I’m now a double-masker outside my home. Underneath, there is a three-ply disposable surgical mask that is then covered by a double-layered home-made cotton mask which looks a little like a kid's pyjamas because the outside material is in fact old children's clothes. After all, if double-masking is good enough for the director-general of Health, it’s good enough for me.
Two masks are better because they offer two layers of resistance to pathogens. Double-masking also helps because sometimes the outer layer forms a tighter seal around the inside layer, and the two combine to help one another in that "greater than the sum of its parts" sort of way.
Sometimes I even wear a face shield, so that’s three layers.
Like it or not, masked people are the new normal we are getting used to, especially given that Covid-19 is most probably here to stay for the foreseeable future. “We all have to accept that Covid-19 is endemic,” said new Health Minister Khairy Jamaluddin on Thursday (Sept 2, 2021), referring to the fact that we cannot at the moment eliminate the virus. “We have to live with this.”
But living with this also means coping with news of children dying from Covid-19, like the one about an eight-year-old in Sarawak on Sept 1, 2021. According to the Institute of Health and Community Medicine at Universiti Malaysia Sarawak, the good news is that 99% of the 178 new Delta variant cases detected in August were asymptomatic or showed mild symptoms. However, children account for 30% of such cases, and those under 12 cannot be vaccinated yet. (Currently, 63% of the adult population of Sarawak has been fully vaccinated.)
This happened in the same week as the release of a report by the US Centers for Disease Control and Prevention (CDC) on how one unvaccinated teacher in a school in San Francisco had infected 22 students and four adults. Fortunately nobody died as a result, but it was the incident that got American school districts reassessing the need for mandatory vaccination and mask-wearing.
What about Malaysian schools? As of earlier in 2021, there were SOPs in Malaysian schools for both mask-wearing and maintaining adequate distancing. While desks in the classroom in that San Francisco school were at least 1.8m apart, the teacher had in fact removed his/her mask at times while teaching.
But the CDC also strongly advises vaccination, which is in line with our Education Ministry’s decision to not allow teachers who don’t want to get the jab to teach face to face. Although that means roughly 2,500 teachers won’t be going back to school, they are in the minority, and the good news is that 83.5% of those working in schools have already been fully vaccinated.
Another recommendation made by the CDC in their document “Guidance for Covid-19 Prevention in K-12 [from kindergarten to 12th grade] Schools”, is ventilation. For the US school in the study, classrooms left doors and windows wide open (something already done in Malaysian schools), and on top of that had portable high-efficiency particulate air filters (something perhaps to be discussed in the next Parent-Teacher Association meeting).
One recommendation made by the CDC that the school in San Francisco did not seem to have in place was regular testing. In particular, the CDC recommends that non-vaccinated people (including students) test themselves once a week. (Vaccinated people should test themselves if they have been in close contact with infected people.)
I would further argue that perhaps it makes sense to test every teacher every week whether they are vaccinated or not. However, there are two issues. Firstly is obviously the cost; at the recently announced wholesale price of RM16 for test kits, I estimate doing this would cost around RM400mil a year for the antigen test.
Secondly is the issue of false positives (the test shows that you are positive when you are in fact negative). Depending on how many teachers are vaccinated and how effective vaccination is, you might have more false positives nationwide than actual positives each day!
But I think parents who can afford the additional RM1,000 or so a year (assuming parents only have access to the RM19.90 retail price) should test their unvaccinated children once a week, and keep them from school if positive (like how you would do so if your child has a temperature).
Nevertheless, you may ask, what is the benefit of going to all this effort? Why should we work so hard to make schools safe when the risk of children being infected at home and at family gatherings is so much higher (especially those with aunties who want to kiss every nephew and niece they meet)?
Given that Covid-19 will be endemic, the likelihood of every child under 12 becoming infected as they grow up is almost definite. If every one of the six million children under 12 in Malaysia got Covid-19, then (assuming a mortality rate of 0.01%) we are roughly looking at 600 extra deaths. As a comparison, that’s about three times as high as the number of Malaysian children under 14 dying from transport-related accidents; and up to 10 times higher than the number of children dying from drowning each year. It is not a trivial number.
On top of that, we haven’t even considered the long-term issues of being infected with Covid-19 – what is known as “long Covid”. A study comprising patients in Britain, Sweden and the United Sates found that more than half of children between six and 16 years old who contract Covid-19 have at least one symptom lasting more than 120 days, and many of them (42.6%) find their day-to-day activities impaired by these symptoms.
So there are serious consequences for taking this lightly.
What taking these precautions does is to “flatten the curve” for children. In one way, we are taking care that they reduce the risk until they are old enough to be vaccinated.
There are other things that time will buy. It seems Pfizer is already looking at vaccines for young children. Or perhaps there will be a reliable cure for Covid-19 (and preferably not one that you need to buy from a vet).
Until then, consider the precautions as extra layers of protection, much in the same way that my two – sometimes three – masks are better than one.
In his fortnightly column, Contradictheory, mathematician-turned-scriptwriter Dzof Azmi explores the theory that logic is the antithesis of emotion but people need both to make sense of life’s vagaries and contradictions. Write to Dzof at firstname.lastname@example.org. The views expressed here are entirely the writer's own.