Four doctors proven right to have advised Singaporeans to wear masks early in COVID-19 outbreak

In Feb, four medical practitioners in Singapore came together to sign a letter, advising people to wear face masks when they leave home so as to control the spread of the COVID-19 virus. That was the time when the coronavirus outbreak began to hit Singapore. The letter entitled, “Health advisory from senior medical practitioners to Singaporeans”, highlighted how “things are not so straightforward” with the COVID-19 as it was with Severe acute respiratory syndrome (SARs) coronavirus in 2003. The signatories were:

• Dr Tham Hoe Meng: Everwell Clinic & Surgery
• Dr Colleen Thomas: Saint Jude Centre for Internal Medicine in Mount Elizabeth Hospital
• Dr Judy Chen: Pariqua Clinic
• Dr Lim Pin Pin: Modern Medical Glenroy (Australia)

They pointed out that “as this virus is said to be milder, infected people with no symptoms could transmit the virus to others silently. A certain percentage will develop deadly disease.” and warned that temperature screening works less well to identify those infected. “As they mingle freely and unmasked, more and more people could be infected daily without even knowing it.”, said the practitioners. They also warned that deaths from COVID-19 could exceed SARs as it did in 2002 because the reported death toll of the virus has already overtaken SARs. “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. It may not possible for everyone to get a new surgical mask everyday. We 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.” wrote the letter. Dr Thomas shared that cloth masks were used when she graduated from medical school so there is no reason why it could not work now.  She also pointed how the wearing of face masks would also change the behaviour of individuals such as being more cautious and staying away from crowd and also influence a certain culture such as making it normal for one to wear a face mask. The letter also covers the point of avoiding unnecessary mingling where they gave several pieces of advice.

• In a taxi, wind-down windows.
• Minimise dwell times in air-conditioned places, malls and food courts.
• Use online delivery services.
• Schools should conduct online learning.
• Places of worship could use fans and natural ventilation, minimise the length of their services, conduct more frequent sessions so people will be in smaller groups and can stand further apart. They should not admit unmasked worshipers.

“If we all do this 2M rule ( wear Mask, stop Mingling) in 2 weeks the worst could be over.” wrote the letter. The practitioners clarified that they are not trying to disclaim the health authorities who have a very challenging task but professionally they feel the need to disseminate this message immediately in the interest of safety and life preservation. “We are confident that the authorities will respond accordingly in the interest of Singaporeans’ health.” The letter was widely shared and praised. PM Lee: We will no longer discourage people from wearing masks From the very beginning, the multi-ministerial task force headed by Health Minister Gan Kim Yong and Lawrence Wong urged Singaporeans to refrain from hoarding masks and said that masks are needed only by those who are unwell and need to see a doctor. In response to the letter, Associate Professor Kenneth Mak, the director of medical services said, wearing a mask is not the most important thing to do to keep the coronavirus at bay. Prof Mak reminded people that the virus is spread via droplets with no evidence that it is airborne. "Be aware of things you commonly touch. The thing most commonly touched is your phone, so wearing a mask is not the most important thing," he added. This was echoed by Prime Minister Lee Hsien Loong which was widely reported in media in a Facebook post earlier on 30 Jan, where he highlighted the MOH’s advice to only need to wear a mask if we are sick. “There is no need to wear a mask if we are well.” wrote PM Lee. However, in an apparent “U-turn” from the Government’s previous stance on masks, Prime Minister Lee announced on Fri (3 Apr) that the authorities will “no longer discourage people from wearing masks”. He said the Government is concerned about “some cases out there community going undetected” even if there are few of them. This was precisely the reason the 4 doctors recommended wearing masks earlier on in Feb. “We also now have evidence that an infected person can show no symptoms, and yet still pass on the virus to others,” he said. "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," he added. It certainly took courage for the four doctors to go public asking Singaporeans to wear masks at a time when the authorities were advising against it. One will wonder if the four doctors will receive any recognition for their selfless act of public service.