Obstacles to re-open the country
Hurdles to Business As Usual – Hurdles to Life as Usual – Living with COVID!
Obstacles to re-open the country
As we come to the 2-month mark of lockdown, its effect on the populous is becoming apparent. The extreme restrictions have had a significant impact on people’s physical health, mental health, and general livelihood, and many people are itching for life to get back to normal. Many countries including New Zealand, Germany, Italy, and Spain have seen the first peak of COVID infections pass, and some have already begun reopening parts of their economy. This has led to concerns from public health officials that relaxing the lockdown too early and too liberally will lead to a rapid increase in infection rates. Indeed, Germany has already seen an increase in R0 above 1 (one infected person will infect more than one person, causing the disease to propagate).
Trying to work out how to reopen a country without causing another spike in COVID deaths is probably the biggest issue faced by public health officials across the world. And trying to convey clear instructions to the public is an issue some countries are currently struggling with. In the next few blogs we will look at the issues faced, what has worked and what needs improvement, and what we as the public can do to keep ourselves safe.
THE MASKS WE WEAR
We have discussed masks at the start of the pandemic, and we have discussed masks as the pandemic has progressed. Why are we bringing it up again?
Masks have been a heated point of contention, but their role in public health has matured over the past few weeks. At the beginning of the pandemic, masks were a rare commodity, with DIY stores running dry of masks, stories of people stealing masks from clinical environments, and very confusing advice on whether the public should wear masks in public.
At that time the WHO had recommended only infected patients and those working with infected people wear masks, to save on the precious PPE for medical professionals. N95 respirators are seen as the gold standard in protective equipment, and hospitals are still struggling to provide staff with enough respirators, let alone the public. Concerns have also been raised on whether using masks will provide a false sense of security, especially if they stop washing hands or touch the infected parts of the masks.
But now we are past the first COVID peak, and advice on masks has changed. People should wear a mask if they are in public. Germany has implemented this advice, as has Austria for its public markets. In the US many stores are requesting public wear masks before entry. Rather than surgical masks or respirators, the use of homemade or purchased cotton masks has been encouraged.
LET’S LOOK AT WHY
Surgical masks and respirators aim to protect the user from inhaling microscopic aerosolized COVID particles. Cotton masks do not function this way. Instead, they prevent the wearer from spreading COVID by catching much larger droplets that is coughed/sneezed or generally breathed out.
The majority of people with COVID-19 are able to spread the infection to others up to 3 days before they show symptoms. Indeed as many as 50% of infections seem to occur from pre-symptomatic individuals. During this time they produce the greatest amount of viral particles, and these particles can stay in the air for several hours. Someone with asymptomatic COVID walking around in public or in a shop could infect lots of people.
So wearing a mask, even if you are not symptomatic or around infected patients helps prevent the spread of the infection. We know already just how infective COVID-19 is, so any measures that reduces infection even a little will end up reducing spread drastically on a population level. It has been compared to seatbelts – one person might not feel the benefits, but they save thousands of lives across the country on a yearly basis.
IS THERE ANY EVIDENCE?
In our blogs, we often talk about the importance of evidence. We look at the quality of evidence, how different types of research gives good and bad evidence, and why we should always give evidence-based advice.
So is there any evidence supporting masks? We have evidence that cloth masks can stop 99% of droplets that are coughed up, and whilst it doesn’t block aerosols or actual viral particles it still has a significant impact on transmission. We also have strong evidence from high infectivity in choir groups and at call centers that the majority of transmission is via the air, rather than from surfaces.
But what about the highest level of evidence? Comparing people who do or don’t wear masks is not a study that can be easily performed or one that has been performed adequately. But why should you wait? There is minimal to no risk associated with wearing a cloth mask, it offers some protection to you and a lot of protection to the public. In these cases, we should take a precautionary approach.
We don’t have any high-quality evidence looking at hand washing or physical distancing. But precautionary measures enforced have helped reduce infectivity. The same applies to masks. The best we can offer is an Australian study looking at mask use during influenza. They found observational data suggest that transmission of viral respiratory infection was significantly reduced during the SARS epidemic with the use of face masks as well as other infection control measures” and “in an adjusted analysis of compliant subjects, masks as a group had protective efficacy in excess of 80% against clinical influenza-like illness.”. In compliant users, masks were highly efficacious.
So that’s our advice. If you're going to go out in public, wear a mask.
If you don’t have a mask, you can order one online. Or be adventurous. Make one out of an old T-shirt or sock. Here are some ways to make one without needing to sew.
Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc