‘If I said paying income tax is optional, would anyone pay?’

Earlier this week, Elizabeth T Jacobs, a cancer and chronic disease epidemiologist at the Mel and Enid Zuckerman College of Public Health and the University of Arizona Cancer Centre, lashed out on Twitter at the Centers for Disease Control and Prevention, the national public health agency of the United States, for its new "mask guidance". The CDC had unveiled updated COVID-19 guidelines for masking, based on three metrics - the number of new COVID-19 cases in an area, the share of hospital beds being used, and hospital admissions. Jacobs argued that she was lucky that she could afford an RTPCR test that allowed her to put some mitigation in place so as not to infect others.. "But there are so many who are not. These are the people that the government wants us to forget. I refuse to do so," she tweeted.

It's a sentiment shared by many health experts across the globe. Dr Rajeev Jayadevan, co-chairman, National IMA COVID Task Force, being among them. In an interview with mid-day, he says that "freedom from COVID" is a long way off, and explains why masking is important to ensure that seniors in the country are protected from future infections.

Edited excerpts from the interview:

Several countries across the globe are either contemplating relaxing mask mandates or have lifted it completely. Maharashtra, for instance, this week announced that masking was no longer compulsory. Do you think it's a problematic call?
It is problematic for two reasons - Since the beginning of the pandemic, the public has been persistently misled into believing that the pandemic is over. We saw that after the first wave, the second wave, as well as the third one. The problem with such a narrative is that if the public believes that the pandemic is over, then when the next wave comes, it's likely that we will react late. If we accept that this is a cyclical disease and that it will keep coming at us, we'd be able to see the first signs of surge, act a little early, prevent damage, and create a large change in the eventual outcome. The more number of days you lose, the graver the outcome. We can't be caught napping.

Second, if the government says masks are ‘optional', it could be perceived by many as an instruction to not use it. Suppose, our government said that from tomorrow onwards paying income tax would be made optional, even though we as citizens know that tax is important for the growth of a nation, I don't have to be an economist to tell you what the outcome is going to be.

Even though vaccination reduces the risk of being infected, the risk of death is still substantial among older people. They get the short end of the stick. Removing masks at a government level, will affect a person at the grassroots level.

Rajeev Jayadevan

Tomás Ryan [associate of the Trinity College Institute of Neuroscience] recently shared alarming details from Ireland in a podcast. The country is seeing higher number of deaths, and hospitalisations due to COVID among populations that are highly vaccinated and boosted. He said that this could most likely be due to the softer stand on mask-wearing.
His concern was with the abrupt cessation of pandemic measures in Ireland [which resulted in a large rise in cases, over 23,000 cases in a single day]. People have stopped wearing masks at stores and in public transport there. Prof Ryan picked up the infection despite wearing a well-fitting N95 mask, and he said that it was most likely because no one else was wearing one. He mentioned how masks reduce viral load and improve air hygiene. [One has to realise that] there is really no freedom [from COVID]. It's like saying global warming has stopped. There are a large number of infections without symptoms that are transmitted, and these numbers may not be reflected in the official data; these are the people who can pass on the virus to an older person.
Universal precaution is important. Why do we continue to chlorinate our water, even when there is no cholera outbreak? Likewise, air hygiene measures have to continue, without restricting economic or social activity.

Should we look at "face masks" as a COVID restriction?
No, and that's what Prof Ryan mentions as well. He calls masks "protection". That's a nice perspective. Mask-wearing can actually give you more freedom. We should stop using words like "mask mandates".

If universal indoor masking rules prevail, we will all feel safer, and less restricted. Because, I know if I wear a mask and enter a shop, and everyone else is too, my chance of getting infected is lower.

Is double masking more effective against COVID-19?
I am not aware of any hard evidence, which show that a double mask provides more protection than a well-fitting N95 mask. The fit of the mask is more important than the type and the cost.

For the longest time, the municipal corporation in Mumbai had mask marshals who would fine people for not wearing masks. There were cases of marshals extorting people, as well.
Let me give you an example of helmet riders in my home state, Kerala, since I am a road-safety trainer myself. A few years ago, the state made it compulsory for riders and, later, pillion riders to wear helmets. The police was also instructed to stop two-wheeler riders and fine them for flouting the rule. At the time, we had a lot of complaints about this, mostly lame excuses. But, because there was a fine, people started wearing it, and accidents and deaths came down considerably.

But suppose instead of a fine, an advisory was issued, would people adhere to it? Penalty is one way of influencing mass behaviour, and I feel that's a form of communicating. No government has an intention to antagonise the people, though it might be superficially portrayed that way, where a common man sees it as harassment.

Likewise, by asking for pandemic appropriate behaviour, I don't think governments are trying to harass people; it's a measure to protect society, rather than
an individual.

Cases are increasing in China. Shangai has gone into lockdown. Should we be alarmed?
Yes. Whenever there is a spurt in cases in any part of the world, it doesn't take more than a few hours to reach other parts. We don't know if a new variant is circulating there. We will have to wait and watch.

Do you think mask-wearing should continue?
Yes, and there should be no excuse for indoor masking. When I say indoors, I mean in the company of strangers inside closed spaces.