Masking our fear or fearing to mask?

I got back from a long-overdue holiday on the Gold Coast with my wife late last week. My wife and I like to visit the Gold Coast because it is a destination that gives us multiple surprises. It caters to people who are after a relaxing tropical holiday where they can relax and lay by the pool the whole day and enjoy a few drinks. It also provides foodies with an unlimited variety of cuisine options to choose from and also offers shopaholics some well-situated shopping destinations to do some impulse buying.

 

No wonder it’s a destination of choice for many holidaymakers both locally and internationally. My last impression of the Gold Coast was two years ago. It was merely a touristy destination where it wouldn’t be hard for you to come across a big coach bus unloading groups of tourists at Surfer’s Paradise. However, this time around, the vibe has changed; it certainly noticeable that the amount of tourists has dropped significantly due to the coronavirus outbreak. I understand that tourism is important to the economy of a city/country but as a fellow tourist, I have to admit that even though it is not politically correct to say so – I enjoy the “not so many tourists around“ Gold Coast a lot more!

 

Despite having five confirmed cases of coronavirus in Gold Coast, I felt that people there are still pretty relaxed about the situation, no panic buying behaviour has been observed among locals – unlike what I’ve seen over the last weekend in Auckland – it was quite traumatising. Every single customer seemed to be desperately clutching on to as many toilet rolls as they could carry and I quickly thought to myself – well sh*ts going down now (excuse my language).

 

It felt like people are trying to get their hands on as many toilet rolls as possible before they inevitably ran out. For me, that was the turning point because when you start to see people panic like that, you inevitably begin to panic as well and I ended up with some toilet roll in my hands despite having just brought some not so long ago. For a split moment, I thought apocalypse is approaching.

 

Look, I don’t blame people for doing what they were doing. It is our natural human instinct to put ourselves and loved ones first over everybody else. Plus, many of those people probably have experience in what SARS and swine flu had offered almost a decade ago which contributed to such behaviour. However, what I don’t understand is why toilet paper, cooking oil and flour? I could be wrong – but would It be logical to stock up on canned and dried food instead? I suppose people might have long been dreaming of being a baker and what’s a better time than pursuing their dream during a virus outbreak? Look, this is just my silly remark. But hopefully, everyone can see the funny side of it.

 

Anyhow, during my time in the Gold Coast, I didn’t notice anyone wearing a mask. Hence, it diminished my thoughts of wearing one on the street. Because being the odd one out is not what I intended to do. Peer pressure plays a huge part in shaping others behaviour during pandemic times like what we are experiencing right now. There is a high tendency for us to abolish our thought of doing something that we believe is right when no one else is doing it around you. We, humans, tend to follow the crowd even if it doesn’t sound or feel right to do so. Our decision to act is shaped by our worries about what another thinks of us.

 

I had quite a few of you emailed me last week about whether you should start wearing a face mask, especially we have just been confirmed of 2 cases of COVID-19 in Auckland in the past few days (actually a 3rd case was being confirmed as of this morning). I think it would be a question that will be asked frequently from now onwards. I believe, as a health professional, I must give you all the accurate information for you to decide for yourself or your family. Before we dig deeper, we need to know what experts are saying. And to be honest, the recommendations are split between opposite ends of the spectrum. The difference is noticeable between countries that have been swept by SARs outbreak in 2003 and for those counties who have not seen great impact during the time. According to an article from the South China Morning Post, an infectious disease specialist in Hong Kong warned people that wearing masks together with washing their hands with soap or alcohol wipes is equally important because COVID-19 is mainly transmitted through contact as well as droplets. A leading microbiologist from Hong Kong also issued advice that social distancing was the only thing to do when asks are not available.

 

On the contrary, I remember reading an article from radio NZ not long ago where the journalist interviewed a consultant virologist from Cambridge University NZ about the effectiveness of face mask in protecting you from COVID-19. He suggested people to “not buy them and instead save their money and spend it on something useful that you enjoy doing, like having a beer. The face masks are absolute rubbish, and they do nothing.” I’ll let you all be the judge of this, but after reading this article, I was furious. I know he probably said in a playful tone, but irresponsible saying like this can potentially do more harm than the good he intentionally sent out to do. Not only that he is actively promoting the use of alcohol publicly but also claiming that face mask is a total waste of time is absurd! Ask yourself a question, if a surgical face mask is “total rubbish” then why do healthcare professionals in particularly in hospitals wear them on the wards? Yes, I agree that surgical face mask, when used in hospital settings, is mainly to prevent contact with bodily fluids when caring for the sick and it does not offer 100% protection. However, in saying that what we know about coronavirus so far is that it spread in large droplets by coughing and sneezing. And according to some experts, all the surfaces where the droplets land are infectious for up to a week. What we also know is that the virus only has receptors for lung cells meaning that it only can infect your lungs. Hence, the only way possible way the virus could enter your body is through the entrance of your nose and mouth. In other words, we will be doomed if our contaminated hands touch our face, mouth or nose and also when an infected person sneezes or coughs into you. Based on this available information, we can conclude that surgical face mask can offer some protection by stopping you from touching your nose and or mouth.

 

Considering that an average person can touch their face for up to 3000 times per day, wearing a properly fitted surgical mask can be very helpful in protecting us from inoculating the virus by our own hands. However, what we also need to be aware of is that the mask will not prevent us from the virus in a direct sneeze from getting into your nose or mouth. This is because a typical three layers of surgical masks is designed to filter large particle droplets of greater than 2 microns (0.002mm) in diameter. Unfortunately, the coronavirus measures between 0.1 and 0.2 microns, which is 10 to 20 times below the cut off for surgical mask.

 

Even if you wear an N-95 respirator mask, it only can filter out particles down to 0.3 microns 95% of the time. However, the good thing with the coronavirus is that it usually travels on a large droplet, which can make your mask easier to filter them. According to the WHO, there may be a benefit in wearing a face mask to reduce the spread of infection to other people. If people are unwell or and come in contact with the individual who may have COVID-19, then face masks are recommended.

 

This made me wonder….

 

Should we all start wearing a surgical face mask then? Or a better question to ask is when should we start wearing one? Base on the current situation in NZ, I don’t think it is necessary unless you are constantly in contact with infected or suspected individuals. Again, the situation is constantly evolving. We’ll never know how the virus may spread in NZ. Or the worst case is that the virus may have already been spreading widely within the community that we are not yet aware of. Hence, I believe that people should have surgical face masks and hand sanitisers handy at home but not to the extent that you will have a year’s supply of it. Before you go crazy stocking up on masks, hand sanitiser or disposable gloves you should think about this – if every single person in NZ decided to start wearing a face mask from now, it is simply not possible to do so without creating a severe shortage. If we all use, we would need a minimum of 144 million a month. That is for a city of 4.8 million. Let’s face it, a more practical way we all could be doing right now (at least for the time being) instead of hoarding face masks in preventing the spread of the virus is by practising the following precautions:

 

• Wash your hands frequently
• Avoid touching your face
• Keep clear of very crowded places (COVID-19 is usually present in large droplets which cannot travel far – if you are more than 1 metre away from an infected individual, your chance of getting the virus is very small)
• Avoid touching any surfaces with your bare hands (using your knuckle or fist instead)
• Use alcohol hand sanitiser when you need to touch anything
• Cough or sneeze into a disposable tissue and discard

By practising the above right now, we all can delay the need to wear a mask and give priority to people who truly needs them, such as the elderly or unwell, people with long term conditions, and of course the frontline health care workers.

May the hygiene force be with you all.

 

Chris Pharmacist