Protocol for wearing masks

CURRENTLY, a lively debate is going on worldwide over the use of face masks in public. In some cases, the discussion has unfortunately descended into opinions based on political philosophies and geopolitics rather than scientific reasoning.

In Malaysia, we are fortunate in having an excellent public health system that has controlled this first major outbreak of Covid-19. We were also fortunate to have sufficient hospital and ICU capacity to provide high-quality treatment of Covid-19 patients.

The World Health Organisation uses a risk-based approach for recommending the use of masks for the general public. Using this risk-based approach, there is no current need for a national policy mandating the use of face masks by the general public in our country.

In other words, use of face masks in the community should not be enforced because community transmission of Covid-19 is very low with sporadic outbreaks.

We also have sufficient national capacity for contact tracing, testing, isolation and care.

The use of masks in public primarily aims to prevent the wearer from spreading droplets (such as spit) to others, but there is very limited evidence on preventing the transmission itself.

For a face mask to be effective, everyone outside the house must wear it continuously and in the right way. Assuming that half of our population is mobile, this means using at least 15 million masks a day.

The community’s compliance with the appropriate use and disposal of the mask further depends on the perceived risk of Covid-19 (transmission), cost and inconvenience or difficulty in using it.

The mandatory usage of face masks should be reserved for a time when it is truly needed to ensure that it remains a useful prevention tool in our arsenal to combat Covid-19.

Using the WHO approach, the use of face mask in public may be recommended when community transmission is moderate or high AND any one of the following is happening:

1) Our public health services are overwhelmed;

2) Physical distancing is difficult; or

3) In high-risk settings involving the elderly, immunocompromised or those with underlying chronic illness.

Individuals with symptoms suggestive of Covid-19 should wear a face mask until they get medical treatment, after which they would need to follow their doctor’s advice.

As the Covid-19 pandemic progresses, we need dynamic and sustainable policies and guidelines based on prevailing community transmission. We should be cautious in implementing strategies used in other countries, as these localities/countries may be at different stages of the pandemic and have differing transmission dynamics.

Our policies should be based on scientific evidence and account for local feasibility and sustainability.

A question I am often asked these days is: “Is there a risk of a second wave?” There is always a risk of subsequent outbreaks, but as a nation, we will be better prepared for them. And there may be a time in the future when community transmission of Covid-19 will spike and public use of face masks would be mandated.

DR SANJAY RAMPAL

Professor of Epidemiology and Public Health

Faculty of Medicine

Universiti Malaya