When do we take the masks off for good?
Published Sep 13, 2022 12:05 am
CLINICAL MATTERS
With the possible exception of vaccines, nothing has been as controversial and hotly contested as the use of masks in the fight against Covid-19. In the US, masks became a polarizing political issue, with some opponents viewing mask mandates as a violation of their human rights. A significant reason for this messy situation is the constantly evolving, sometimes contradictory guidance released by authorities on the proper use of masks.
Early in the pandemic, the World Health Organization and the US CDC did not recommend that asymptomatic people wear masks. The prevailing scientific data at that time suggested that SARS-CoV-2 was just like its cousin SARS-CoV, the causative agent of SARS. People with SARS infection do not transmit disease until they develop symptoms. Due to an acute shortage of personal protective equipment, public health authorities wanted to prioritize the use of essential medical equipment for healthcare workers.
As more data was gathered, it became clear that asymptomatic transmission was significant for Covid-19. It was still less efficient than in symptomatic patients, but universal masking to decrease the risk of transmission was subsequently recommended. Prior to the deployment of vaccines, masking was a major intervention for preventing the spread of infection. The early iterations of the virus were not as contagious as the subsequent variants of concern, and viral loads in respiratory secretions were not very high. Even if there was breakthrough infection, the decreased amount of transmitted virus when masked was less likely to cause severe disease. As a result, even cloth masks were initially recommended by CDC due to the ongoing shortage of medical masks and respirators. All these interventions decreased transmission and saved many lives.
When Covid-19 vaccination became available in 2021, early data showed substantial efficacy in preventing severe Covid-19 infection. Vaccines also decreased the risk of infection regardless of severity and significantly decreased viral transmission. With clear proof that vaccines curb SARS-CoV-2 infectiousness, the US CDC began relaxing mask mandates for fully vaccinated individuals.
With highly effective vaccines interrupting transmission, it looked like the pandemic was almost over. Unfortunately, Alpha and the rest of the variants of concern emerged, which had vaccine-eluding properties and were more transmissible. With cases soaring in the US and the UK and a clear decrease in the efficacy of vaccines against preventing infection, there were attempts to bring back mask mandates but these were not as successful. With the arrival of the even more contagious Delta and Omicron variants, cloth masks were deemed no longer effective. Boosters were also needed to improve protection against severe disease in high-risk populations.
Medical grade masks are now the standard for protection, with surgical masks being entry level and well-fitted N95 respirators providing the highest level of risk reduction. More important than the type of mask, however, is its consistent and proper use. A surgical mask that is worn constantly can be just as, if not more effective than an N95 respirator that is frequently removed. Therefore, the Department of Health recommends wearing the most protective mask you can afford, ensuring that the mask fits well, and finding one that can be worn comfortably and consistently.
Continued mask mandates have served the Philippines well, along with the unprecedented nationwide vaccination plan. From ranking second in number of cases early in the pandemic, we are now fifth in the Southeast Asian region, despite having the second largest overall population. Cases have been quite low since the end of the January 2022 Omicron wave, and the current BA.5 wave has not exceeded 5,000 cases a day despite increased mobility.
With the possible exception of vaccines, nothing has been as controversial and hotly contested as the use of masks in the fight against Covid-19. In the US, masks became a polarizing political issue, with some opponents viewing mask mandates as a violation of their human rights. A significant reason for this messy situation is the constantly evolving, sometimes contradictory guidance released by authorities on the proper use of masks.
Early in the pandemic, the World Health Organization and the US CDC did not recommend that asymptomatic people wear masks. The prevailing scientific data at that time suggested that SARS-CoV-2 was just like its cousin SARS-CoV, the causative agent of SARS. People with SARS infection do not transmit disease until they develop symptoms. Due to an acute shortage of personal protective equipment, public health authorities wanted to prioritize the use of essential medical equipment for healthcare workers.
As more data was gathered, it became clear that asymptomatic transmission was significant for Covid-19. It was still less efficient than in symptomatic patients, but universal masking to decrease the risk of transmission was subsequently recommended. Prior to the deployment of vaccines, masking was a major intervention for preventing the spread of infection. The early iterations of the virus were not as contagious as the subsequent variants of concern, and viral loads in respiratory secretions were not very high. Even if there was breakthrough infection, the decreased amount of transmitted virus when masked was less likely to cause severe disease. As a result, even cloth masks were initially recommended by CDC due to the ongoing shortage of medical masks and respirators. All these interventions decreased transmission and saved many lives.
