NATIONAL NEWS - The World Health Organisation (WHO) is sticking to its guns that people who are not infected with the coronavirus or caring for someone with Covid-19 should not wear masks.

Dr Mike Ryan, executive director of the WHO health emergencies programme, said on Monday there is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. 

“In fact, there's some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly," he said.

The recommendation was made primarily based on the global shortage of masks. "Right now the people most at risk are frontline health workers who are exposed to the virus every second of every day. The thought of them not having masks is horrific," Ryan said.

However, the latter statement merely serves to confirm the belief that the correct use of masks fulfil a crucial function to prevent the spread of the virus.

The worldwide debate about the wearing of masks is also raging in South Africa following a statement by the Western Cape Ministry of Health asking the general public – those who have not been exposed to or infected with the coronavirus – to refrain from wearing masks and gloves.

Western Cape Health Minister Nomafrench Mbombo said, "Wearing a mask or gloves when going to the supermarket or pharmacy to buy essentials is ineffective, unnecessary, and will not protect you from the coronavirus. In fact, it spreads the virus faster because it makes you a carrier from one person to another, it also gives false security that you don’t need to wash or sanitise your hands."

She added, "Personal protective equipment (PPE) is a scarce commodity and should be used appropriately and by the appropriate people. If you are not ill and not in close contact with someone who has coronavirus, you do not need to wear a mask or gloves. These are only important if you are in direct contact with - or caring for a person who is confirmed or suspected to have Covid-19, at home or in a health facility. This is part of infection control."

Wrong tack
The WHO and Mbombo’s statements are widely criticised by citizens who say they are taking the wrong approach. One avid mask wearer, Lily Adamson, says their tack should be to ask people to wear homemade masks only and to educate the public about the correct use and sterilisation of homemade masks. 

“People should be taught not to wear damp or dirty masks.”

Dr Pieter E Streicher (PhD Engineering) says in an article that, although non-medical people do not currently know how to handle and wear homemade face masks, there is no reason why they will not be able to learn the correct practices. 

“One way to practise to not touch your face would be to wear a homemade face mask at home [Price, 2020]. The face mask will make you more aware of when you touch your face. This needs to be practised long before you wear a homemade face mask in public, or long before you need to care for a Covid-19 patient in your household.

“During the lockdown period, the intention is for you to only go out to buy food or medicine. This should be a short mission avoiding the prolonged-wear risks. There should be no eating or drinking during this mission. When returning home, it must be assumed that the homemade mask is contaminated, and it must be washed immediately.”

Homemade masks
Streicher provides the following advice on mask making: “Masks can be made from a variety of readily available materials. T-shirt material and pillowcase material have been shown to adequately filter droplets and have good breathability, according to the scientific paper by Davies and others (2013). In poorer countries, where physical distancing is more difficult, everyone still has access to T-shirts.”

Meanwhile a comprehensive video by data scientists Jeremy Howard and Rachel Thomas of the University of San Francisco, in which they make an appeal to every human on planet earth to wear a mask when in public, has gone viral.

Howard and Thomas agree mask use is controversial because of the limited supply of proper masks. They agree that social distancing is the best protection, but for most of us it is impossible to stay away from others all the time.

They advise people to immediately remove the mask after wearing and to sterilise it by placing it in an oven at 70° for 30 to 60 minutes – and of course to wash your hands and face.

This of course is an impossibility for millions of South Africans who live in shacks with no ovens (or electricity) and no running water. 

The only options available to the poor is washing the mask by hand or having a few homemade masks that one can rotate after a minimum of three days. A 72-hour or more “resting period” should see any trace of the coronavirus disappear. 

But even this is impractical. Where are you meant to keep the possibly contaminated mask for three days if you share a small confined space with others?

Jury still out 
According to the European Centre for Disease Prevention and Control (ECDC), there is limited guidance and clinical research to inform on the use of reusable cloth face masks for protection against respiratory viruses. “Available evidence shows that they are less protective than surgical masks and may even increase the risk of infection due to moisture, liquid diffusion and retention of the virus. 

Penetration of particles through cloth is reported to be high. In one study, 40–90% of particles penetrated the mask.

“In a cluster randomised controlled trial, cases of influenza-like illness and laboratory-confirmed viral illness were significantly higher among healthcare workers using cloth masks compared to the ones using surgical masks. Altogether, common fabric cloth masks are not considered protective against respiratory viruses and their use should not be encouraged. 

"In the context of severe personal protective equipment shortages, and only if surgical masks or respirators are not available, home-made cloth masks (e.g. scarves) are proposed as a last-resort interim solution…”

Gloves 
Although the virus can survive for up to three days on hard surfaces like glass, steel, counter tops and plastic, the use of gloves as a protective measure against Covid-19 for the general public is not recommended. 

A virologist at Imperial College London told www.independent.co.uk that they worry items like gloves give a “false sense of security” and washing hands regularly is a far better precautionary measure.

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