Is the "mask mandate" slowly killing us?

Dear Editor,


On April 8, 2020, the Office of the Prime Minister (@opmthebahamas) announced that every person that leaves their place of residence must wear a mask, and shops may deny entry to a person if they are not wearing a mask ('the mask mandate'). This national mandate has since been strictly enforced across sectors with recent penalties such as a fine of $200 or imprisonment for non-compliance as per section 4 of the Emergency Powers (COVID 19 Pandemic) (No. 6) Order, 2020. However, prior to the initial announcement of the mask mandate, there was, and somewhat still is, a global debate surrounding the feasible, economic, environmental, and health issues associated with such a mandate.

 

In March 2020, I abruptly postponed BPTC and LLM studies at City, the University of London in the United Kingdom to flee to The Bahamas. I had accepted that my leadership-driven academic career was coming to a sudden end. Before leaving the UK, however, I actually met with my local GP and was advised not to wear a mask because they collect bacteria and, if not used carefully, could lead to a greater risk of spreading viruses in public or at home.


On 22 March 2020, I was scheduled to travel outbound from London, UK to Toronto, Canada and then Nassau, The Bahamas. This was the hectic weekend of the COVID-19 global travel bans and restrictions. During the two flights, I changed and disposed of my masks properly, physical and social distanced from others, especially during the 5-hour layover in the arrival area of the Pearson Int'l Airport, as well as practiced hand hygiene. Despite my GP's advice, I still opted to wear masks during my travels because of the high risks associated with crossing two jurisdictions via two global cities, and I know I often touch my face. I took special care not to touch my face, or the surface of my masks, or any other items by using a cart. I believe that this package of preventive measures significantly contributed to a very low risk of infection. I am grateful to have returned home safely with no symptoms after a 14 day self-isolation period at home. Now, my mission is to commit to a life of professional growth and national development here in The Bahamas.


 

On 7 April 2020, Ian Sample, a Science editor at the Guardian (UK), published an article reporting statements by medical experts like Prof David Heymann, of the London School of Hygiene and Tropical Medicine, who chaired the WHO’s scientific and technical advisory group for infectious hazards. '[He] said that unless people were working in healthcare settings, masks are “only for the protection of others, not for the protection of oneself”.' Prof Heymann went on further to say, masks could create a false sense of security that they are 100% preventive. We can all now appreciate that they are not 100% preventive given that the virus is transmittable through innocent and/or negligent contamination by masks and through the eyes. This is also evident by the high confirmed cases, samongst medical professionals, and even the unfortunate deaths of the late Dr Judeas Eneas, Percy Smith, ___ and so many others. This is why medical expert Dr. Anthony Fauci, a long-serving director of the National Institute of Allergy and Infectious Diseases (NIAID), has gone as far as to suggest that citizens should wear goggles or a face shield coupled with masks in order to prevent spreading or catching the virus.


Nevertheless, the false sense of security also leads to potentially lower adherence to other critical preventive measures such as physical distancing and hand hygiene. The question now arises whether this false impression and the likelihood that the general public is not professionally skilled to handle or dispose of potentially contaminated items (i.e. persons may innocently contaminate themselves when they adjust, remove and dispose of their masks) could end up putting people at greater risk.


 

We have seen various public and private organizations mobilizing to make masks more accessible to the public. The Bahamian government encouraged an emerging masks and face shields manufacturing industry by imposing a ban on the imports of non-medical masks. Although this may be considered the first COVID-19 #BuyBahamian trade policy to ensure that Bahamian dollars remain within the country, the government must still ensure that manufacturers are creating masks with the correct design and materials. If otherwise, the health risks will definitely undermine the economic benefits of such a policy. Therefore, corporate and government institutions in the Bahamas have a newfound social responsibility not only to ensure better access and enforcement of the mask mandate but that suppliers are properly educated on how to professionally produce them and customers understand how to handle them with care, especially distinguishing between single-use medical and cloth masks.

Take for instance the Commissioner of Police, Mr Paul Rolle's giveaway of care packages, which is obviously greatly appreciated, along with medical masks to members of the Montell Heights Community, Nassau Village, and Windsor Lane. The immediate alarming issue here is that we know that the WHO has stated, "There is limited evidence that wearing a medical mask by healthy individuals in households, in particular those who share a house with a sick person, or among attendees of mass gatherings may be beneficial as a measure preventing transmission." [Source: The updated interim guidance entitled 'Advice on the use of masks in the context of COVID-19'].


The questions arise as to whether the officers informed the communities of the risks associated with wearing the provided single-use medical masks for long periods of time? Is the Commissioner of Police aware of the fact that "the use of medical masks in the community may divert this critical resource from the health workers and others who need them the most? Experts still assert that in settings where medical masks are in short supply, medical masks should be reserved for health workers and at-risk individuals when indicated." (page 8 of Interim guidance).


