The tide against mask scepticism is turning - and it will be a tsunami

Just in the couple of days since we published our article about Czech Republic's success in combating the spread of COVID-19, we have seen governments around the world starting to shift their position on masks. We think that once it takes off - it will become a global phenomenon.

A quick summary of mask related events just in the last 2 days.

US CDC (Centre for Disease Control and Prevention)

The CDC has updated its guidelines and position on the use of face masks and now recommends "wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission."

The important distinction is the emphasis on "cloth" face coverings, and not surgical or N95 masks. This is because there is still a shortage of medical grade masks in the US and the CDC does not want the public to compete with medical professionals for these masks, albeit that they are more effective than cloth masks at preventing spread of the virus.

The CDC now recognises the fact that asymptomatic carriers of coronavirus can continue to spread the virus through "speaking, coughing, or sneezing", and that the use of even cloth masks in close interactions can slow the spread of the virus.

In fact, the situation is so urgent that the CDC has even released a FAQ page on how to wear a mask/face covering and also how to make DIY masks using a sewing machine or even just to cut up an old t-shirt.

Singapore's "circuit breaker" preemptive strike against COVID-19, and new mask guidelines

On April 2, Singapore announced a preemptive "circuit breaker" set of policies aiming to slow the spread of COVID-19. The articulate and measured address by Prime Minister Lee Hsien Loong, in three languages no less, can be seen below.

It effectively amounts to a semi-lockdown measure, closing schools, most businesses and compels residents to stay at home "except to purchase daily necessities, essential services, or for urgent medical needs". Light exercise outside such as cycling is allowed (which we are happy to hear!), but only on your own.

Within the announcement, there was also a shift in position of the use of masks. Singapore is now diverting from WHO's general recommendations on the use of masks, due to the increased numbers of local transmissions, as well as "some evidence that infected people showing no symptoms may infect others".

The fundamental change is now that if residents are for any reason "unable to avoid close contact with other, then wearing a mask could provide some protection". It then essentially asserts that the preference is for the use of reusable masks, due to the global shortage of surgical masks, and the prioritisation of those masks for healthcare workers.

Importantly, the Singapore government will now distribute reusable masks to all residents with registered home addresses. This signifies a dramatic change of policy as the high population density of the population effectively means that all Singaporeans will be expected to wear masks in their daily lives.

Taiwan updates guidance on masks

Taiwan, who's successful containment of COVID-19 thus far has been broadly praised across the globe, has also tightened its guidance on the wearing of masks due to increases in domestic cases. Currently, Taiwan has reported 355 cases, and while most cases are "imported" cases from returning nationals, there has been small, incremental increases in domestic cases with no link to foreign travel.

In response, the government is now mandating all users of public transport to wear masks. In addition, it has introduced social distancing guidelines of 1 meter outdoors and 1.5 m indoors, and when that is not possible, such as in the public transportation systems, then people should wear masks. So far, the Taiwan government have not gone to making mask wearing compulsory like the Czech Republic. However if the number of COVID-19 cases rises dramatically, it seems likely to move in that direction.

Taiwan has a domestic mask rationing system where all citizens can purchase 9 surgical grade face masks every 14 days at an astoundingly low price of US$0.73 per three masks, upon inspection of their National Insurance Card (the island has virtually 100% national healthcare coverage). There is reportedly no mask shortage in Taiwan and residents can purchase without delays. In fact, the government has also recently announced a program to donate 10 million masks to the US and Europe. Exporting of masks or price gouging of masks is illegal and subject to heavy fines.

US and UK Media

Influential media sources in US the UK have started to publish opinion pieces with more definitive stances in favour of wearing masks, for example CNBC's article "Why we should all start making our own face masks during coronavirus—and an expert-approved guide on how".

In the Guardian, the opinion piece "To help stop coronavirus, everyone should be wearing face masks. The science is clear" stirred debate with over 370 comments and shared over 5,000 times.

Thinking is starting to shift, and the direction is clear

The WHO is currently taking consultations and is considering changing its guidance on the wearing masks by the general public. The evidence for increased use of masks is mounting, and we are likely to see countries continue to update guidance irrespective of WHO's official recommendations. If, however, the WHO does update its guidance, we will no doubt launch into a new phase of COVID-19 containment with the humble cloth face mask at the centre of the battle against the coronavirus.

Cover photo credit: CDC