Foist Public Health Measures Through Education, Not Punishment: Medical Experts

Wearing a face mask reduces Covid-19 transmission by decreasing the shedding of virus in the air and environment, especially from people who don’t display symptoms.

KUALA LUMPUR, August 10 — Medical professionals have criticised the enforcement of ambiguous regulation on wearing face masks in public areas, touting education as the key to public health measures.

Former Malaysian Medical Association (MMA) president Dr Milton Lum emphasised that the public should be well-informed before legislating the mandatory use of face coverings in Malaysia amid the Covid-19 outbreak.

“The answer has to lie in education. In a public health emergency that we have today, the cooperation of the public is needed to control the disease transmission.

“For that, you have to have appropriate messaging, you have to be transparent in your data that you disclose to the public. Most importantly, educating them is the appropriate way,” Dr Lum told CodeBlue, when asked to comment about fines imposed for not wearing face masks in public areas.

Beginning August 1, the government has made it compulsory for all to wear face masks inside public transportation, crowded public spaces, and areas where social distancing is impossible.

However, police meted out RM1,000 compounds even before the National Security Council (NSC) released on August 5 a list of 14 venues that require face masks, as well as “crowded public areas and enclosed spaces filled with many people”. The 14 venues are: mosques and surau; non-Muslim places of worship; social events; public transport; zoos; school bus or vans; sports and recreation (compulsory in public areas when not engaged in sports activities); health premises (clinics and hospitals); public and farmers’ markets; cinemas and live events; retail premises (shops, dobi, restaurants, shopping centres, supermarkets, car workshops, petrol stations); hair and beauty salons; spas, beauty and reflexology centres; and family entertainment outlets.

According to Senior Defence Minister Ismail Sabri Yaakob, those who flout the mandatory mask rule can be subject to prosecution under the Prevention and Control of Infectious Diseases Act 1988 that provide for a fine of up to RM1,000, close to the minimum monthly wage of RM1,100 or RM1,200.

“How many people can afford to buy three-ply masks everyday? Consideration must be given to such aspects when you make an announcement,” Dr Lum added.

The police have also come under fire for allegedly selective prosecution, after a teenager was shown on TV3 crying when he was fined RM1,000 for pulling down his face mask at a train station, as Malaysians highlighted pictures of ministers and their followers not wearing face coverings at political gatherings at indoor public areas.

Gopeng MP Dr Lee Boon Chye. Picture by Boo Su-Lyn.

At the same time, PKR’s health spokesman Dr Lee Boon Chye said the government must ensure the availability and affordability of quality face masks, besides issuing clear instructions on the rule, before implementing the law.

“Firstly the availability and affordability of quality face masks, especially for low income groups. Hence I have recommended the government to provide quality reusable cloth masks to all 5.4 million primary, secondary, and preschool children to begin with. More masks can be distributed to B40 households via Bantuan Sara Hidup database,” the former deputy health minister told CodeBlue.

“Secondly, the legislation is ambiguous. The areas where mandatory mask wearing is enforced is unclear. Even though the National Security Council (MKN) listed down specific areas, MKN also includes public crowded places. Definition of public crowded places is unclear and subjected to interpretation,” he added.

Rationale Behind Wearing Face Masks

A surgical face mask. Image by Juraj Varga from Pixabay.

Health experts continued to stress that wearing face masks is indeed important to reduce Covid-19 transmission in the community.

“This is needed for health care workers and high risk individuals. For effective protection, we need a N95 mask and three-ply surgical mask and, less so, three-layer cloth mask,” Dr Lee mentioned.

“Wearing a mask also reduces transmission via reducing shedding of virus in the air and environment, especially from asymptomatic or pre-symptomatic Covid-19 infected patients,” he added, referring to people with coronavirus who do not show any symptoms.

“This is an effective public health approach to reduce transmission of the virus and this should be the main objective of mandatory wearing of masks.”

The World Economic Forum reported that the United States might have reduced almost 40 per cent of Covid-19 deaths in the country by June if the government had mandated masks from April.

Dr Lum noted that non-pharmaceutical intervention — such as wearing masks, maintaining physical distancing and regular hand washing — is essential to combat Covid-19 transmission, as the world is currently dependent on supportive drugs to treat the disease without any specific treatment targeting the virus.

He also stressed that the type of masks and the methods of using them are a major concern in controlling the coronavirus transmission in the community.

“The effectiveness of a mask depends on the type of the mask that is being used. A cloth mask is less effective than a three-ply surgical mask. A three-ply surgical mask is less effective than a N95 mask,” Dr Lum said.

“It also depends on how the mask is being used. Some, after wearing it, will pull it down to the chin. There’s no use when you pull it up again. When you bring it down the chin, whatever organisms in the area will go back into your nose when you pull the mask to cover your nose again,” he added.

Can Reusable Masks Prevent Covid-19 Transmission?

Dr Tan Poh Tin (far right), a consultant paediatrician and public health specialist based in Kuching. Picture from Dr Tan Poh Tin.

Dr Tan Poh Tin, a paediatrician and public health specialist in Sarawak, stated that cloth masks are good options for the public to use to reduce Covid-19 transmission in the community, citing a study conducted by the School of Engineering, University of Edinburgh.

The study stated that reusable cloth masks are just as effective as surgical masks to block the wearer’s breath flowing directly forward and reduces the forward distance travelled by an exhaled breath by more than 90 per cent.

“Studies have shown that even a single-layer mask can help to block droplets to some extent. Double layer is better. Now they have mixed layers too,” Dr Tan told CodeBlue in an interview.

“If you don’t have a mask at all, then definitely when someone speaks or sings or shouts, some aerosol or droplets come out and they do carry the germs with them for a certain distance,” she added.

It is to be noted that Vietnam has introduced new reusable, biodegradable face masks using coffee beans. India also has produced three-layered biodegradable masks made of herbal extract from neem oil, turmeric, holy basil, carom seeds, black pepper, gum arabic, clove, sandalwood and saffron.

In fact, Singapore distributed reusable cloth masks to its people to protect themselves from the coronavirus.

“To me, it is not a compromise at all. It is a long-term eco-friendly situation. For an average person who is not a doctor or frontliner, I think it is a good option. People who consider themselves as a high-risk group can pay more for surgical masks. But an average person on the street can use reusable masks,” said Dr Tan.

An April literature review‘Face Masks Against Covid-19: An Evidence Review’ led by a researcher from the University of San Franciscso — shows that non-medical masks use materials that obstruct droplets of the necessary size and have been effective in reducing transmission of influenza. The study also reveals that places where mask usage is required or widespread have shown substantially lower community transmission when the public uses non-medical masks.

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