Masks still save lives: As third wave begins, a guide on why and how to mask up

Since March 2020, doctors have been asking everybody to wash their hands regularly and wear masks to avoid the spread of the virus but many have slowly let go of these habits. Pic/Atul Kamble

The Covid-19 pandemic has seen a resurgence recently and if the last two years have taught us anything, it is to not take the coronavirus for granted. Since March 2020, doctors have been asking everybody to wash their hands regularly and wear masks to avoid the spread of the virus but many have slowly let go of these habits.

While some may be tired, others simply don't seem to care or are even anti-masks. However, as Omicron cases are on the rise, wearing a cover over the nose and mouth is the least we can do to protect ourselves and the people around us. Over the course of 24 months, there have been many discussions about the kinds of masks one should be wearing and they have even turned into a fashion statement for many, with brands designing them too.

With the third wave beginning to looming large, Mid-day Online reached out to Dr Lancelot Pinto, consultant pulmonologist and epidemiologist at PD Hinduja Hospital & MRC to understand the basics of why we need to wear masks; something that medical experts have repeatedly told people to do. Pinto also explains the difference between the different masks and the correct way to wear them.

Two years into the pandemic, what have we learnt about how masks save lives?

Numerous experiments over the past two years have proven that masks lower transmission and protect individuals from getting infected. There is also a suggestion that if you do get infected while wearing a mask the quantum of virus infecting the individual might be less and therefore cause milder infection (this is akin to ‘variolation').

In a country like India, which has one of the highest rates of tuberculosis and respiratory diseases like Chronic obstructive pulmonary disease (COPD), masks could be invaluable in preventing transmission of Tuberculosis and protecting individuals with COPD from triggers such as pollution and infection from other airborne transmissible infections.

Do people need to double mask?

One needs to double mask with surgical/medical masks especially when one is indoors in poorly ventilated places or places with central air-conditioning and elevators. If one is using a mask such as an N95/K95, double masking isn't necessary.

What is the correct way to wear a mask/double mask?

One needs to ensure that the part of the mask that has a wire is upwards, so it can be pressed over the bridge of the nose to ensure a tight seal. The blue/green side of the surgical mask goes on the outside. If the colour on both sides is the same, feel the surfaces; the softer, more absorbent side goes on the inside. Masks with ties or ones in which the bands go over the head tend to have a better seal than ones which go around the ear.

What is the difference between a surgical mask, cloth mask and N95 mask? Which one and what combination is preferable?

A surgical mask has three layers: an outer fluid repellent layer, a high efficiency middle filter layer, and an absorbent inner layer. Double masking, with one of the masks being a surgical mask and the second being another surgical mask (preferable) or a cloth mask is reasonably efficient at protection, provided they are worn properly with a tight fit.

Cloth masks tend to be comfortable, but are inefficient at filtering the virus, and are likely to be useless against a highly transmissible variant such as Omicron. One could wear a cloth mask as a second mask over a surgical mask, but they should not be used by themselves.

N95/K95 masks are the most efficient, filtering about 95 per cent of tiny airborne particles. These would be the preferred masks to wear.

There are some who believe that one does not need to wear a mask if their immunity is strong or if they are double vaccinated. Is this true or false?

A variant such as Omicron is known to evade immunity conferred by vaccines and prior infection, causing breakthrough infections and reinfections, respectively. It would not be wise for anyone to assume they are immune.

There is even a conception that masks cause carbon dioxide poisoning. Is this true or false?

There is an increase in carbon dioxide due to rebreathing of exhaled air while wearing a mask. However, this increase is negligible for short term use, and is unlikely to have health consequences. It definitely does not cause carbon dioxide ‘poisoning'.

What is the right masking protocol for children?
This is challenging with young kids who are under six-years-old. We should try to enforce this only in closed, crowded, poorly ventilated spaces. When in open outdoor spaces or on the sports field, one would not recommend masks for very young children like infants and toddlers. Older children can be taught to use masks in the appropriate situations.

Some people complain of feeling breathless while wearing masks for a longer time. How can that be solved?

Not using the same mask for a prolonged period prevents the mask getting clogged and thereby increasing the resistance to breathing. Those who find N95/K95 masks claustrophobic can be advised to double mask as above.

As a specialist dealing with the outbreak for two years, what sort of resistance do you see about masking and what is your advice to most patients or their family on the subject?

Masks have several benefits beyond COVID, and we must try and gradually incorporate this into our culture, just as many East Asian countries have. We need to teach our children to be mindful of spreading their germs to others, and encourage them to mask up whenever unwell, and encourage such behaviour.

In a densely populated country like ours, with a high prevalence of airborne respiratory infections, we need to focus more on a combination of masking and adequate ventilation as an effective public health intervention to curb the spread of disease. These are likely to be low-cost, high yield interventions.