Do You Still Need To Wear A Mask In Public If You Seem Healthy? Here's What MOH & WHO Says

The Ministry of Health (MOH) encourages the use of face masks in crowded and confined places based on the World Health Organization's latest guidelines that state that it could provide "a barrier for potentially infectious droplets".

Cover image via Vincent Thian/AP

On 10 June, Malaysia entered into its next phase to battle the COVID-19 pandemic. This phase — called the Recovery Movement Control Order (RMCO) — has fewer restrictions and will last until 31 August.

In a special televised address on Sunday, 7 June, Prime Minister Muhyiddin Yassin announced that while the Conditional Movement Control Order (CMCO) will end as scheduled on 9 June, the RMCO marks the entry of the country into the 'exit strategy' phase.

"During the implementation period of RMCO, more restrictions will be relaxed to allow the public to carry out their daily activities while complying to the standard operating procedures (SOPs)," said Muhyiddin.

He announced that almost all social, religious, business, and educational activities will be allowed to resume in stages under strict SOPs during the RMCO and that if there is an increase in the number of COVID-19 cases within this period, Enhanced MCO will be executed in the affected areas.

Under RMCO, while interstate travel will be permitted — except for areas placed under Enhanced MCO — international travel will remain close as the country's borders remain shut.

Among other things, hair salons, morning and night markets will be allowed to open along with eased out restrictions on leisure activities such as visiting museums and entertainment outlets, etc.

The Prime Minister also announced that Hari Raya Aidiladha celebration and Qurban activities will also be permitted in this new phase. However, the organisers must adhere to SOPs.

Additionally, while schools will be opened in stages, places like nightclubs, theme parks, and karaoke centres, as well as large gatherings such as kenduri (feast), will still be barred during the RMCO.

This raises an important question about wearing a face mask in crowded places where social distancing might not be possible

So what are the health authorities like The Ministry of Health (MOH) and the World Health Organization (WHO) saying about wearing face masks even for people who are or seem healthy?

The WHO, in its latest advice issued on 5 June, recommends wearing masks for infected individuals to prevent onward transmission and also for those who are healthy for protection.

The agency, however, added that the use of a mask alone is insufficient to provide an adequate level of protection or source control that and other personal and community level measures as such hand hygiene, physical distancing should also be adopted to suppress transmission of respiratory viruses.

Separately, the WHO director-general Dr Tedros Adhanom Ghebreyesus stated that masks are not a replacement for physical distancing, hand hygiene, and other public health measures to fight COVID-19.

"People can potentially infect themselves if they use contaminated hands to adjust a mask or to repeatedly take it off and put it on, without cleaning hands in between. Masks can also create a false sense of security, leading people to neglect measures such as hand hygiene and physical distancing. I cannot say this clearly enough: masks alone will not protect you from COVID-19," Dr Tedros said.

Following which, Health director-general Dr Noor Hisham Abdullah said that MOH strongly recommends and encourages the use of face masks in public places that are crowded.

Masks are useful in reducing the risk of viral transmissions

According to Dr Noor Hisham, the public is strongly recommended to use face masks, especially the elderly and those with symptoms of COVID-19 at crowded places such as during public commute.

Meanwhile, the WHO gave examples of where the general public should be encouraged to use medical and non-medical masks in areas with known or suspected community transmission.

Image via WHO

The agency added that studies provide evidence that the use of a medical mask can prevent the spread of infectious droplets from symptomatic infected person to someone else and potential contamination of the environment by these droplets and that disposable surgical masks or reusable 12–16-layer cotton masks are associated with the protection of healthy individuals within households and among contacts of cases.

However, the agency also emphasised that the use of masks by healthy people comes with its own set of potential harms and benefits

Among the benefits, it listed:

— reduced potential exposure risk from infected persons before they develop symptoms,
— reduced potential stigmatisation of individuals wearing masks to prevent infecting others or of people caring for COVID-19 patients in non-clinical settings,
— making people feel they can play a role in contributing to stopping the spread of the virus.

One other benefit, according to the WHO, is that wearing masks by the general public has the potential to boost social and economic benefits.

"The production of non-medical masks may offer a source of income for those able to manufacture masks within their communities. Fabric masks can also be a form of cultural expression, encouraging public acceptance of protection measures in general," it said, adding that "the safe re-use of fabric masks will also reduce costs and waste and contribute to sustainability".

While listing out likely disadvantages of the use of a mask by healthy people, the WHO said:

— a false sense of security, leading to potentially lower adherence to other critical preventive measures such as physical distancing and hand hygiene,
— potential increased risk of self-contamination due to the manipulation of a face mask and subsequently touching eyes with contaminated hands,
— potential self-contamination that can occur if nonmedical masks are not changed when wet or soiled. This can create favourable conditions for microorganism to amplify,
— potential headache and/or breathing difficulties, depending on the type of mask used,
— potential development of facial skin lesions, irritant dermatitis or worsening acne, when used frequently for long hours,
— waste management issues; improper mask disposal leading to increased litter in public places, risk of contamination to street cleaners, and environmental hazard,
— difficulty communicating for deaf persons who rely on lip-reading.

Furthermore, the WHO said that if masks are recommended for the general public, the decision-maker should consider steps like clearly communicating the purpose of wearing a mask, where, when, how

"Explain what wearing a mask may achieve and what it will not achieve, and communicate clearly that this is one part of a package of measures along with hand hygiene, physical distancing, and other measures that are all necessary and all reinforce each other," the agency said.

— Inform/train people on when and how to use masks safely, i.e. put on, wear, remove, clean, and dispose,
— consider the feasibility of use, supply/access issues, social and psychological acceptance,
— continue gathering scientific data and evidence on the effectiveness of mask use,
— evaluate the impact (positive, neutral or negative) of using masks in the general population.

While we are on the topic, read how the pandemic has shone a light on the extraordinary work of a Malaysian doctor who stopped a plague:

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