Make cloth face masks compulsory, UCT experts urge Zweli Mkhize

16 April 2020 - 08:30 By Sipokazi Fokazi
Mixed messages have been put out about whether face masks are effective in minimising exposure to Covid-19. UCT experts are urging the government to make them compulsory.
Mixed messages have been put out about whether face masks are effective in minimising exposure to Covid-19. UCT experts are urging the government to make them compulsory.
Image: 123RF / maridav

As SA grapples with the Covid-19 pandemic — which has now infected more than 2500 people locally and killed at least 34 — University of Cape Town medical experts have made a plea to the national government to make the wearing of cloth masks in public places compulsory as one of the strategies to flatten the curve.

In a letter to health minister Zweli Mkhize, a group of “concerned healthcare professionals” said while they support key messages from the national department of health on the importance of social distancing, hand hygiene and staying home during lockdown, one strategy was missing: the wearing of masks.

“This is a fast-moving epidemic with new knowledge emerging daily. We, as concerned healthcare professionals, ask the national department of health to consider adding another bold initiative to further reduce transmission,” they wrote.

“We believe that based on the current evidence, widespread use of masks as an addition to current public health measures could significantly reduce infections and caseload.”

Mkhize has recently recommended the widespread wearing of masks, but it is not compulsory. “Wearing masks is important. We are recommending that people can use cloth masks — just make sure there’s a three-layer kind of thing,” he said last week.

The UCT experts said their appeal is based on emerging evidence from countries such as China and Hong Kong that showed the effectiveness of wearing masks, which has not only reduced the transmission of Covid ——19 but resulted in substantial reductions in other respiratory diseases, particularly when used with other strategies such as handwashing, social distancing and respiratory hygiene.

In SA, the wearing of masks would also protect vulnerable people who live in overcrowded communities where social distancing is difficult.

“The best practice to manage these risks is to ensure that every person wears a face covering when they are in public spaces,” they said.

While health experts have been united in other prevention strategies such as social distancing, respiratory hygiene and frequent handwashing, there have been mixed messages on the use of universal masks.

The World Health Organisation (WHO) initially opposed the wearing of masks by healthy people, only to change its stance last week after new evidence from Hong Kong indicating that the widespread use of masks there had reduced the spread of coronavirus.

The world body has since updated its guidelines, saying while masks can help to limit the spread of the disease, they were insufficient on their own.

Prof Heather Zar, one of the co-authors of the letter, said wearing masks would not only drastically reduce the fast transmission of Covid-19, but could also reduce the stigma associated with the virus.

Heather Zar is one of the authors of a letter that has been written to Health Minister Zweli Mkhize
Heather Zar is one of the authors of a letter that has been written to Health Minister Zweli Mkhize
Image: Supplied

“If everyone wears a mask, that also reduces stigma. Everyone is protecting the other, but masks can be highly effective for preventing spread not only of coronavirus but also of other germs like influenza, as we are just starting our flu season,” she said.

The experts said most secondary Covid-19 infection in China occurred in families where masks were not worn inside the home — and similarly in Hong Kong, where the virus spread has been contained.

While the supply of masks has been a major concern around the world, the medics argued that making cloth masks is relatively simple as they can be easily manufactured and used in conjunction with other home-made face coverings, such as scarves or bandanas.

“One concern about mass use of face coverings is the false sense of safety, which may lead people to engage in less safe behaviour, such as gathering in large groups. To address this concern, communication to the public would need to emphasise face covering as one of the public health strategies to reduce transmission,” they said.

They also called for the regulation of medical mask sales, saying these should be reserved for health workers only.

Head of medicine at UCT and Groote Schuur Hospital Prof Ntobeko Ntusi, who is part of the concerned healthcare professionals, said: “There is a gross shortage of N95 masks globally. These should be reserved for use only by healthcare workers involved in high-risk procedures that involve aerosolisation, which posed a high risk of transmission.

“At Groote Schuur Hospital, we have reviewed the evidence for use of masks to protect healthcare workers and have started providing surgical masks to staff as part of a comprehensive preventative approach focusing on hand hygiene, physical distancing, disinfecting of surfaces and wearing masks by all cadres of staff,” he said.

Some more tips on wearing masks:

  • the mask should cover both nose and mouth and must go below the chin and up to ears;
  • cloth masks should be never be shared and must be washed in soapy water daily to sterilise them;
  • wash both hands before putting on a mask and after taking it off; and
  • don’t touch the mask while you are wearing it and keep it in a dedicated paper packet until you can wash it.