When Covid-19 vaccination became available in 2021, early data showed substantial efficacy in preventing severe Covid-19 infection. Vaccines also decreased the risk of infection regardless of severity and significantly decreased viral transmission. With clear proof that vaccines curb SARS-CoV-2 infectiousness, the US CDC began relaxing mask mandates for fully vaccinated individuals.
With highly effective vaccines interrupting transmission, it looked like the pandemic was almost over. Unfortunately, Alpha and the rest of the variants of concern emerged, which had vaccine-eluding properties and were more transmissible. With cases soaring in the US and the UK and a clear decrease in the efficacy of vaccines against preventing infection, there were attempts to bring back mask mandates but these were not as successful. With the arrival of the even more contagious Delta and Omicron variants, cloth masks were deemed no longer effective. Boosters were also needed to improve protection against severe disease in high-risk populations.
Medical grade masks are now the standard for protection, with surgical masks being entry level and well-fitted N95 respirators providing the highest level of risk reduction. More important than the type of mask, however, is its consistent and proper use. A surgical mask that is worn constantly can be just as, if not more effective than an N95 respirator that is frequently removed. Therefore, the Department of Health recommends wearing the most protective mask you can afford, ensuring that the mask fits well, and finding one that can be worn comfortably and consistently.
Continued mask mandates have served the Philippines well, along with the unprecedented nationwide vaccination plan. From ranking second in number of cases early in the pandemic, we are now fifth in the Southeast Asian region, despite having the second largest overall population. Cases have been quite low since the end of the January 2022 Omicron wave, and the current BA.5 wave has not exceeded 5,000 cases a day despite increased mobility.
The recent initiative of Cebu City to make masks optional outdoors was met with mixed reactions. The Department of Interior and Local Government and the Department of Health initially opposed the directive since this was inconsistent with national policy based on the prevailing IATF guidelines. Given the relatively low hospital utilization rates for the last few months and the need to further boost economic activity, however, it was deemed prudent to revisit the restrictions. The IATF-EID subsequently met. While the DOH continues to maintain that the safest policy is to continue present mask mandates, a cautious transition to a voluntary mask policy outdoors was deemed reasonable. This is in light of decreased mortality rates from the virus as a result of widespread vaccination and the availability of effective treatment. At the time of this writing, we are still waiting for the executive order as approved by the President, along with the time frame of implementation.
After two years of wearing masks, it is completely understandable that people are anxious about removing them in public. When I traveled to Canada in April 2022 after a hiatus of more than two years, it was terrifying to finally take off the mask. The same scenario happened to my kids when we brought them to the US this summer. It took quite a bit of time for them to get comfortable with the idea. Thankfully, none of us got Covid-19 in our travels. Even if we had gotten Covid-19, we were all fully vaccinated and boosted and the risk of severe disease was low.
If the new optional masking policy does get implemented, there are built in safeguards. First, optional means that you can continue to wear a mask outdoors if you aren’t ready to take the risk. I will probably keep mine on for now, especially in Metro Manila where there are a lot of people on the street. I know more than a few people will do the same and take their time to get used to the new normal. Second, the relaxation rules will only apply to outdoor spaces, which aren’t crowded and are well-ventilated. If you’re in a crowded public market, even if it’s open air, you will still need to wear the mask. Third, there are already existing exceptions for outdoor masking—eating, exercise, and sports. The adjustment just extends a new set of exceptions.
A major caveat is that seniors and those with immunocompromising conditions are still strongly encouraged to wear masks even with these new exceptions since they remain at higher risk for dying than the general population. If you have seniors in your home, or you recently had Covid-19, strict mask wearing both indoors and outdoors is still encouraged.
As we take these baby steps to normalcy, it is ok to be worried and feel some anxiety. Thanks to our vaccines and effective medications against Covid-19, we have substantial safety nets. The government is now slowly shifting responsibility for protection to the individual as we all learn to live with the virus as normally as possible. The choice on how much protection you still need is now yours.
