India’s highest science advisory body, the Office of the Principal Scientific Adviser (PSA), and the Union Health Ministry appear out of sync on whether masks should be widely used by people.
The Ministry’s standing recommendation is that not everybody should be wearing masks. Among those who are not healthcare workers, only those who had a cough or exhibited signs of a flu or a respiratory illness need to be wearing them as did those caring for COVID-19 patients. The reason this isn’t recommended for the public at large — though now almost anyone on the street can be seen to be wearing them — is that it will lead to a shortage and unavailability for doctors, nurses and other hospital staff.
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On Tuesday, however, the office of the PSA through the Press Information Bureau recommended the widespread use of masks. It endorsed, above all, home-made masks that could easily be made and were reusable with washing and sanitising.
“The proposed guide is meant to provide a simple outline of best practices to make, use and reuse masks to enable NGOs and individuals to self-create such masks and accelerate widespread adoption of masks across India. The key criteria for proposed designs are Ease of Access to Materials, Easy of Making at Home, Ease of Use and Reuse. Wearing of masks is especially recommended for people living in densely populated areas across India,” notes the advisory, which was made public via the Press
The office of the PSA is a key coordinating agency among government scientific bodies and industry to accelerate decisions on dealing with COVID-19. It does not recommend the use of the health mask or the N95 mask that are expensive, not-reusable and largely used in hospital settings.
K. Vijay Raghavan, Principal Scientific Adviser, did not immediately respond to a request for comment.
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The Health Ministry, which is the nodal agency for monitoring the pandemic, said it was “studying the recommendations” of the office of the PSA.
Health Ministry spokesperson Lav Agrawal said at the daily press briefing on Tuesday, “The World Health Organization hasn’t given a categorical opinion on its [mask] usage. However, a technical committee is looking into this issue and suitable guidelines will be issued soon. Our stress is on social distancing. We request that not everyone wear a mask. We have defined guidelines on who should and shouldn’t be wearing one.”Ministry’s advisory
Its most recent advisory, as on the March 17, was that masks need be worn by the healthy only if they are taking care of a sick person with suspected COVID infection. It also advises masks for those who are coughing and sneezing.
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Raman Gangakhedkar, who was also at the briefing as a representative of the Indian Council of Medical Research (ICMR), said: “There’s a wide gap between the number of cases in the United States and India and the risk of exposure isn’t as much here. Hence only those sick or at risk of exposure should be wearing them.”
Other than the question of shortage, the scientific consensus was that COVID-19 was not an airborne disease and most people contracted it through coming into contact with infectious droplets picked up from surfaces.
“The government's policy regarding the use of masks is evolving. Probably they are now taking more notice of the fact there may be a sizeable number of asymptomatic carriers of the infection — some studies suggest nearly 25% of COVID-19 infected may be asymptomatic — and wearing a mask is a good precautionary measure,” said Sunit Singh, molecular virologist, Institute of Medical Sciences, Banaras Hindu University.
The March 31 advisory from the office of the PSA recommends the use of home-made cotton masks that are reusable after appropriate washing and disinfection that can be done at home.
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It also a cites a study that says “... if 50% of the population were to wear masks, only 50% of the population would be infected by the virus. Once 80% of the population wears a mask, the outbreak can be stopped immediately,”. This however is from a 2019 study in journal Risk Analysis and based on a modelling study on containing influenza outbreaks. Sars Cov-2 is comparably contagious but different in structure from influenza viruses.
On March 27, George Gao, Director, Chinese Centre for Disease Control and Prevention, said in an interview to Science that the United States and Europe made “a big mistake” by not wearing masks. “Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”