To wear or not to wear the face mask during Covid-19 pandemic?

Should the public wear a face mask? This is the key question during this Covid-19 pandemic. Months after the pandemic began, the public is confused if a mask is essential to keep them safe despite the World Health Organisation and the health ministry reiterating that people who are not sick need not wear masks.

They say only those who are unwell or caring for the sick need to wear one, so that the masks can be reserved for the frontliners.

Besides that, experts worry that masks could give people a false sense of security and make them less disciplined about social distancing and handwashing.

However, the public is not convinced by this advice. It is common to see Malaysians wearing masks in public, and some supermarkets or hypermarkets are imposing the rule “no mask no entry”.

Recently, there were more health experts supporting the idea that face masks may be beneficial in preventing the spread of Covid-19.

Covid-19 is transmitted through droplets, not airborne transmission. Face masks work by stopping infected droplets from the wearer’s nose or mouth, rather than stopping acquisition of the virus from others.

Since a Covid-19 patient may not show any symptoms and be contagious, if everyone wears a mask, the asymptomatic patient may be less likely to spread the disease to others. If everyone wears a mask, individuals protect one another, reducing overall community transmission.

Places like Hong Kong and Taiwan, which applied social distancing and universal mask wearing early, may have got their cases under better control. South Korea and Japan distribute masks to the public. Recently, the Czech Republic and Slovakia even made wearing masks mandatory. The Czech Republic has a slogan that promotes wearing of masks: “My mask protects you, your mask protects me”.

George Gao, the director of the Chinese Centre for Disease Control and Prevention (CDC), shares the thinking of the Czech government. He believes not wearing a mask is a big mistake. If people who are infected but asymptomatic wear a mask, it can prevent droplets that carry the virus from escaping and infecting others. Some researchers are quoted as saying that wearing masks is a perfectly good public health intervention that is not used.

Although a systematic review and meta-analysis may not provide evidence on the effectiveness of a face mask on flu-like diseases among the public, we should observe the progress made by countries like China (including Hong Kong), Taiwan, South Korea and Japan.

These countries have very proactive measures in dealing with Covid-19, and they managed to flatten the epidemic curve. They recommended masks be worn by the public in high-density areas such as supermarkets, shopping malls (China), when taking public transport or staying in crowded places (Hongkong), or in confined and badly ventilated spaces (Japan).

Lack of solid evidence supporting the effectiveness of masks against Covid-19 is no reason to dismiss its use, because there may never be definitive scientific proof. However, community use of masks alone is not the only method to stop the spread. Social distancing, staying home, contact tracing, testing and quarantine of people who are potentially infected are important steps in flattening the curve.

It is time for the government to make rational recommendations on appropriate face mask use to complement other public health measures. Older adults and those with comorbidities should wear masks, if available.

Universal use of face masks should be considered with adequate supplies. In addition, research on the effectiveness of cloth face masks which is reusable after washing should be encouraged.

Dr Moy Foong Ming is a professor at the Department of Social & Preventive Medicine, Faculty of Medicine, Universiti Malaya. - FMT