Escandón, Karina

Escandón, Kevin

Kuppalli, Krutika

Martin, Graham P

English

Apollo (Cambridge)

Disaster Medicine and Public Health Preparedness 1©Society for DisasterMedicine andPublic Health, Inc. 2020. This is anOpenAccess article, distributed under the termsof the Creative CommonsAttribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in anymedium, provided the original work is properly cited. DOI: 10.1017/dmp.2020.336Appropriate Usage of Face Masks to PreventSARS-CoV-2: Sharpening the Messaging Amidthe COVID-19 PandemicKarina Escandón, BA ; Graham P. Martin, PhD ; Krutika Kuppalli, MD ;Kevin Escandón, MD, MScKey Words: coronavirus, COVID-19, mask, public health, SARS-CoV-2Many governments currently recommend ormandate universal use of face masks amidthe coronavirus disease 2019 pandemic.Cloth face masks and makeshift face coverings – frombandanas and scarves to do-it-yourself and commer-cially available masks – are being advised for sourcecontrol in many countries and regions to mitigate severeacute respiratory syndrome coronavirus 2 (SARS-CoV-2)transmission. Unfortunately, instances of individuals inap-propriately wearing masks are being witnessed in publicand on social media as they have become part of our“new normal” (Figure 1).The directives from some public health officers and themessaging by some mask advocates, though well-intended, have been overly simplistic with slogans,such as “Wear a face covering, something is better thannothing,” “Just wear a mask, it’s common sense,” and“The science behind masks is simple and clear.”1-3Also, polarizing narratives and the broad use of termssuch as face covering have led to misconceptions andconflicting messages about the types of masks andthe instructions for their use.The use of masks is not intuitive, and the sciencebehind them is not straightforward.4,5Whereas simplis-tic and overconfident messaging is misleading, accuratemessaging about the benefits, risks, and uncertainties isessential to gaining public support for the uptake ofnon-pharmaceutical interventions and thus theCOVID-19 response. Based on available filtration effi-cacy data, the degree of protection from cloth masks isvariable and greatly hinges on mask composition,thickness, permeability, electrostatic properties, andfacial fit.5-7 Furthermore, masks require careful instruc-tions (Table 1) to improve the likelihood of achievingtheir real-world benefits and to avoid the potential forself-contamination and mask contamination with viralparticles.6,8-10 Inappropriate mask wearing is likely toreduce the effectiveness of masks. Several studies havereported the challenges related to appropriate maskuse, compliance, and acceptance.9 Mask adherence doesnot simply reflect discipline; knowledge, risk perception,social acceptability, values, preferences, trust, and acces-sibility and affordability of masks play a major role.Health education, effective scientific communication,context-sensitive policymaking, and communityengagement are key tools to enhancing the under-standing of masks’ benefits and downsides, encouraginghealth-seeking behaviors, warning against compla-cency, building trust in public health agencies, andavoiding judgment and shaming. Diverse and tailoredinformation campaigns (eg, mainstream press, socialmedia, public advertising, training seminars) and commu-nity outreach programs that incorporate surveillancearound mask adherence practices are needed. Likewise,potential unintended consequences should be studied,anticipated, and addressed to maximize any benefits andminimize any downsides of widespread mask use.9 Amidthis pandemic, there are research opportunities on differ-ent approaches to information provision; attitudes, behav-iors, and beliefs toward proper mask wearing; and clothmask designs, duration of use, reuse, breathability, and dis-infection methods.4In this article, we challenge inaccurate communicationon community masking and argue for the need toimprove public health messaging. In contrast to theabovementioned statements, more accurate state-ments are: “Wearing a cloth mask correctly may helpslow down viral spread,” “Wear a cloth mask when inenclosed or crowded spaces,” and “Help reserve medi-cal masks for health care workers by not hoardingthem.” Such messages provide clarity while acknowl-edging nuances and lingering uncertainties, rather thanproviding oversimplified mask indications or misleadingaccounts regarding the effectiveness of face masks.About the AuthorsDepartment of Anthropology, Universidad Nacional de Colombia,Bogotá, Colombia (Ms Escandón); The Healthcare ImprovementStudies Institute (THIS Institute), University of Cambridge,LETTER TO THE EDITORCambridge, United Kingdom (Dr Martin); Division of Infectious Diseases,Medical University of South Carolina, Charleston, South Carolina (DrKuppalli) and School of Medicine, Universidad del Valle, Cali, Colombia (DrEscandón).Correspondence and reprint requests to Kevin Escandón, School of Medicine,Universidad del Valle, Calle 4B # 36 - 00, Cali 760043, Colombia (e-mail:kevin.escandonvargas@gmail.com).Conflict