With the possible exception of vaccines, nothing has been as controversial and hotly contested as the use of masks in the fight against Covid-19. In the US, masks became a polarizing political issue, with some opponents viewing mask mandates as a violation of their human rights. A significant reason for this messy situation is the constantly evolving, sometimes contradictory guidance released by authorities on the proper use of masks.
Early in the pandemic, the World Health Organization and the US CDC did not recommend that asymptomatic people wear masks. The prevailing scientific data at that time suggested that SARS-CoV-2 was just like its cousin SARS-CoV, the causative agent of SARS. People with SARS infection do not transmit disease until they develop symptoms. Due to an acute shortage of personal protective equipment, public health authorities wanted to prioritize the use of essential medical equipment for healthcare workers.
As more data was gathered, it became clear that asymptomatic transmission was significant for Covid-19. It was still less efficient than in symptomatic patients, but universal masking to decrease the risk of transmission was subsequently recommended. Prior to the deployment of vaccines, masking was a major intervention for preventing the spread of infection. The early iterations of the virus were not as contagious as the subsequent variants of concern, and viral loads in respiratory secretions were not very high. Even if there was breakthrough infection, the decreased amount of transmitted virus when masked was less likely to cause severe disease. As a result, even cloth masks were initially recommended by CDC due to the ongoing shortage of medical masks and respirators. All these interventions decreased transmission and saved many lives.
When Covid-19 vaccination became available in 2021, early data showed substantial efficacy in preventing severe Covid-19 infection. Vaccines also decreased the risk of infection regardless of severity and significantly decreased viral transmission. With clear proof that vaccines curb SARS-CoV-2 infectiousness, the US CDC began relaxing mask mandates for fully vaccinated individuals.
With highly effective vaccines interrupting transmission, it looked like the pandemic was almost over. Unfortunately, Alpha and the rest of the variants of concern emerged, which had vaccine-eluding properties and were more transmissible. With cases soaring in the US and the UK and a clear decrease in the efficacy of vaccines against preventing infection, there were attempts to bring back mask mandates but these were not as successful. With the arrival of the even more contagious Delta and Omicron variants, cloth masks were deemed no longer effective. Boosters were also needed to improve protection against severe disease in high-risk populations.
Medical grade masks are now the standard for protection, with surgical masks being entry level and well-fitted N95 respirators providing the highest level of risk reduction. More important than the type of mask, however, is its consistent and proper use. A surgical mask that is worn constantly can be just as, if not more effective than an N95 respirator that is frequently removed. Therefore, the Department of Health recommends wearing the most protective mask you can afford, ensuring that the mask fits well, and finding one that can be worn comfortably and consistently.
Continued mask mandates have served the Philippines well, along with the unprecedented nationwide vaccination plan. From ranking second in number of cases early in the pandemic, we are now fifth in the Southeast Asian region, despite having the second largest overall population. Cases have been quite low since the end of the January 2022 Omicron wave, and the current BA.5 wave has not exceeded 5,000 cases a day despite increased mobility.
With the possible exception of vaccines, nothing has been as controversial and hotly contested as the use of masks in the fight against Covid-19. In the US, masks became a polarizing political issue, with some opponents viewing mask mandates as a violation of their human rights. A significant reason for this messy situation is the constantly evolving, sometimes contradictory guidance released by authorities on the proper use of masks.
Early in the pandemic, the World Health Organization and the US CDC did not recommend that asymptomatic people wear masks. The prevailing scientific data at that time suggested that SARS-CoV-2 was just like its cousin SARS-CoV, the causative agent of SARS. People with SARS infection do not transmit disease until they develop symptoms. Due to an acute shortage of personal protective equipment, public health authorities wanted to prioritize the use of essential medical equipment for healthcare workers.
As more data was gathered, it became clear that asymptomatic transmission was significant for Covid-19. It was still less efficient than in symptomatic patients, but universal masking to decrease the risk of transmission was subsequently recommended. Prior to the deployment of vaccines, masking was a major intervention for preventing the spread of infection. The early iterations of the virus were not as contagious as the subsequent variants of concern, and viral loads in respiratory secretions were not very high. Even if there was breakthrough infection, the decreased amount of transmitted virus when masked was less likely to cause severe disease. As a result, even cloth masks were initially recommended by CDC due to the ongoing shortage of medical masks and respirators. All these interventions decreased transmission and saved many lives.
