Fri | Aug 7, 2020

Michael Abrahams | Why everyone should wear a mask…properly #masks4all

Published:Monday | April 6, 2020 | 12:30 AM

As the COVID-19 pandemic gallops across the planet, leaving a trail of sickness, death and social upheaval in its wake, a debate has raged among lay people as well as medical professionals regarding who should be wearing masks.

There is no argument against medical personnel wearing masks while managing COVID-19 positive patients. That is a no-brainer. But the benefits of the populace wearing masks when out and about are becoming apparent.

One of the main concerns why mask-wearing by the general public was not initially encouraged is the concern that if masks used by heath care workers were purchased and used by the populace, supplies would become strained and the devices unavailable for those who genuinely need them. For example, N95 masks, specialised masks used by medical professionals when dealing with infectious patients, are now in short supply, but regular folk can be seen wearing them on our streets.

However, during a recent interview, Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the United States, made a good point, saying, “When we say you don’t need to wear a mask, what we’re really saying is make sure you prioritise it first to the people who need the mask. In a perfect world, if you had all the masks you wanted, then somebody walking in the street with a mask doesn’t bother me. You can get some degree of protection.”


Now, cloth masks, even homemade DIY ones, are being encouraged by a growing number of experts, organisations and governments. For example, Dr Mike Ryan, World Health Organization (WHO) health emergencies programme executive director, has now backtracked on previous comments and said, “We can certainly see circumstances in which the use of masks, both homemade and cloth masks, at the community level may help with an overall comprehensive response to this disease.”

One concern about the use of cloth masks is the fact that these materials are porous and that viral particles can pass through them, rendering them useless as barriers. But they are not inefficient. Research has found that the infection is spread mainly by droplets, which are considerably larger than individual viruses.

Droplets are expelled when a person sneezes, coughs, laughs, speaks or even exhales. Infection is spread to you when the droplets are expelled in the vicinity of your face, or when you touch a surface contaminated by them, then touch your nose, mouth or eyes.

According to a 2009 World Health Organization report, when someone coughs, they can spray up to 3,000 droplets, and a sneeze can produce as much as 40,000. Cloth is not a perfect barrier but is enough to stop at least some of the droplets from reaching your face if they are coming your way, or landing on surfaces or someone else’s face if you expel them, especially if more than one layer of material is used.


Another argument used against the widespread wearing of masks is that they are not needed if you or others around you are not sick. But emerging research has found that not only are some persons infected with the virus asymptomatic, but also that the virus can be shed and spread by these individuals.

CDC director Dr Robert Redfield said in a recent interview that up to 25 per cent of infected people may not show symptoms, and that people who are symptomatic shed the virus up to two days before displaying symptoms.

Also, a study published in the journal Science shows that "nondocumented infections were the infection source for 79 per cent of documented cases." According to Jeffrey Shaman, the lead author, this "stealth transmission" is flying under the radar and becoming a major driver of the epidemic.

Importantly, observations of regions where masks are in widespread use has shown that these areas have “flattened their curves” during the pandemic. In other words, they have kept their infection and death rates relatively low while the infection decimates several countries and their health, economy and other sectors.

Significant blunting of the effects COVID-19 has been observed in South Korea, Taiwan, Hong Kong, Vietnam, Singapore and the Czech Republic. These countries and territories employ varying levels of testing and quarantine protocols, but they all have one thing in common: the widespread use of masks. In some countries, such as the Czech Republic, it is mandatory to wear a mask when out in public, and failure to do so can attract a US$800 fine for public disobedience.

A study published in the Journal of the American Medical Association found that under some conditions, droplets from sneezes, coughs and exhaling can travel more than 26 feet and linger in the air for minutes.

We may be exposed way more than we realise. So, although masks are of value, we must not be lulled into a false sense of security when wearing them, and we need to remain vigilant and still practice social distancing and regular and proper handwashing.


And masks must be worn and maintained properly.

One of the benefits of wearing a mask is that it also presents a barrier between your hands and your nose and mouth. However, when wearing a mask, you should still refrain from touching your face and the outer aspect of the mask to avoid contamination.

If the mask becomes moist or wet, it should be removed, and must always be washed properly after use by agents that will kill the virus.

Washing in hot soapy water works, and various disinfectants can also be used. A list of effective agents can be found on the website of the United States Environmental Protection Agency (EPA).

Even though evidence suggests that masks reduce personal risk, critics state that data on efficacy are scant. However, as a group of Hong Kong scholars recently stated in The Lancet, "there is an essential distinction between absence of evidence and evidence of absence.”

The paucity of data regarding widespread mask use does not mean that masks are not effective. Right now, the potential benefits clearly appear to outweigh the risks.

The Czech motto is: “your mask protects me, my mask protects you”. I agree.

- Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to and, or tweet @mikeyabrahams