of Interest StatementThe authors have no conflicts of interest to declare.Author ContributionsKarina Escandón was responsible for the conceptualization and writing of theoriginal draft. All authors were responsible for substantial contributions to thecontent and critical revision.REFERENCES1. Bulletin Editorial Board. It’s just common sense to wear a mask, so pleasedo it. June 29, 2020. https://www.bendbulletin.com/coronavirus/editorial-its-just-common-sense-to-wear-a-mask-so-please-do-it/article_04c32738-ba2d-11ea-956d-5bc725a5fad5.html. Accessed July 10, 2020.2. Howard J. The Conversation. Masks help stop the spread of coronavirus –the science is simple and I’m one of 100 experts urging governors to requirepublic mask-wearing. May 14, 2020. https://theconversation.com/masks-help-stop-the-spread-of-coronavirus-the-science-is-simple-and-im-one-of-100-experts-urging-governors-to-require-public-mask-wearing-138507.Accessed June 1, 2020.3. Trusler M.CMAJ. Re: Who should wear a face mask? Comment on “Whoshould wear a face mask?” May 1, 2020. https://www.cmaj.ca/content/re-who-should-wear-face-mask. Accessed June 15, 2020.4. Martin GP, Hanna E, McCartney M, et al. Science, society, and policy inthe face of uncertainty: reflections on the debate around face coverings forthe public during COVID-19. Crit Public Health. 2020;epub, doi: 10.1080/09581596.2020.1797997.FIGURE 1Appropriate and Inappropriate Mask Wearing Amid the COVID-19 Pandemic.TABLE 1Instructions for Optimal Mask Wearing, Storage, and Disposal6,8-10• Wash hands thoroughly with water and soap for at least 20 seconds or clean them using an alcohol-based hand sanitizer (only if hands are not visibly dirty) before wearing amask and after touching or removing the mask.• Put the mask on and ensure that it fits snugly around the face and covers the nose, mouth, and chin completely at all times while wearing it.• Avoid touching the face and the mask. If you touch the mask, wash or sanitize your hands.• Do not fiddle with the mask. Do not share a mask with others.• Remove the mask from the tie straps behind the head or the elastic ear loops, without grabbing the front.• Discard single-use masks immediately upon removal or when it becomes damaged, moist (eg, contaminated with bodily fluids and secretions), or visibly dirty. Routinelywash reusable cloth masks with regular detergent and let them dry before wearing again.• Keep masks in a clean, dry place (eg, a clean plastic or paper bag).• Sincemoisture from breathing inside masks may affect their effectiveness, it should be cautioned against the use of a single mask for extended periods. It is recommended tochange to a fresh mask when the mask being worn becomes damp.• Masks should not be worn by children under age 2 years, people whomay have baseline breathing difficulties, and people who are unconscious, incapacitated, or otherwiseunable to wear a mask correctly. Alternatively, these people should rely on keeping the respiratory etiquette along with all other personal and environmental hygienicmeasures.• Primary school-aged children should have adult supervision when wearing a mask.• Masks should not be seen as an alternative to physical distancing.Face Mask Usage to Prevent SARS-CoV-22 Disaster Medicine and Public Health Preparedness5. Escandón K, Rasmussen AL, Bogoch II, et al. COVID-19 and false dichoto-mies: time to change the black-or-white messaging about health, economy,SARS-CoV-2 transmission, andmasks. 2020;epub, doi: 10.31219/osf.io/k2d84.6. Chughtai AA, Seale H, MacIntyre CR. Use of cloth masks in the practiceof infection control – evidence and policy gaps. Int J Infect Control.2013;9(3):1-12. doi: 10.3396/IJIC.v9i3.020.13.7. Taminato M, Mizusaki-Imoto A, Saconato H, et al. Homemade cloth facemasks as a barrier against respiratory droplets – systematic review.Acta PaulEnferm. 2020;33:1-11. doi: 10.37689/acta-ape/2020AR0103.8. World Health Organization. Advice on the use of masks in the contextof COVID-19: interim guidance. June 5, 2020. https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak. Accessed June 10, 2020.9. Bakhit M, Krzyzaniak N, Scott AM, et al. Downsides of face masks andpossible mitigation strategies: a systematic review and meta-analysis.medRxiv. 2020;epub, doi: 10.1101/2020.06.16.20133207.10. Centers for Disease Control and Prevention. Use of cloth face coveringsto help slow the spread of COVID-19. 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html. Accessed June 27, 2020.Face Mask Usage to Prevent SARS-CoV-2Disaster Medicine and Public Health Preparedness 3

Appropriate Usage of Face Masks to Prevent SARS-CoV-2: Sharpening the Messaging Amid the COVID-19 Pandemic.

https://www.repository.cam.ac.uk/bitstream/handle/1810/316028/Appropriate%20Usage%20of%20Face%20Masks%20to%20Prevent%20SARS-CoV-2%20Sharpening%20the%20Messaging%20Amid%20the%20COVID-19%20Pandemic.pdf?sequence=1&isAllowed=y

Appropriate Usage of Face Masks to Prevent SARS-CoV-2: Sharpening the Messaging Amid the COVID-19 Pandemic.

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