Analyzing Covid-19 outbreaks and Public mask controversy
View(s):Retrospective study on ongoing infection in Singapore and Czech Republic. one country used public masks and stopped using it, the other was not used to masks but started using it during the outbreak
Background
The Covid-19 has taken a big toll on most of the nations; developed, developing and Least developed alike, not much difference was seen between the outcome of the countries which have stronger or poorer public health care systems.
Nations surviving
There are but a handful of nations, countries in east Asia and one country in Europe Czech Republic who have successfully flattened the curve and kept it under control. For the rest of Europe all the preventive measures have failed and have caused disastrous effects on public as well as the healthcare infrastructure which are on the verge of collapse.
Why?
The need arises to analyze the scenario of several nations, especially Czech Republic and Singapore in our effort to understand the difference, as it could give valuable information in managing the outbreak successfully.
WHO “The World Health Organization”
The health care system in almost all countries (195) in the world, for more than half a century, have come under the direction of The world health organization. It means the medical practice of countries have little diversity if any and are scrutinized if gone out of suggestions. Civilians and their social and cultural practices are the main difference in hygienic practices.
Research and Implementation for Covid-19
Research and analysis take more than 10 years (10-25years) to reach WHO to be implemented as strategies and suggestions. Covid-19 has a history of 3 months. We find only a handful of studies.
and graphs of corvid based information. This grants a researcher to take into consideration the information available outside the research community or medical journals.
New Pandemic
We never had in our lifetime such a pandemic of viral infection since Spanish flu, with such virulence and communicability. Most of the strategies we have studied and researched are of existing diseases, mostly of our lifetime.
Objective
To Retrospectively analyze the outcome of some major countries on the available information on the Covid-19 and find a relationship with public face masks and outcome; and try to understand the pattern of disease spread in Singapore and Czech Republic relating to the public face mask for the asymptomatic population.
Leading the first study analysis to find the science between (“masks4All”campaign) and the positive outcome, of so called “flattening the curve” quickly.
Methodology
The objective is analyzed from research findings from large sample sized study information to small sample sizes study and on reports and information provided by world recognized organizations and by governments’ pages or media reporting.
with the use of statistic studies and covid-19 prevalence graphs and graphics published in ECDC (European center for Disease Control) and explaining the effectiveness of cotton mask as a barrier by a research done in India proving the effectiveness of cottons masks in preventing contamination of the surgery area from the user (28) .
Results
Different public mask wearing recommendation of various world nations
Public mask wearing nations
1. Japan
2. South Korea
3. China (mostly after Covid-19) (Taiwan )
4. Singapore (later chose not to wear face mask)
5. Czech Republic (later chose to wear face mask1)
Non-mask wearing nations
1. USA
2. UK
3. Italy
4. Germany
Both groups show significant difference in outcome especially spread of disease, although the death per infected varied (China with larger population and epicenter with no knowledge of covid-19 did better than some countries in the lower list).
These countries were selected because obvious public mask wearing laws either for or against and the practice by the civilians are more towards their recommendations of governments and these countries have moved significantly in to the epidemic days and have considerable amount of general population and considerable number of infected cases.
When comparing the number of covid-19 cases, mask wearing nations did better with the outcome with the exception of Singapore with a strong health care system. was advising possible surgical mask for public on 22nd January 2020 then on 12th March 2020 (citation needed on dates) updated the health ministry page strongly discouraging masks for normal civilians.
Singapore started to show an increase in new cases which the government points out as foreign cases. As of 31 March 2020, 12pm, the Ministry of Health Singapore (MOH) has confirmed 16 imported and 31 local cases of COVID-19 infection in Singapore. 16 imported cases had travel history to Australia, Europe, ASEAN, and other parts of Asia. 13 cases are linked to clusters or previous cases. 18 cases are currently unlinked, and contact tracing is ongoing.
Singapore with a total population of 5.7 million with such an advanced healthcare system with spending on security the case numbers are more significant and shows that 18 cases are unlinked, compared to the population of South Korea 51.6 million, Japan 126.5 million and Taiwan 23 million total populations.
MOH Singapore is struggling to come to common grounds with its medical professionals on whom to wear masks, since the beginning of January 2020. A WHO official of Singapore recommend using non-medical masks for general public. then government moved forward with de-promoting campaign of facemask on 29th January 5.2 million masks were to be given free by the Singapore government to 1.3 million homes targeting Wuhan virus from February 01 although given free they suggested that to wear only when sick or while going to see a doctor. Another article shows masks out of stocks and government advising strongly for the public not to wear mask if well.
The Czech Republic with a population of 10.65 million is the only country in Europe and the world implemented the strict mask law after the outbreak of covid-19 A graph showing the curve movement of Czech Republic till 16th March been seen as the curve moving steep in line with other European nations then the curve flattened and numbers did not cross the 3000 mark on 30th as this is being analyzed although the death rate is comparatively high compared to the number of recovery and total infected may suggest a weaker healthcare infrastructure.
The Czech Republic implemented the obligatory face mask with a fine of 20,000 CZK (LKR. 140,000.00) on 18th of March when they had 762 positive cases out of 940 tested and 12 days later on the 30th of March when this analysis being done the total number of cases were 3,001 out of 48,811 tested and the number of new cases reduced to 184 from the peak of 373 on 27th of March.