When Covid-19 vaccination became available in 2021, early data showed substantial efficacy in preventing severe Covid-19 infection. Vaccines also decreased the risk of infection regardless of severity and significantly decreased viral transmission. With clear proof that vaccines curb SARS-CoV-2 infectiousness, the US CDC began relaxing mask mandates for fully vaccinated individuals.
With highly effective vaccines interrupting transmission, it looked like the pandemic was almost over. Unfortunately, Alpha and the rest of the variants of concern emerged, which had vaccine-eluding properties and were more transmissible. With cases soaring in the US and the UK and a clear decrease in the efficacy of vaccines against preventing infection, there were attempts to bring back mask mandates but these were not as successful. With the arrival of the even more contagious Delta and Omicron variants, cloth masks were deemed no longer effective. Boosters were also needed to improve protection against severe disease in high-risk populations.
Medical grade masks are now the standard for protection, with surgical masks being entry level and well-fitted N95 respirators providing the highest level of risk reduction. More important than the type of mask, however, is its consistent and proper use. A surgical mask that is worn constantly can be just as, if not more effective than an N95 respirator that is frequently removed. Therefore, the Department of Health recommends wearing the most protective mask you can afford, ensuring that the mask fits well, and finding one that can be worn comfortably and consistently.
Continued mask mandates have served the Philippines well, along with the unprecedented nationwide vaccination plan. From ranking second in number of cases early in the pandemic, we are now fifth in the Southeast Asian region, despite having the second largest overall population. Cases have been quite low since the end of the January 2022 Omicron wave, and the current BA.5 wave has not exceeded 5,000 cases a day despite increased mobility.
The recent initiative of Cebu City to make masks optional outdoors was met with mixed reactions. The Department of Interior and Local Government and the Department of Health initially opposed the directive since this was inconsistent with national policy based on the prevailing IATF guidelines. Given the relatively low hospital utilization rates for the last few months and the need to further boost economic activity, however, it was deemed prudent to revisit the restrictions. The IATF-EID subsequently met. While the DOH continues to maintain that the safest policy is to continue present mask mandates, a cautious transition to a voluntary mask policy outdoors was deemed reasonable. This is in light of decreased mortality rates from the virus as a result of widespread vaccination and the availability of effective treatment. At the time of this writing, we are still waiting for the executive order as approved by the President, along with the time frame of implementation.
After two years of wearing masks, it is completely understandable that people are anxious about removing them in public. When I traveled to Canada in April 2022 after a hiatus of more than two years, it was terrifying to finally take off the mask. The same scenario happened to my kids when we brought them to the US this summer. It took quite a bit of time for them to get comfortable with the idea. Thankfully, none of us got Covid-19 in our travels. Even if we had gotten Covid-19, we were all fully vaccinated and boosted and the risk of severe disease was low.
If the new optional masking policy does get implemented, there are built in safeguards. First, optional means that you can continue to wear a mask outdoors if you aren’t ready to take the risk. I will probably keep mine on for now, especially in Metro Manila where there are a lot of people on the street. I know more than a few people will do the same and take their time to get used to the new normal. Second, the relaxation rules will only apply to outdoor spaces, which aren’t crowded and are well-ventilated. If you’re in a crowded public market, even if it’s open air, you will still need to wear the mask. Third, there are already existing exceptions for outdoor masking—eating, exercise, and sports. The adjustment just extends a new set of exceptions.
A major caveat is that seniors and those with immunocompromising conditions are still strongly encouraged to wear masks even with these new exceptions since they remain at higher risk for dying than the general population. If you have seniors in your home, or you recently had Covid-19, strict mask wearing both indoors and outdoors is still encouraged.
As we take these baby steps to normalcy, it is ok to be worried and feel some anxiety. Thanks to our vaccines and effective medications against Covid-19, we have substantial safety nets. The government is now slowly shifting responsibility for protection to the individual as we all learn to live with the virus as normally as possible. The choice on how much protection you still need is now yours.