‘Voluntary masking should be the way forward’

Updated on Apr 03, 2022 11:33 PM IST

Mumbai Maharashtra has dropped its mask mandate

Those who are forced to use a mask because of a mandate often wear it in ways which are unlikely to protect - loosely, under the nose, on the chin, or with frequent touching of the mask (Pratik Chorge/HT PHOTO)
Those who are forced to use a mask because of a mandate often wear it in ways which are unlikely to protect - loosely, under the nose, on the chin, or with frequent touching of the mask (Pratik Chorge/HT PHOTO)
ByDr Lancelot Pinto and Reuben Abraham

Mumbai Maharashtra has dropped its mask mandate. We welcome it, and not because we don’t believe in masks. Both of us are individuals who had Covid after the first wave, and are convinced that masks helped us delay the infection, and possibly have a milder infection. This is validated by scientific studies that have proven, beyond a doubt, that masks protect. Yet, we believe that mandatory masking, especially in open spaces, does little to prevent spread. There are several reasons to believe this.

Despite stringent mask mandates, a majority of Indians were infected in the first two waves. This is reflected in the high seroprevalence rates in both government and private studies. Even with the Omicron variant, spread was rampant. The low incidence of severe disease in the latter case was attributed to a combination of a high seroprevalence and vaccination coverage. Recent studies have also shown that SARS-CoV-2 transmission is arrested only by high efficiency masks (N95 or K95) or surgical masks, and cloth masks do little to prevent spread. Yet, most people wear cloth masks as they are relatively comfortable to use.

Those who are forced to use a mask because of a mandate often wear it in ways which are unlikely to protect - loosely, under the nose, on the chin, or with frequent touching of the mask. There is enough anecdotal evidence around us that such individuals possibly constituted the majority, even in the middle of surges, and it reflects the lack of a good communications strategy regarding proper mask use.

So what does mandatory masking actually do? It leads to imposition of fines, policing citizens for what should be a health policy issue and discrimination among individuals for behaviors that they are expected to pay out-of-pocket for. It also led to utterly irrational policies such as mandating masks within private vehicles and in open spaces. Meanwhile, crowded indoor spaces, where masking is likely to be most useful, were often exempt.

Similarly, expecting little children to wear masks was not just unrealistic, but likely counterproductive in terms of developmental outcomes. Masking isn’t completely innocuous either. A study among volunteers using K95 masks found an increase in carbon dioxide levels within 15 minutes of use. Although the increase was considered clinically insignificant for short term use, we know little about the long term effects.

Mandatory masking also results in the generation of waste, the magnitude of which cannot be ignored. Voluntary masking should be the way forward. We need to normalize wearing a mask, as many East Asian countries have done, more so post the SARS epidemic. In fact, it’s likely that those who wore masks diligently in India would have done so, with or without a mandate. So, we need to educate the rest to help them make risk assessments (indoors versus outdoors, crowded versus not, well-ventilated versus poorly-ventilated) to make choices regarding the need for masking.

In addition, India deals with another respiratory illness on a more regular basis - tuberculosis – which kills hundreds of thousands of people every year. High quality masks have the additional benefit of offering some protection against TB too. We also need to encourage individuals to protect others by masking up when ill, and such sensitization needs to begin from an early age.

In most healthcare contexts, supporting behavioural change with the right education measures and policy nudges work far better than mandating it. In addition to voluntary masking, the other modification that can yield huge benefits is provision of better ventilation in buildings. The Environmental Protection Agency (EPA) in the US has recently issued science-based guidance on indoor ventilation, filtration and disinfection as part of the Biden administration’s push for focusing on preventing indoor transmission. This is part of an initiative called “Clean air in buildings challenge,” which makes the case that an investment in clean indoor air has returns well beyond preventing the spread of COVID-19.

Rather than enforcing mandatory masking ever again, India needs a mandate on indoor air quality and ventilation, to prevent spread of transmissible airborne diseases such as SARSCoV-2 and tuberculosis. Before the cholera breakout in London in the mid-1800s, clean water was not an important consideration for governments. A better understanding of the causes of cholera led to a push for clean water. Eventually clean, potable water became a right in most developed countries. In a similar vein, we must use the lessons from Covid-19 to make a concerted push for better ventilation and clean indoor air.

Dr Lancelot Pinto is a pulmonologist and epidemiologist at PD Hinduja Hospital, and Reuben Abraham, CEO of Artha Global, a Mumbai and London-based policy research & consulting firm

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