Under pressure, airlines begin mandating passenger face masks

‘Delta Air Lines, American Airlines and United Airlines on Thursday mandated that passengers must wear face masks on board planes, and more are likely to follow, following intense pressure from airline unions and some lawmakers.

‘Flight attendant unions and Democratic lawmakers have been pressing the federal government to mandate masks on planes. Regulators have so far resisted the pressure, but the airline industry is beginning to turn toward implementing mask requirements piecemeal anyway.’

Read here (Politico, April 30, 2020)

How the face mask became the world’s most coveted commodity

‘No object better symbolises the pandemic than the mask, and no object better explains the world into which the pandemic arrived. Social distancing, at first, felt like a strange notion: the inaction of it, the vagueness of it. But the mask sang out to our deepest consumeristic impulses. In the absence of a drug or a vaccine, the mask is the only material protection we can buy; it’s a product, and we’ve been trained like seals to respond to products. As a result, in every corner of every country, the humble face mask – this assembly of inexpensive plastic – has been elevated into a fetishised commodity. One mask broker described it as “a madhouse”, another as “the craziest market I’ve ever seen”...

‘Whatever the new normal is after this pandemic, everyone I spoke with agreed on one thing: there will be masks. Lots and lots of masks. They’ll be handed out on airlines and at hotels; they’ll be stacked next to the till at Boots; they’ll be stashed in sock drawers and linen closets in practically every home. Every country will produce and stockpile its own supply, unwilling to rely any more on the vagaries of the international market; Germany, forever ahead of the curve, has already begun.’

Read here (The Guardian, April 28, 2020)

Potential to develop a more effective cloth mask with finer weave, more layers and a better fit

This study, which compares the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs), says the following: ‘Cloth masks are used in resource-poor settings because of the reduced cost of a reusable option. Various types of cloth masks (made of cotton, gauze and other fibres) have been tested in vitro in the past and show lower filtration capacity compared with disposable masks.

‘The protection afforded by gauze masks increases with the fineness of the cloth and the number of layers, indicating potential to develop a more effective cloth mask, for example, with finer weave, more layers and a better fit.

‘Pandemics and emerging infections are more likely to arise in low-income or middle-income settings than in wealthy countries. In the interests of global public health, adequate attention should be paid to cloth mask use in such settings. The data from this study provide some reassurance about medical masks, and are the first data to show potential clinical efficacy of medical masks.’

Read here (NCBI, April 22, 2015)

Watch a video on making surgical masks as safe as N95 masks: Towards Surgical Mask Brace 2.0, a scalable, open source design by ex-Apple engineers

Why adapt surgical masks?

• ‘Safety: Surgical masks have a government standard that regulates their filtration efficiency. They are regulated to meet ASTM standard F2100 which guarantees filtering 95% or more of COVID-19 sized particles.
• ‘Accessible: Surgical masks are faster to manufacture and more readily available. Currently, of the 200 million masks China makes a day, only 600,000 are N95 standard masks. That means surgical masks can be made more than 300x faster than N95’s.’

Watch here (fixthemask.com, undated)

Singapore announces enhanced “circuit breaker”: Masks now mandatory in public places

‘Everyone must wear a mask when outside of their homes. This applies on public transport, taxis, private hire cars, walking to or at markets, and also for essential workers at all workplace premises, whether they are frontline staff (such as food handlers, cashiers and bus drivers) or performing back office functions (such as data entry personnel and payroll executives). Individuals may remove their mask while engaging in strenuous exercise outdoors (e.g. running/ jogging), but they must put it back on after completing exercise. Mask-wearing is not recommended for young children below the age of two for child safety reasons. Medical experts have also advised that some groups may have difficulties wearing a mask, including children with special needs and young children aged two and above, and we will exercise flexibility in enforcement for these groups.’

Read here (Ministry of Health, Singapore, April 14, 2020)

Leaders in Africa, South Asia, and Latin America need to look carefully at alternative policies

‘Some possibilities include:

• A universal mask-wearing requirement when workers leave their homes (as masks and homemade face coverings are comparatively cheap, and such a policy is likely feasible for almost all countries to implement); 
• Targeted social isolation of the elderly and other at-risk groups, while permitting productive individuals with lower-risk profiles to continue working; 
• Improving access to clean water, hand-washing, and sanitation, and other policies to decrease the viral load; and 
• Widespread social influence and information campaigns to encourage behaviours that slow the spread of disease but do not undermine economic livelihoods. This could include restrictions on the size of religious and social gatherings or programs to encourage community and religious leaders to endorse safer behaviours and communicate them clearly.’

Read here (Foreign Policy, April 10, 2020)

WHO issues guidelines on the use of masks in community, homecare and healthcare settings

‘This document provides advice on the use of masks in communities, during home care, and in health care settings in areas that have reported cases of COVID-19. It is intended for individuals in the community, public health and infection prevention and control (IPC) professionals, health care managers, health care workers (HCWs), and community health workers. This updated version includes a section on Advice to decision makers on the use of masks for healthy people in community settings.’

Read here (WHO, April 6, 2020)

Covid-19: To mask or not to mask? — Amar Singh

‘The wearing of mask is an issue that is currently being hotly debated in many parts of the world. Some are calling it the “great mask debate”. I had planned earlier this week to write a full article on this but I think it would serve us better to read some of the very valuable commentaries that have already been done. What I hope to do is to summarise the key points to help us come to a better understanding on whether the general public should wear masks.’

