LAST October 28, 2022, President Ferdinand R. Marcos Jr. signed Executive Order No. 7 that allows the voluntary wearing of face masks, whether indoors or outdoors, except when in hospitals, medical or public transport vehicles. It also reiterated the continued observance and implementation of minimum public health standards.
The word “voluntary” is highly debatable, particularly in the medical community, given the fact that Covid-19 is still active. Variants and subvariants continue to emerge, plus the reality that vaccination coverage is quite low.
How can Filipinos remain protected in crowded public places? How should Filipinos be made aware and convinced that wearing of face masks, aside from vaccination and physical distancing, is one of the most effective deterrents against the dreaded disease?
To mask or not to mask?
Dr. Marissa Alejandria, Director of the Institute of Clinical Epidemiology of the UP Manila National Institutes of Health and immediate past president of the Philippine Society for Microbiology and Infectious Disease (PSMID), said they will still encourage everyone to wear masks indoors.
It should be noted that Covid-19 cases are decreasing and the deaths have drastically decreased both globally and locally. The infection fatality ratio is now down to one to two percent but variants continue to emerge, she said, like the XBB and the BQ.1.1. Though there is a rise in the number of cases, the vaccines continue to be effective in preventing hospitalization and death but are ineffective in blocking transmission. While highly transmissible, cases are predominantly mild especially among the vaccinated and boosted, Dr. Alejandria said during the latest TV UP webinar Stop C.O.V.I.D. Deaths titled “To Mask or Not to Mask.”
As for the country’s vaccination rate, the primary series is about 70 percent but booster coverage is still less than 50 percent, hence the need to increase boosting coverage. The emergence of variants means transmission is still ongoing so the virus can mutate, and the science in the transmission of Covid-19 is still the same. This means that person to person transmission is still the predominant mode through respiratory droplets that can enter the eyes, nose or mouth to the mucous membrane. The virus can also be aerosolized, become airborne and turn into respiratory droplets especially in enclosed places where airflow and ventilation is not good.
Is wearing masks still good enough and still safe?
Dr. Alejandria said wearing masks is still effective indoors. She said masks protect those infected from exhaling virus-laden droplets and at the same time protect healthy individuals, those without the virus or any symptoms and thus prevent the further spread of the virus.
“The community benefits from wearing masks because it acts to control the virus from being released and also acts to reduce inhalation of droplets by a healthy person. With source control and filtration functions, masks benefit both the community and the individual, the infected and the healthy ones, especially when worn correctly and consistently,” Dr. Alejandria explained.
Added to that, she said the wearing of masks has no side effects and is literally safe since it does not affect respiration. She also cited experimental and epidemiological studies showing the benefits of masking as well, like in Bangladesh in 2020. Surgical or cloth masks distribution, role modeling, plus active mask promotion tripled use by 42.3 percent that resulted in a nine percent reduction in symptomatic Covid prevalence.
Dr. Alejandria also pointed to a cruise ship where the wearing of face masks reduced infection by 79 percent, and that universal masking can help reduce infections, mortality and hospitalization growth rates. When using data for economic analysis, universal masking can prevent the need for lockdowns and reduce economic losses.
Choosing the mask to use
It is important to choose a mask with multiple layers to keep respiratory droplets in and that of others out, and to choose a mask with a nose wire to prevent air from leaking out of the top. The “Philippine Covid-19 Living Clinical Practice Guidelines” recommends the use of either a well-fitted cloth mask or a medical mask. “If a cloth mask will be used, it should have at least two layers of cotton or non-woven nylon with aluminum nose bridge.”
Those who should wear masks are those with symptoms, immunocompromised, the elderly, those with comorbidities, those living with people who are immunocompromised, elderly or with comorbidities, the unvaccinated and those in crowded areas, enclosed spaces and with poor ventilation. “Several studies have already shown that age is an important risk factor, where the elderly, those with other diseases, are at a higher risk of severe Covid-19.”
Be informed
Overall, Dr. Alejandria said people should be informed about the preventive actions they can take to protect themselves, their family, and the public, such as getting vaccinated and boosted, wearing well-fitted masks, getting tested and staying home when sick, practice cough etiquette and hand hygiene, disinfecting high-touch surfaces, avoiding crowds and poorly ventilated spaces, and maintaining physical distance.
“Public health is a shared responsibility. Let us all work together for safe, Covid-free environments,” Dr. Alejandria concluded.
Image credits: Nonie Reyes