reviewing its guidelines on masks, following findings from new research in the US which suggests that droplets from coughs can reach as far as 6m and from sneezes up to 8m.
Government to distribute reusable masks to all households starting Sun
In tandem with the revised health guidelines regarding masks, Mr Lee said that the Government will be distributing reusable masks to all households starting this Sun (5 Apr).
“We still want to conserve surgical masks for the people who really need them–healthcare workers in clinics and hospitals … For everyone else, in a community setting, alternatives like reusable masks will give some added protection,” he elaborated.
Mr Lee applauded the efforts of “many community groups” who have been “making and distributing reusable masks for the elderly and vulnerable”.
“Wearing a mask may help to protect others, in case you have the virus but don’t know it. This is so that you keep your droplets to yourself.
“It can also protect yourself a little better, especially if you are elderly, or vulnerable because of pre-existing conditions,” he added.
However, Mr Lee stressed the importance of good personal hygiene in warding off the risk of transmitting or being infected with the virus.
“Remember, mask or no mask, you still need to wash your hands, and keep a safe distance away from other people,” he said.
Any masks will be better than no masks: PM Lee’s wife Ho Ching
Mr Lee’s wife Ho Ching, in a Facebook post on Wed (1 Apr), shared a blog post on how to make a face mask at home using only a handkerchief and a hair tie without sewing or cutting.
“Bravo to the creativity and the spunky efforts to do our bit for ourselves and our friends and family,” Mdm Ho wrote.
“Any masks will be better than no masks – however low the risk, a mask can help lower it further by a little bit.”
She explained that if two people meet and both wear a mask, it would reduce the risk of COVID-19 infections even further.
“We don’t need a hospital-grade surgical mask for general public use, as the chances of meeting a really sick patient are low,” she said. “We should save the surgical masks for our healthcare workers.”
She then went on to tell a story that in the early 1900s, a Penangite doctor in China was pushing hard on having the healthcare team wear masks. All they had was a surgical gauze, which is quite porous, folded over a piece of cotton cloth.
Likewise, she asked Singaporeans to “make do”.
“So, we too can make do, and be the 1st line of defence by washing hands, keeping a safe distance, or use a mask as an added safe distance, so as to save our healthcare workers and not overwhelm them with too many patients too suddenly,” said Mdm Ho.
She also advised returnees from abroad to keep a safe distance from others whether or not they have a home quarantine.
“So whether or not, we have a home quarantine, do keep a safe distance from others, including old folks at home, until you have been home for at least 14 days,” Mdm Ho advised, adding: “If you feel you want to put on a mask, go ahead.”
Her brother-in-law Lee Hsien Yang, the younger brother of PM Lee, on Thu shared a photograph of an ornate fabric mask made by his wife Lee Suet Fern, a lawyer by profession and an accomplished quilter, as seen in her win at the 2019 Yokohama Quilt Time Festival in Japan.
“My reusable mask, just made for me,” wrote Mr LHY.
Government previously actively discouraged healthy people from wearing masks
The multi-ministry task force on COVID-19 — co-chaired by Health Minister Gan Kim Yong and Lawrence Wong — urged Singaporeans from the onset of the outbreak in Singapore to refrain from hoarding masks, stressing that masks should only be used by those who are unwell.
During the earlier mask distribution exercise by the government, Trade and Industry Minister Chan Chun Sing — who is also Minister-in-charge of the People’s Association — warned that masks distributed by the government are not “masks for us to take, open immediately, use it to go to the hawker centre”.
“These masks are to be kept in the household for members of our families who might get ill and need to access medical help,” he stressed.
The Ministry of Health reiterated the same message to the public via daily ads in major newspapers.
Experts have been emphasising the importance of masks during outbreak for months
Over the course of the pandemic, however, experts around the world have come forward to extol the importance of mask usage for everyone, whether or not they are unwell.
Adrien Burch, an expert in microbiology at the University of California at Berkeley, noted that despite claims by the Centre for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) that wearing face masks ‘don’t work’, there is no strong evidence to support that. He added that there is evidence that masks can help to prevent infections, CNN reported on Thu (2 Apr).
Referring to a Cochrane Review, Mr Burch pointed out a study on local transmission of the 2003 Severe Acute Respiratory Syndrome (SARS) in Beijing which discovered that “consistently wearing a mask in public was associated with a 70% reduction in the risk of getting infected”.
“Based on the research, face masks are much more likely to help than to hurt,” according to Burch. “Even if it’s just a homemade cloth mask, if you wear it correctly and avoid touching it, the science suggests that it won’t hurt you and will most likely reduce your exposure to the virus.”
Countries such as Taiwan, South Korea, and China have long encouraged their people to wear masks in public to prevent the spread of the virus.
Ivan Hung, an infectious disease specialist at the Hong Kong University School of Medicine told CNN on Thu (2 Apr) that wearing a mask is likely the most important factor in controlling the infection, based on data related to COVID-19 cases in Hong Kong.
“And it not only brings down the cases of coronaviruses, it also brings down the influenza,” he said.
“In fact, this is now the influenza season, and we hardly see any influenza cases. And that is because the masks actually protected not only against coronaviruses but also against the influenza viruses as well.”
George Gao, director-general of the Chinese Center for Disease Control and Prevention, told Science Magazine in an interview that not wearing masks — a phenomenon currently widely seen in the United States and European countries — during the COVID-19 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 presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others,” he said.
Kim Woo-joo, a professor of infectious diseases at the Korea University Guro Hospital and South Korea’s most prominent coronavirus expert, similarly told Asian Boss in an interview on 24 Mar that wearing masks to prevent infection of COVID-19 is “definitely effective”.
“Why else would doctors wear masks in hospitals? They wear them because they prevent infection,” he added, referencing the effectiveness of masks during the SARS and MERS outbreaks.
Professor Kim, who has around 30 years of experience in the area of infectious diseases, said he finds it quite “odd” that not many people wear masks in the West.
“The US Surgeon-General said people didn’t need to wear masks, and WHO recommended people not to wear masks, but I’d have to disagree.
“I did read his tweet … You have to understand the context. I think the point was to prevent the public from hoarding masks, because medical professionals need them more,” said Professor Kim, particularly due to the shortage of masks in the US.
Professor Kim also criticised the WHO’s statement on how people are only encouraged to wear masks in Asian countries due to purported cultural differences, stating that such a view is “problematic” as masks have been “proven” to prevent infection.
“Just look at China, Hong Kong, Japan and Korea … In the meantime, if you look at many European countries and the US, the virus is spreading rapidly. One of the reasons Korea has a relatively low rate of infection is because everyone is wearing a mask and washing their hands regularly,” he said.
Even in Singapore, four medical professionals have previously highlighted the significance of masks among the general public during the COVID-19 outbreak despite MOH’s advisory.
In a letter titled “Health advisory from senior medical practitioners to Singaporeans” dated 10 Feb, the practitioners highlighted how “things are not so straightforward” with the COVID-19 outbreak as it was with the Severe Acute Respiratory Syndrome (SARS) coronavirus in 2003.
“We are advising everyone to wear a mask always when leaving home. If one faces a person and both parties are masked, it is considerably safer, constituting a 2-barrier protection,” the letter read.
The practitioners acknowledged that while it “may not possible for everyone to get a new surgical mask everyday”, members of the public “need to find creative solutions”.
“Some people have purchased washable cloth masks, sewed them, constructed them with suitable paper, or tied a scarf to the face. These measures are better than no mask at all,” the practitioners noted.
