When the coronavirus crisis began exploding around the world in February, governments struggled to tell their populations how to behave. Don’t panic, but don’t be too complacent either. Don’t stigmatise those with symptoms, but don’t get too close to them. Cover your faces when coughing or sneezing, but don’t wear masks.
That last direction has proven to be somewhat controversial. The World Health Organisation, as well as experts and authorities in many parts of the world – including India – said there was no need for the public to wear masks, even as Covid-19 turned into a pandemic. Then suddenly, at the start of April, everything changed.
The WHO, the US and Indian authorities are urging people to wear masks when they are outdoors. Municipal authorities in Mumbai have made mask-wearing compulsory. An expert committee in Kerala has recommended the state require everyone outdoors to wear one.
With this crisis likely to be a matter of months and years rather than weeks, it is important for everyone to understand what they can do to protect themselves and others.
Here’s what you need to know.
What is India’s offical position on masks?
For a while, Indian authorities insisted that masks were only required for healthcare workers or those directly dealing with a suspected or confirmed patient of Covid-19. This is no longer the case. India now recommends that everyone should wear “homemade face covers,” or cloth masks.
In an advisory issued on April 3, however, the government said “certain countries have claimed benefits of homemade face cover for the general public. Such homemade face cover is a good method for maintaining personal hygiene. Such usage certainly will help in maintaining overall hygienic health conditions.”
With this in mind, it recommended that “people who are not suffering from medical conditions or having breathing difficulties may use the handmade reusable face cover, particularly when they step out of their house. This will help in protecting the community at large.”
The advisory makes it clear that this only applies to the wider public, with much more exacting standards for the masks meant for healthcare workers or those dealing with a Covid-19 patient.
How do I get a ‘face cover’?
The government still does not recommend that ordinary citizens go out and purchase N-95 masks or even surgical masks, since there is a shortage of these and they should ideally be reserved for healthcare workers or those who are likely to come into contact with Covid-19 patients.
Instead, the government recommends using homemade face covers, either sourced from a group that has been making them or, ideally, simply putting one together at home. In fact, any cotton cloth – from shirts to dupattas to scarves to gamchas – used to cover your face and washed according to the instructions will do. The thicker the material, the greater protection it offers you.
The New York Times looked at a number of different options of what material works best, with flannel pajama fabric and vacuum cleaner bags working the best, European-style coffee filters getting a medium score, and simple cotton scoring the least but still managing to offer a certain amount of protection.
“If you don’t have any of the materials that were tested, a simple light test can help you decide whether a fabric is a good candidate for a mask.
‘Hold it up to a bright light,’ said Dr. Scott Segal, chairman of anesthesiology at Wake Forest Baptist Health who recently studied homemade masks. ‘If light passes really easily through the fibers and you can almost see the fibers, it’s not a good fabric. If it’s a denser weave of thicker material and light doesn’t pass through it as much, that’s the material you want to use.’”
The Office of the Principal Scientific Advisor to the Government of India attached an annexure to the April 3 advisory, detailing how Indians can make these face covers at home.
The advisory puts forward two different ways of putting together a home-made face mask, one if you have a sewing machine and another if you don’t.
“The homemade face cover should be prepared in such a manner that it can cover the mouth and nose completely and can be tied over the face easily,” it says.
Here are the instructions for making one with just a handkerchief or any cotton material and rubber bands:
The United States’ Centres for Disease Control have also put forward a way to make a facemask that relies on just scissors and a T-shirt.
When do I use the these face covers?
India’s advisory suggests usage of face covers whenever you go out, and particularly for anyone who lives in particularly dense areas. Parts of the country, from Mumbai to Odisha to Kerala, are now making them mandatory, and in many places, shops are not allowing people entry unless they are wearing masks.
How do I store and clean these face covers?
The official advisory says that each individual in a house should have their own face covers. They should not be shared by anyone. It also recommends that each person have two face covers of their own, so that “one can be washed while the other is used”.
Storage recommendations are simple. Take any plastic bag at home, clean it thoroughly with soap and water, and let it dry out. Once that is done, keep the clean face cover in the bag and rotate face covers for daily use.
As for cleaning, here are the official instructions:
What explains the U-turn in directions?
To some extent, authorities are simply responding to a developing situation and updating their advisories. But many questions have been raised about why it took so long, particularly for the WHO, to change its directions regarding using of face covers.
Early thinking about why masks should not be used, even though they have always been part of advisories for respiratory diseases, was that they would lead to shortages for healthcare workers who need them more. It was believed that ordinary people would not know how to use them without making things worse.
While the concerns about shortages still hold, which is why governments are recommending home-made face covers, they came coupled with advisories to not cover your nose and mouth. At first, some experts and authorities did recommend masks – but only for the sick, so that they would prevent them infecting other people.
But from February, it was clear that Covid-19 could be spread by asymptomatic people, meaning those who weren’t sick but may still have been infected by the coronavirus. This meant that simply recommending masks for the sick would not be sufficient to prevent spread.
Moreover, countries that mandated masks and face covers – such as Taiwan and Hong Kong – have cited that as among the primary reasons that their infection numbers remaind low, despite high levels of exposure to Chinese tourists and visitors.
Attention has also been drawn to China’s relentless effort in January and February to build up its stock of masks, including going so far as to ask expatriate Chinese workers to buy face masks in countries like the United States, Brazil and Nigeria, and send them home to help combat the virus.
Yet until April, the WHO – which has been thoroughly criticised for failing to closely scrutinise Chinese claims about the virus – did not widely recommend usage of face covers.
Zeynep Tufekci, an associate professor at the University of North Carolinawrote a much talked-about piece in the New York Times in mid-March arguing that the recommendations against mask usage had backfired.
In an interview with analyst Ben Thompson, Tufekci compared the global consensus against mask-wearing to the governmental misinformation that was spread about Iraq having Weapons of Mass Destruction, suggesting that a combination of hierarchy and lack of questioning led to the spread of actively harmful information.
“We know Taiwan informed the World Health Organization that this was transmitted human-to-human. And that’s when I ordered my modest supply of masks, like the first week of January, because from the SARS experience and then in Hong Kong, I just knew this was a crucial thing in case somebody in your family got infected. This is just sort of the obvious first step, a modest supply of masks and of course in Hong Kong and Taiwan, in Asia, a lot of places, people wear them during the flu season, it cuts down flu.
I watched somewhat flabbergasted over the next few months as the recommendation not to wear masks got harder and harder...
I lived through the Iraq War run-up too, again, I’m from the Middle East, so no doubt that authorities, even seemingly more credible ones and even good ones like CDC and World Health Organization are not bad ones per se, but they can be sources of misinformation. By the way, I don’t think masks are the only top-down misinformation in this particular case. I think we’re in an Iraq War-like situation, there’s been a massive amount of misinformation across the political spectrum.”