According to a local media of Czech Republic They have asked public to wear masks, respirators or scarfs contrary to the report in Wikipedia saying the law as mandatory respirators citation needed.
The government notice of the obligatory mask law needs translation under https://www.cheb.cz/assets/File.ashx?id_org=5091&id_dokumenty=979121
I could not find the use of masks commonly in Czech Republic in their culture or is a norm earlier than 2020 (absence of evidence is not evidence of absence; they might have been wearing) I could not find a single video or photo of any Czech Republic in YouTube or google after the Covid-19 outbreak.
Furthermore, the WHO has recommended no mask policy for public if not coughing or sneezing symptoms which rest of the world follows except the east Asian countries and Czech Republic;
Japan face mask wearing research on a flu epidemic in 2012 (with proof of other hygienic practices increase with face masking in contradiction to WHO suggestion that using mask will give false sense of security.
A research report on lancet concludes that wearing masks for public have had positive outcome if countries have adequate stocks, and in future pandemics of similar airborne disease, nations should be in a state to produce large quantities of masks like Taiwan.
Summary
The pattern of difference among the east Asian nations who followed some kind of a mask 4 and Czech Republic who changed the policy to Obligatory mask (n95 to scarf) for public in the middle of the pandemic and the other group of nations in west with the exception of Singapore whose major population is of Chinese origin started wearing masks early (surgical) had a flatter curve, then de-promoted from wearing face mask for public.
The outcome was obvious on the two group of countries and on those two countries who had clear mask policy, who then changed their policy in between the pandemic shows both groups have clearly changed their outcome in positively and negatively these two isolated countries in their region’s practice (choose opposite to the rest in the region) can be considered as a crude control study.
The experiment done in India comparing effectiveness of surgical mask and reusable cotton mask (like the ones used in operation theaters before surgical mask usage) concluded both act almost equally the surgical mask slightly superior in preventing the user from contaminating the surfaces through the mask.
Suggestion
Masking the asymptomatic general public to prevent surface contamination and reduce direct aerosol spread.
seems one of the important, very significant game changer in the covid-19 fight {in combination with hand hygiene of general public, contact tracing, Isolation of suspected covid-19 patients and quarantine at different levels which all these countries followed}.
countries in east Asia and Europe show clear evidence and the east Asian country of Singapore with ethnic Chinese majority population having controlled the epidemic earlier, then very recently had community based outbreaks after stopping mask usage. Its findings are highly suggestive of the influence of mask as the ethnicity climate and region is almost as same as the other east Asian countries.
FDA (Food and Drug Administration) says, as covid-19 has false negative test reports, they suggested all with contact history to be considered Risks patients. Having false negative in public include: delayed or lack of supportive treatment, lack of monitoring of infected individuals and their household or other close contacts for symptoms, resulting in increased risk of spread of COVID-19 within the community, or other unintended adverse.
CDC (Centers for Disease Control) has done a study showing indirect transmission from asymptomatic carriers in Wuhan who has spread the disease to several personals without developing symptoms and later had symptoms and had the disease. graph,
Another study done in Taiwan points out that the spread of Covid-19 is very high in the beginning of symptoms (patient could not be ready with precautionary protective wear if public has no masks).
The same study points out that it’s the health staff who have contracted the disease more but that has not happened with the nosocomial manner but the spread was outside of the hospitals and the other staff seems uninfected suggests the Effectiveness of PPE for staff.
these clear evidence suggest masks for public to prevent possible spread from the asymptomatic mask wearer to the others, but not to protect the mask wearer, therefore mask will prevent the infected asymptomatic, early symptomatic, and false negative patients who are in the community from spreading diseases.
Is It doable?
n95 and surgical masks are not the only suggestion for diseased or asymptomatic because, Masks are used earliest in surgical procedures to prevent spread of infection to the surgical wound of a patient being operated from surgeon’s mouth and nose, earlier masks were cotton and were reusable with sterilizing. As recent as 2009 in Sri Lanka, operating masks were cotton and reusable. They were used with no significant break of infections of surgical wounds.
A research done in India suggests that cotton cloth mask being effective in preventing particles such as bacteria in aerosol and droplets to be filtered and with no difficulty in breathing as covid-19 has the ability to contaminate the surfaces with water droplets and aerosols while talking laughing coughing sneezing;
cotton masking for the public will cover the
1. Asymptomatic carriers
2. Early symptomatic spread of all Covid-19 patients who will be diagnosed
3. False negative Covid-19 patients among the healthy public
It could be cost effective if the mask is produced locally and homemade just like in Czech Republic as all type of masks and scarfs were allowed for the public to wear. And same masks that were used in our operation theaters before the 2009 which can be manufactured at home if proper instructions are given.
While requesting the public to wear cotton masks as immediately as possible, we need a dedicated field of textile engineers and microbiologists to do quick study of the effectiveness of cost effective cloth materials. As we have garment factories waiting to be exploited such were producing cotton t-shirts and tea factories with tea bag materials. Other improvised ideas proposed by the public to be checked by the team.
Last but not least It should be kept in mind the blunder that we made was we were selfish so we thought the mask was to protect us but not the others, in this context the mask for all is to protect the others not us but by everyone protecting others we protect ourselves. This is a lesson for harmony and peace within humanity and with nature. If we don’t help others, we will die of greed. protect others and the environment we will be in PEACE.
-Dr. T Kirubendran MBBS (SL)
kiru005@gmail.com