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Several countries are making masks mandatory - but experts differ over whether they're effective

Some European countries have ordered people to wear masks outside.

A man in Berlin wears a mask.
A man in Berlin wears a mask.
Image: DPA/PA Images

THE ISSUE OF masks – should you wear one, does it stop the spread of Covid-19 – has been growing in Ireland and around the world in recent days. 

As things stand, there is apparently no clear answer with experts and national governments as likely to disagree as members of the public on what the best approach is. 

In Ireland, the HSE is not recommending that people wear face masks – instead, people should continue staying inside and washing their hands. 

But many people are pointing to the experience of other countries – not just in Asia, where wearing a mask was more common pre-pandemic, but to other European states. 

And with the World Health Organisation set to review its own advice on the value of wearing masks, some are bracing for a u-turn – it currently only recommends healthy people wearing a mask if they’re looking after a suspected or confirmed coronavirus case, or where handwashing isn’t possible.

“The big mistake in the US and Europe is that people aren’t wearing masks,” George Gao, the head of the China Centre for Disease Control, told the journal Science.

And this doesn’t have to be high-quality professional PPE – increasingly, people are wondering whether cloth masks or homemade masks will make a difference against Covid-19. 

Europe

There’s already evidence of a growing split in Europe when it comes to wearing a mask. 

In the Czech Republic, an order making the wearing of face masks mandatory has been in place since 19 March, while Austria and Slovakia have both introduced similar measures. 

In Germany, the country’s disease control agency urged people to wear homemade masks – last week, the east German city of Jena grabbed headlines when it decided to make people wear face masks when shopping or on public transport. 

The federal health agency advice stresses that “community masks” are not a complete safeguard – and warns against a range of common mistakes people make when using and removing masks. 

les-petits-masques-solidaires-barsac In some countries, people are being encouraged to make masks at home. Source: Moritz Thibaud/ABACA

Dilemma

The World Health Organisation advice on masks neatly captures the very real dilemma faced by authorities in recommending whether or not masks should be used. 

“Wearing medical masks when not indicated may result in unnecessary costs and procurement burdens and create a false sense of security that can lead to the neglect of other essential measures, such as hand hygiene practice,” advice published on 19 March states. 

But in another statement this evening, the organisation said that the use of masks among the general public could be justified in areas where hand-washing and physical distancing were difficult – although it warned that masks alone could not stop the virus.

In other words, wearing a mask isn’t as simple as it seems. With clinical masks in short supply, some countries might be hesitant to recommend the use of masks and further add to demand – even if there are some health benefits.

It’s a reality that the Czech Republic has faced up to. With surgical masks in short supply in the country, citizens have got to work creating home-made face masks for the rest of the population. 

Evidence

But as more and more states decide to go their own way on masks, pressure will grow on the World Health Organisation. 

The fact that the US is now advising people to wear masks outdoors illustrates that it’s becoming more and more difficult for countries not to start reviewing advice. 

Alongside that political pressure, some point to evidence that suggests masks could be beneficial. One scientist and masks advocate has called Covid-19 a “silent assassin”, pointing to an article in the respected journal Nature that people can be infectious even in the early days after catching the coronavirus. 

Other studies – few related specifically Covid-19 – are being used by advocates to suggest that any kind of mask – even a homemade, cloth mask – is better than nothing during a pandemic. 

It’s perhaps an attitude summarised by Austria’s chancellor Sebastian Kurz, who said that his country would do all it could do “quickly return to normalcy and a functioning economy”. 

But as one MIT researcher, the author of a study on droplets and aerosols has noted, there have been no studies that have directly looked at the “biophysics of droplets and gas cloud formation for patients infected with the SARS-CoV-2 virus”.

Put simply, like so many things about Covid-19, the lack of concrete data about the virus makes giving advice about masks particularly difficult.

Kim Roberts, the leader of the virology research group in Trinity College Dublin, said people should be cautious when using masks. 

“The data would suggest masks can have a modest impact on reducing transmission, as long as used in conjunction with the two-metre rule, not going out if you have symptoms and regular hand-washing,” she told TheJournal.ie. 

If you aren’t a health professional, you’re not the priority for certified, clinical masks, Roberts stressed. 

“The risk is lower for the rest of us when we go shopping,” she said. 

When it comes to cloth makes, she thinks they can have a “modest benefit”.

“But that benefit varies depending on the material that mask is made from,” Roberts says.  “It’s important people understand the limitations as well as the benefits of wearing masks.”

For instance, there is a plausible argument to be made that while there could be a slight benefit to wearing a mask, this is outweighed by our own lack of knowledge of how to safely clean, store and use masks. 

“If wearing a cloth mask, you need to think about how you are going to take it off safely and wash it,” says Roberts. 

Taking it off outside – which means touching it with your hands – could even cause more spread of the virus if the wearer has Covid-19. 

Ultimately, as country after country becomes set on masks as a potential pandemic solution, more and more focus needs to be on teaching people how exactly to wear masks. 

And just because everyone else is wearing a mask doesn’t mean they’re doing so correctly.

“Wearing masks can make people feel safer. And it can make people feel like they’re doing everything they can to reduce transmission. But that is only true if people wear masks properly,” says Roberts. 

With reporting from AFP

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