Read here (The Malay Mail, April 3, 2020)

Case for wearing face masks (3): WHO considering changing guidelines

‘Speaking at a Chatham House briefing on Wednesday, Prof David Heymann, an infectious disease expert who led the global response to the SARS outbreak, said that new evidence from Hong Kong had prompted a reconsideration of the role of face masks. “The WHO is debating that tomorrow to understand if there is evidence that would call for a change in what WHO is recommending,” he said.

‘The data from Hong Kong was shared confidentially with the WHO, but is likely to be published soon, Heymann said. He added that, in reassessing its policy, the WHO would take into account health workers’ need for masks in all countries.’

Read here (The Guardian, April 1, 2020)

Face masks: Asia may have been right about coronavirus and face masks, and the rest of the world is coming around

‘Writing last month, Adrien Burch, an expert in microbiology at the University of California, Berkeley, noted that “despite hearing that face masks ‘don't work,’ you probably haven't seen any strong evidence to support that claim. That's because it doesn't exist…

‘In fact, there is evidence of the exact opposite: that masks help prevent viral infections like the current pandemic.

‘Burch pointed to a Cochrane Review -- a systemic analysis of published studies on a given topic -- which found strong evidence during the 2003 SARS epidemic in support of wearing masks. One study of community transmission in Beijing found that "consistently wearing a mask in public was associated with a 70% reduction in the risk of catching SARS.”’

Read here (CNN, April 1, 2020)

Case for wearing face masks (2): Microdroplets pose coronavirus risk

‘An NHK experiment found that microdroplets emitted while sneezing and coughing and during conversations stay in the air for longer than normal droplets, potentially posing a uniquely dangerous risk for coronavirus infection.’

View here (NHK, March 31, 2020)

Approved: System to decontaminate N95 masks and allow reuse -- as many as 20 times

‘A system to decontaminate N95 masks to allow healthcare workers to safely reuse them -- as many as 20 times -- has been approved by the US FDA. It uses hydrogen peroxide vapour to “destroy bacteria, viruses and other contaminants, including... SARS-CoV-2,” and it can process up to 80,000 masks per day.’

Note: This is interesting. If the principle of decontamination and re-use is acceptable, what other ways can we use to recycle personal protection equipment (PPEs) especially in poor countries?

Read here (Politico, March 29, 2020)

Case for wearing face masks (4): History -- showing how Wu Lien-Teh from Penang, in the face of racism and widespread doubt, soldiered on to make the face mask an icon of modern healthcare

‘In the fall of 1910, a plague broke out across Manchuria—what we know now as Northern China—which was broken up in politically complex jurisdictions shared between China and Russia...

‘The Chinese Imperial Court brought in a doctor named Lien-teh Wu to head its efforts. He was born in Penang and studied medicine at Cambridge. Wu was young, and he spoke lousy Mandarin. In a plague that quickly attracted international attention and doctors from around the world, he was “completely unimportant,” according to Lynteris. But after conducting an autopsy on one of the victims, Wu determined that the plague was not spread by fleas, as many suspected, but through the air.

‘Expanding upon the surgery masks he’d seen in the West, Wu developed a hardier mask from gauze and cotton, which wrapped securely around one’s face and added several layers of cloth to filter inhalations. His invention was a breakthrough, but some doctors still doubted its efficacy.

‘“There’s a famous incident. He’s confronted by a famous old hand in the region, a French doctor [Gérald Mesny] . . . and Wu explains to the French doctor his theory that plague is pneumonic and airborne,” Lynteris says. “And the French guy humiliates him . . . and in very racist terms says, ‘What can we expect from a Chinaman?’ And to prove this point, [Mesny] goes and attends the sick in a plague hospital without wearing Wu’s mask, and he dies in two days with plague.”

‘Other doctors in the region quickly developed their own masks. “Some are . . . completely strange things,” Lynteris says. “Hoods with glasses, like diving masks.”

‘But Wu’s mask won out because in empirical testing, it protected users from bacteria. According to Lynteris, it was also a great design. It could be constructed by hand out of materials that were cheap and in ready supply. Between January and February of 1911, mask production ramped up to unknown numbers. Medical staff wore them, soldiers wore them, and some everyday people wore them, too. Not only did that help thwart the spread of the plague; the masks became a symbol of modern medical science looking an epidemic right in the eye.’

Read here (Fast Company, March 24, 2020)

Case for wearing face masks (1): People who wore masks during the SARS outbreak had a 70% lower risk of being diagnosed compared with those who never wore masks

‘We also used this investigation to quantify the impact of behaviours (i.e. mask wearing, handwashing) that were promoted to reduce the risk for SARS. Wearing masks outside the home in a reference period corresponding to the 2 weeks before symptom onset for cases was significantly protective against clinical SARS.

‘Supporting the validity of this finding, there was a dose-response effect: by multivariable analysis, persons who always wore masks had a 70% lower risk of being diagnosed with clinical SARS compared with those who never wore masks, and persons with intermittent mask use had a 60% lower risk.’

Read here (NIH, 2004)