To mask up or not to mask up? It's no longer a debate in SA

The mass wearing of face masks may assist in curbing the spread of Covid-19, but it'll only work if done correctly

12 April 2020 - 00:01 By Sanet Oberholzer
"My mask protects you and your mask protects me."
"My mask protects you and your mask protects me."
Image: 123RF/Nataliya Okhapkina

One of the biggest questions of 2020 so far is: “To mask up or not to mask up?” Move over, Hamlet. We've decided that we want to hang in there. Life is mostly worth living, even in lockdown, and we're trying to figure out how best to do this. But the issue of masks has been contentious.

At the start of the coronavirus outbreak the World Health Organisation (WHO) was clear on its stance: it didn't recommend that people who are not sick wear face masks, stating that there's little evidence to suggest that doing so poses any benefit to the wearer and that masks would better serve health care workers and those already infected.

One of the biggest motivations against the wearing of masks by the public was a significant shortage of masks for health care workers globally.

Speaking at a media briefing in Switzerland last week, Dr Maria van Kerkhove, an infectious disease epidemiologist at the WHO, said front-line health care workers the world over are facing a significant shortage of personal protection equipment such as gloves and masks.

But little was known about the virus at the beginning of the year and the global health authority has changed its stance on the wearing of masks as more data has emerged. In a U-turn, the WHO said in a statement last week that there are circumstances in which the use of masks may prove to be effective at a community level.

This follows decisions by an increasing number of countries that have decided to follow in the footsteps of their Asian counterparts in advising their citizens to mask up.

The decision to reverse previous recommendations has also hit closer to home. In a communication issued on its website on March 29, the Western Cape department of health issued an appeal to the public to avoid wearing gloves and masks “due to the risks these items pose in spreading the coronavirus if not used properly”.

The statement read: “If you are not ill and not in close contact with someone who has coronavirus, you do not need to wear a mask or gloves.”

But, updated policy guidelines from the department issued on April 2 stated: “As the epidemic unfolds, the wider use of masks are [sic] indicated even for people who are not ill, especially if they move around in the public.”

On Friday, health minister Zweli Mkhize shared a similar message, saying “wearing masks is important. We want to recommend widespread use of masks.”

“We are recommending that people can use cloth masks, just make sure there’s a three-layer kind of thing,” Mkhize added. “We’d like to reserve the specialised masks ... for those who are dealing with intense infections in hospitals.”

Wearing masks is important. We want to recommend widespread use of masks
Heath minister Zweli Mkhize

This is a sentiment echoed by Tyrone Rubin, who brought the global #Masks4All movement to SA and started #AfricaMasks4All. The purpose of the movement is to encourage the public to reserve the use of medical-grade masks for health care professionals but to use homemade masks.

“It's not only about masks,” says Rubin. “It's testing first and tracing second and social distancing third.” But he says masks can be an important tool in the fight against the spread of the virus.

At the heart of the argument are two points. One is source control: my mask protects you and your mask protects me. Proponents of masks argue that they are less useful in protecting the wearer but prevent the wearer from infecting others. But this only works if everyone is on board. The second point is the asymptomatic nature of the virus — a point that has gained traction globally.

Last week, the American Centres for Disease Control issued a recommendation that people who aren't feeling sick should wear a face cloth covering, stating evidence from recent studies that indicate a significant percentage of infected individuals are asymptomatic. Furthermore, it's possible to infect other people before symptoms develop.

It's hard to argue with this logic: even the WHO advocates that sick people wear masks. Problem is, it's not always easy to tell who is sick.

While the wearing of masks is not a fix-all solution, it may assist in curbing the spread of infection if everyone buys into the concept. But it only works if done correctly and without disadvantaging health care workers on the front lines.

The Western Cape health department offers a few basic guidelines on its website: wash your hands before putting on the mask. Do not touch your face while wearing the mask and remove it if it gets wet. Touch only the straps of the mask when taking it off and place it in a container until you wash it with soap and hot water. Do not share masks, and wash your hands once you've removed your mask.

• See the Western Cape government's website for more information on using a mask responsibly. For more information on the #AfricaMasks4All movement visit

• This article is an updated version of one that was published in the Sunday Times Lifestyle print supplement on April 12.


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