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Should I Wear A Mask In Public All The Time?

Short answer: Yes!

Longer answer: I am 99.9% certain that EVERYONE should wear a mask when out in public ALL THE TIME.

There are two main reasons why I am saying this: one’s medical, and the other one is cultural.

Medical

The first thing to note is the World Health Organization’s own advice on ‘When and how to use masks‘. Broadly speaking, the WHO says that you should wear a mask in the following situations:

  • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
  • Wear a mask if you are coughing or sneezing.

Here in Malaysia, the official advice from ‘Kementerian Kesihatan Malaysia’ (KKM) is similar to the one given by the WHO. I have a lot of admiration and respect for our KKM, as well as its Director-General (who I think is a national hero regardless of how much he tries to deny it!). Nothing of what I say should take away from the fact that they have done an incredible job at managing the COVID-19 situation in Malaysia. Having said that, I humbly beg to differ with regards to their advice on the use of face masks.

One of the main reasons for saying that masks are not needed for all is due to the worry of not having enough masks for healthcare providers. I fully understand that, and in a situation where the supply of masks is limited, I completely support giving it to those who need it the most. Once that is taken care of, however, we really should consider making it ‘highly recommended’ for people to wear masks in public all the time.

Of course, the science behind this is still developing. But absence of proof is not proof of absence. In other words, just because we don’t have scientific papers showing how wearing masks in public reduces COVID-19 transmission rates, doesn’t mean that masks don’t work! The main problem with saying ‘you only need to wear a mask if you’re sick’ is this: people can be asymptomatic carriers.

An asymptomatic carrier, or even a COVID-19 positive individual with very mild symptoms, may not even be aware that he/she has the infection. Here the science is stronger. We know that people can be asymptomatic carriers. We know that asymptomatic carriers can pass on the virus to other people. After all, that is the basis of our social distancing and restriction of movement efforts. So if you take into account that we can be walking around feeling perfectly well while shedding the virus, then it doesn’t really make sense to say that you only need some form of protection i.e. masks, only if you’re unwell and at risk of passing it on to others.

Medically-speaking, do face masks work all the time? Of course not. No reasonable intervention does. But even a 5%, or 10% improvement, is better than nothing. Progress, not perfection. If you’re even remotely familiar with how new medical treatments are approved, you will know that some drugs/procedures are given approval simply for showing a statistically significant, but clinically marginal, benefit over their competitors. So if I were to tell you that we have a cheap, relatively safe, readily available intervention that can help to further ‘flatten the curve’, wouldn’t you want to use it?

Cultural

The other main reason for recommending widespread use of face masks in public has to do with destigmatizing the whole condition. If people are only told to wear face masks when they are unwell, then guess what your reaction will be when you encounter someone in public wearing a face mask? You’ll probably avoid that person like the plague, or like COVID-19, as it were.

I’ve heard many stories of healthcare workers being inadvertently exposed to the virus because one of their patients chose to withhold important travel or contact information. I don’t believe all of these cases are due to selfishness, malice, or stupidity on the part of the patient. Fear of stigma can make you do foolish things.

Look, this movement control order cannot last forever. Once it is lifted, and people try to go back to their normal lives, there is a real risk of another wave of COVID-19 infections. We can do more to ‘flatten the curve’ further by making it acceptable to wear face masks when going shopping, when at school, or when attending meetings.

Suggestions

If I were helping the government to implement this policy, in addition to all the economic measures that have been announced, I would certainly consider handing out washable face masks especially to the people who need it the most e.g. the urban poor who are less likely to be able to practise social distancing effectively.

Given a choice between disposable and washable face masks, I’d vote for the latter, simply because they are more practical and sustainable. In order to meet the demand for washable face masks, I think there are a few possible solutions, for example engaging local businesses to manufacture and distribute them, and even teaching people how to make their own. I mean, if Penor Prison inmates can make personal protective equipment, why can’t people make a basic face mask themselves?

Does it matter that it is made of cloth instead of whatever fancy material that medical-grade face masks are made of? Probably.

Does it matter if it is 1-ply, or 2-ply, or 3-ply? Maybe.

But remember, we should aim for progress, not perfection. Even some level of protection is better than none, given the situation.

Epilogue

This post was inspired by an excellent article by Ben Thompson over at Stratechery entitled ‘Unmasking Twitter‘.

I used to think that wearing face masks when you’re feeling well is a bit of a waste of time, despite my wife telling me otherwise. (Editor’s note: Kids, this is the reason why your significant other is called your better half!) I now think that we should strongly recommend the use of face masks in public all the time.

For the record, I am perfectly happy to be proven wrong by any doctor, epidemiologist, social activist, keyboard warrior, or even acik bawang Facebook. Just show me the evidence. I am only interested in getting to the truth, something that will help us win this war against COVID-19. This is not about me trying to be smarter than all the other experts. This affects all of us, and now is not the time to be dogmatic or egoistic about potential solutions.

Speaking of which, I hope you will excuse me while I figure out how to apologize to my wife and admit that she’s been right all along. Maybe I should use my Doraemon voice…

By Imran Idris

I am a husband, father, son, neurologist, neuroscientist-in-training, Tolkien-fan, and owner of two toy wombats named Mulder and Scully.