ISSN 2330-717X

Shifting Public Health Messaging About Face Coverings Could Improve Uptake And Boost Universal Masking – Analysis

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As on September 14, there were 29,220,373 cases and 929,088 deaths due to COVID-19 worldwide. While responsible agencies across the world are taking mitigatory measures, every one of us must follow COVID-19 precautionary measures strictly in letter and spirit. Wearing appropriate face –covering is one such proven measure. We must encourage the use of  face-covers. Sadly this measure is not taken universally. There are many reasons for that .

Researchers from Nuffield Department of Primary Care Health Sciences, University of Oxford and  TB Proof,   South Africa found that  “Shifting public health messaging about face coverings from a medical intervention to a social practice could improve uptake”. How to popularize the use of face coverings is an interesting, socially relevant and important issue. Some researchers have analyzed it in depth and published their views in The British Medical journal (The BMJ)

“Face coverings need to be grounded in the social and cultural realities of affected communities” they argued. This approach may boost universal masking

Encouraging the public to see face masks as a social practice, which they can use to express their cultural background or their personality, could encourage more people to use them regularly, say researchers writing in The BMJ.

Face covering to be grounded in socio cultural reality

The researchers felt that protracted debates about face coverings as a medical intervention had a flipside. It has delayed implementation of a valuable preventive tool – and they say face coverings need to be grounded in the social and cultural realities of affected communities.

Most countries now recommend or mandate the wearing of face coverings to some extent, to reduce the spread of covid-19.

The researchers traced the way the debates developed. The initial argument whether the public should wear them  was on the medical narrative of benefits and harms: (a) whether they would be effective and (b) equally, importantly  whether recommending medical masks for public  would reduce the supply for healthcare professionals.

This view of face masks as a medical intervention has persisted in public health messaging about the use of face coverings. This includes emphasising medial narratives about “donning and doffing,” (putting on a face covering in a certain way) “decontamination” (how to clean it) and “risk” (not touching certain parts of it).

“But recognising and embracing the socio-cultural narrative of face coverings could encourage the public to select one that is meaningful to them and that they will therefore be more likely to wear”, the authors added.

The researchers noted that wearing face coverings is being rapidly introduced as a public health intervention in countries with no cultural tradition of doing so,

 “For successful uptake, such interventions need to be grounded in the social and cultural practices and realities of affected communities, and campaigns should not only inform, but also work to shape new socio-cultural norms.” They argue

Framed socio-culturally, face coverings are clothing or accessories, they explain, and wearing one is a social practice–a behaviour that has a particular meaning in a particular society.

Face covers depict a different identity

The researchers listed the different ways face coverings are looked upon socially:  face coverings have been associated with assuming a different identity (worn by a superhero); criminals wore them to avoid recognition and persecution; women in some cultures were expected to wear them to exhibit modesty; patients wore them when they have an infectious disease; face covers offer protection against pollution, dust, pollen, and some people wear them for cultural ceremonies.

The symbolic meaning of a face covering to a particular society will also be influenced by social expectations (e.g., what we expect a shop assistant, bus driver, or nurse to be wearing), norms (what is viewed as morally correct and as right and proper behaviour), and laws and regulations (whether it is mandatory).

There are examples of face coverings adapting to cultural traditions. For example, in India, a loose end of a piece of clothing, from a saree is now more frequently used also to cover the face during the current pandemic.

The researchers have closely watched what some Asian countries follow, since some Asian countries had previous respiratory virus epidemics when they used face covers in public, uptake of face covers by them during covid-19 has been swift and near universal. 

“This might also be linked to cultural meaning systems that emphasise the boundary between a clean and pure inner self and a potentially polluted outside (similar to the removal of shoes on entering the home)”, the researchers observe

Personalizing face covering

They also thought that the ability to personalise cloth face coverings also offers an opportunity to improve uptake through desirability as an accessory

Materials of construction of face covers varied widely. They had different styles. This raises questions about the efficacy and reliability of face coverings, and public health policy must consider the trade-off between efficacy and compliance, 

 “A face covering that is 100% effective at preventing transmission but only worn by 10% of the population will have less impact than one that is 50% effective but worn by 95% of the population.” They asserted,

The authors concluded that instead of continuing to debate technical specifications and efficacy, the promoters of face coverings should explore socio-cultural framings to encourage their use,

 “This can be done by emphasising underlying values such as solidarity and communal safety. Such measures are likely to enhance the uptake of face coverings and help curb the devastating impact of the pandemic.”

Impact of Universal masking

On July 14,2020, the Journal of the American Medical Association (JAMA) published a research letter by Wang and others showing association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers. The researchers reported significant reduction in SARS-CoV-2 positivity among HCWs with the introduction of universal masking. They carried out the study in, Mass General Brigham (MGB), the largest health care system in Massachusetts, with 12 hospitals and more than 75 000 employees. 

An accompanying editorial noted that early in the pandemic, the Centers for Disease Control and Prevention (CDC) recommended that anyone symptomatic for suspected coronavirus disease 2019 (COVID-19) should wear a face covering during transport to medical care and prior to isolation to reduce the spread of respiratory droplets. 

“After emerging data documented transmission of SARS-CoV-2 from persons without symptoms, the recommendation was expanded to the general community, with an emphasis on cloth face coverings that could be made more widely available in the community than surgical masks and to preserve personal protective equipment such as N95 respirators to the highest-risk exposures in health care settings. Now, there is ample evidence that persons without symptoms spread infection and may be the critical driver needed to maintain epidemic momentum.” The editorial clarified 

The editorial  asserted that the report by “ Wang et al provides practical, timely, and compelling evidence that community-wide face covering is another means to help control the national COVID-19 crisis.”

While I was writing this piece, I had a chance to see from a vantage point sections of population in Navi Mumbai, India. Many did not wear any mask or face-covering; some of those who did were not aware of how they must wear them. Many wore it around their neck!

Researchers through elegant experiments have shown that airborne viruses carried by aerosols can infect persons. SARS-CoV-2 is a very different beast. Some enthusiasts of social net work who do not mind to use the choicest epithets against their political adversaries, term scientific facts as “scary” and “unenlightening”. State, Central and other responsible agencies are making earnest endeavours to mitigate the adverse effects of the virus. Each individual must take care and strictly follow COVID-19 norms. Regular hand washing, keeping physical distances and wearing masks.

Dr. K S Parthasarathy

Dr. K S Parthasarathy

Dr. K S Parthasarathy is former Secretary, Atomic Energy Regulatory Board and a former Raja Ramanna Fellow in the Strategic Planning Group, Department of Atomic Energy, Mumbai. Dr. K S Parthasarathy may be contacted at [email protected]

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