Although it is popular knowledge that medical masks are better at stopping COVID-19 transmission than masks made of cotton or polyester [Source: Guardian], which is obvious given their high demand, the issue here is that the government intentionally provided single-use disposable medical masks to the general public. Without a proper understanding of how to use them may definitely perpetuate the forewarned false sense of security and arguably raise brows of targeted genocide. In fact, it is mind-boggling to see our armed forces distributing medical masks to the public (as opposed to 3-layered fabric masks), especially given the recent outcry for personal protective equipment for our frontline health and care workers.


On 1 July 2020, it appears that the Bahamian government has put an end to single-use plastic only to mandate another single-use item that is now plaguing our waste systems and oceans. Unfortunately, cutting the ends of the masks is not going to be enough to combat this emerging global environmental issue. It is 2020, the year of unavoidable entanglements, and a big stopwatch ticking on our planet. William Keevil, a professor of environmental healthcare at, my alma mater, the University of Southampton, was right when he said that governments felt under pressure to be seen to be doing something, even if it was a waste of time and valuable resources.

 

In May 2020, Ms. Keva Bain, the Bahamas permanent representative to the United Nations was elected to serve as president of the 73rd World Health Assembly (WHA), which is the decision-making body of the WHO. Her appointment, followed by the shift in global consensus against wearing a mask in public, and low numbers of confirmed cases arguably gave the impression that The Bahamas was leading the charge against the COVID-19 pandemic. But we know this to be untrue given all the half-baked and failing policies to date.


On 5 June 2020, the WHO and the UK changed their stance on wearing face coverings which, among many other guidances, included:

  • Wearing 3-layer cloth masks in confined spaces (i.e. where physical distancing isn't possible);

  • Cloth masks should be washed in soap or detergent and water of at least 60C at least once a day.

  • On 24 August 2020, the British Prime Minister, Boris Johnson, said students in secondary school no longer are advised against using face masks, as the country prepared to reopen classrooms.

  • Special rules for an infant under 12 (e.g. children under 2 should not wear a mask).

  • Anyone who has trouble breathing should not wear a mask.

  • Anyone who is unable to remove the mask without assistance should not wear a mask.

US visitors are advised, among many other things, "to wear a face mask in any situation where it is necessary to enforce physical distancing guidelines, such as when entering and transiting air and sea terminals, while navigating security and customs screenings, at baggage claim and in public spaces." [Source: US Embassy]. Indeed, the feasibility of enforcing the mask mandate depends on whether the public has the access or capability to use them. CDC "recognizes that wearing masks may not be possible in every situation or for some people. In some situations, wearing a mask may exacerbate a physical or mental health condition, lead to a medical emergency, or introduce significant safety concerns." Therefore, adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a mask or to reduce the risk of COVID-19 spreading if it is not possible to wear one.

 

The ultimate question is whether the mask mandate is slowly killing us all? How safe is the mandate if people are still not informed about or skilled enough to use different types of masks in different contexts? How safe is the mandate if it appears to be counterproductive to our efforts to combat climate change and protect our ecosystems? This debate will be on-going given the fact that the WHO has advised countries to set up studies to monitor the effectiveness of a mask mandate for the general population. The CDC also notes that its mask mandate guidance will be updated as new scientific evidence becomes available. In light of all this, the government of The Bahamas should consider the following recommendations in order to find a more proportionate balance of imposing the mask mandate:

  • In align with the WHO's recommendation, the government must conduct good quality research to assess the effectiveness of this intervention to prevent and control transmission. Such research needs to look at whether SARS-CoV-2 particles can be expelled through non-medical masks of poor quality worn by a person with symptoms of COVID-19 while that person is coughing, sneezing or speaking. Research is also needed on non-medical mask use by children and other venerable persons.

  • Launch a collaborative effort between the Ministry of Health and the Department of Statistics to evaluate the impact (positive, neutral or negative) of using masks in the general public (including behavioural and social sciences). They can achieve this by collecting data from confirmed cases and uninfected persons to answer the questions whether citizens are wearing, removing, cleaning and disposing of masks safely; and whether any findings have impacted or likely to increase the risk of infections throughout the country. The agencies must communicate any relevant findings to the public in order to support the need for improved educational programming and social practices.

  • Draft and implement rules for non-medical mask production and manufacturing businesses in accordance with the WHO's guidance. See Table 4 in "Advice on the use of masks in the context of COVID-19: Interim guidance"

  • Clearly communicate to the general public the purpose of wearing different types of masks in various contexts and in a professional and proper manner. This should include how to clean or dispose of the masks as recommended by the WHO (page 8 of the Advice on the use of masks in the context of COVID-19: Interim guidance). For a comprehensive online guide on: "How and when to wear a mask".

  • Public and private partnerships beautification projects within communities and tourists areas to collect mask litter, especially near beaches and national parks.

  • The Ministries of Environment and Tourism must launch an educational initiative to agitating people (especially visitors) of statistics surrounding the poor disposal of masks leading to ocean pollution and environmental degradation. Special penalties may be imposed on visitors for littering, which may be re-invest into innovative efforts to combat and prevent such pollution in our waters.

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