India’s daily new Covid-19 cases have fallen to a 23-month low. Naturally, most Covid-related restrictions have been relaxed, except for face masks and physical distancing. Till date, only Maharashtra has relaxed the mask mandate. Should the country follow?
The fact is that public health interventions are not set in stone. They are based on the scientific evidence then available, the epidemiological situation and the local context. Once implemented, each such intervention should be regularly reviewed and revised as the situation evolves. In two years of the pandemic, most Covid-19 strategies have been regularly revised in India. For example, contact tracing, a mainstay of the early pandemic response, has largely come to a halt. Covid tests are now only recommended for symptomatic cases. During the pandemic, evidence has emerged that surfaces have a minimal role in the spread of the virus, so today there is very limited emphasis on handwashing and disinfection, unlike at the start of the pandemic. Even though the recommended physical distance of six feet in a public place has not been officially revised; with all social and economic activities, including indoor activities, permitted at 100% capacity or during the pre-pandemic period, the policy has become largely redundant and impractical. In this context, it’s a little bizarre that people are required to maintain physical distancing in outdoor spaces.
Implementation of public health interventions is also determined by careful consideration of benefits and risks. For example, vaccines have minimal risks, but their benefits are far greater. Let’s apply the same principle to masks. At the start of the pandemic, during times of high transmission and waves of SARS CoV2, when everyone was susceptible and a majority of the population was unvaccinated, the benefits of masks outweighed the harms, discomfort and minor but potentially harmful effects such as CO2 buildup inside the mask. However, when transmission is low, the benefit of wearing a mask is significantly reduced. In times of low transmission, the mask policy must also take into account the local context. In hot and humid environments like India, prolonged wearing of a mask can cause sweat and saliva to dampen the mask, which can become a breeding ground for bacterial infections or cause skin allergies and Rashes. Studies have also reported that in young children, face masks can lead to reduced ability to communicate and poor attention span, which can hinder the learning process in schools.
At present, in India, the benefit of universal masking seems negligible. It’s time for a nuanced, calibrated and graduated approach to masks.
First, school-aged children have the lowest risk (among all age groups) of severe Covid-19 outcomes. Therefore, every Indian state should immediately and completely remove the mask mandate for all children, in all settings – indoor or outdoor. The wearing of the mask for children must be voluntary and exclusively determined by the parents or the child. Over the past few months, even though Department of Health guidelines suggested that masks for children ages 6 to 11 were optional, schools in most states have mandated mandatory masking for children in this age group. age. School authorities have no say in a child’s decision to wear a mask. Second, for the adult population, each Indian state can and should make masks voluntary outdoors. Most states can also make masks voluntary for indoor settings. For a small number of states, where cases are relatively high, a decision on whether masks should be voluntary can be made based on local/district level data.
Third, there is a need to continue to educate the public about the benefits of masks in general, especially for high-risk population groups such as immunocompromised, unvaccinated or partially vaccinated people, with pre-existing health conditions as well as for over 60 years old. . Public awareness messages should continue to promote voluntary adherence and encourage people to adopt behavior appropriate to the risk of SARS CoV2 transmission. Fourth, although the risk is currently low, the possibility of further waves in the future cannot be ruled out. Therefore, health policymakers need to come up with objective criteria for how and when the mask mandate might need to return. In any case, the approach must be localized and people must be made aware.
The public health benefits of face masks are currently minimal. The idea that mask mandates should be upheld as a reminder of the pandemic is condescending. However, making masks voluntary should not be interpreted to mean that everyone stops wearing masks, but lets people make a choice based on self-assessment of risk. We must also remember that in any future increase in Covid-19 cases, masks may have to be worn again, compulsorily. Until then, it’s time to breathe easier.
Dr. Lahariya is a physician and epidemiologist.
The opinions expressed are personal.
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The opinions expressed above are those of the author.
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