By Dr Nuruliza Roslan

Imagine this:

While you are out on a grocery run, you saw something bug-like with spiky pink crown on your face mask. How would you react?

A. Rip off the mask frantically and tossing it into the nearest bin.

B. Spray the innocent and cute microbe that landed on your face mask with the disinfectant you kept in hand.

C. Awww, what a cutie. This deserves an IG post!

D. Keep calm and continue shopping.

The scenario above can play out should there ever be a technology where we can see with our own eyes, bacteria, viruses, or even dust on our face mask in real-time. Unfortunately, the technology that allows us to see microbes without the aid of microscopes, or even electron microscopes in the case of viruses (as shown by Figure 1) has yet to be developed. Based on the fictional situation, would you be more concerned to dispose of your 3-ply surgical face mask immediately or wash your cloth face mask after each use if you could see the microbes on it? Plus, paying more attention on how to properly wear a face mask?

In a move to break the chain of rising COVID-19 infections, the Malaysian government announced an MCO for two weeks beginning from 1st June 2021 and extended it for another fortnight. The four-digit daily cases of COVID-19 reported just indicates how one must NOT let their guard down just as yet and keep on adhering to the new normal SOPs in protecting oneself from COVID-19.

Kita masih belum menang, MalaysiaKu.

Coronaviruses measure at ~0.1 – 0.5 um (Figure 2), making it a perfect candidate for airborne transmission. Data collected since the start of the pandemic shows that SARS-CoV-2 can disperse via respiratory droplets that are generated when people talk, breathe, sneeze, or cough (1).

Figure 1: Relative size that can be captured by various detection devices Source: http://www.mc3cb.com/viruses.html

Agencies such as the WHO and the Centre for Disease Control (CDC) recommend wearing face masks to limit community spread of the SARS-Cov-2 virus (2, 3, and 4). Disposable three-ply masks (good for eight hours as long as they do not get wet or damaged) or recyclable cloth face masks protect against infection by creating a barrier to stop the virus from reaching the mucous membranes of our nasal passage or mouth. Its efficacy is increased when we take care to not touch the outer surface of the used face mask before discarding, along with frequent hand washing or using the sanitiser. Cloth masks have the advantage of being more environmentally friendly and relatively low cost; they can be washed and reused instead of adding to the garbage piling the landfills of the world. Figure 3 explains the common types of face masks and their proper use and disposal.

Figure 2: Relative size of particles against scale Source image: Visual Capitalist

Recently, Director-General of Health Tan Sri Dr Noor Hisham Abdullah said that wearing of double face masks in public spaces is encouraged but not mandatory (5). This being said as he was referring to the CDC recommendation, that wearing of double 3-ply masks provides 95% effectiveness in keeping out viruses (Figure 4). This finding was published by the medical journal the Lancet which reported strong evidence that the virus could be airborne and not only spread by droplets (6).

Malaysia is among more than 100 countries worldwide which have made the face mask mandatory in public (7). The choice of the best type of mask boils down to the person wearing it and the purpose for wearing it. Of all the disposable mask types, the N95 respirators provide the most protection against the coronavirus due to its ability to filter out aerosols as well as droplets.

However, the N95 masks are meant for health professionals – particularly for those working in close contact with COVID-19 patients – and those whose work require protection against airborne hazards; thus it is not suggested for public usage. Regular folks can choose disposable or reusable face mask that are easily available in the market which fits the accepted standard and make sure that the mask fit properly especially around the nose and chin without large gaps at the sides of the face. Some chose to make their own cloth face mask; these masks must also adhere to the recommendations by WHO to ensure that it is safe and will protect the wearer as indicated.

Figure 3: Comparison between cloth and disposable surgical face masks

However, the face mask will NOT serve as armour against COVID-19 if it is NOT used properly. The disposable 3-ply surgical face mask must never be recycled nor can it be shared, the mask must be changed when soiled/wet/torn/damaged, and the maximum period it can be worn is only up to eight hours if you are healthy or have no symptoms (see Figure 3). The cloth face mask must be washed and dried properly daily and it too cannot be shared. You need to wash or sanitise your hands before putting on a mask and after disposing it.

Earlier in the pandemic, many complained that the mask is uncomfortable; some say that they feel suffocated while people who wear spectacles griped that the mask fogs up their lenses. People with hearing disabilities are concerned that the mask makes it impossible to read lips which can hamper their communication; thankfully, transparent face masks and shield are now available to overcome this issue. Most importantly, do not wear your face mask BELOW the NOSE or allow the mask to rest/hang around your neck; the face mask is useless as a protection against COVID-19 if not used correctly.

One of the more urgent considerations is the impact of disposable face mask on our environment (8). These masks are often incinerated in a clinical setting, but those discarded by the general public end up in the landfill, or worse, thrown away willy-nilly. There have been reports of face masks tangling the beaks, legs, and wings of birds, and the increase of face masks in rubbish clogging the waterways are endangering our marine and other wildlife (9), as well as affecting our water quality.

To address non-adherence to the established new normal standard operating procedures (SOPs) to combat COVID-19, Malaysia has implemented various types of penalties against non-compliance. To many, it is only logical to comply for our health protection; after all the disposable masks are now available for less than RM1 per piece and the slightly pricier cloth reusable ones are a small sacrifice to pay. However, vulnerable groups whose pockets have been badly affected by the lockdown measures may find it difficult to spend RM20 – RM50 per box of disposable masks in order to comply with the SOP. It is much worse for those who have many members in the household or those who have to work outside every day or commute in the heat which may require them to use more than one face mask per day. While wearing the face mask is for the greater good, we must not allow those who are already suffering economically from the pandemic to be harmed further by the new norm regulations that are more punitive towards those who cannot afford to obey.

We are currently in the fourth surge of COVID-19, and doing our part to minimise the spread is more important than ever. Public mask wearing and physical distancing are the most effective measures to reduce the spread of the virus when compliance is high. A concerted effort is needed across the board to ensure that mask compliance covers all aspects of mask wearing such as proper face mask etiquette and that the masks function according to the standards. Universiti Islam Sains Malaysia started its campaign #USIMjagasemua on educating about proper face mask etiquette in light of combating the spread of COVID-19 since July 2020 and will continue to do so until this scourge is no longer affecting us all.

You cannot control what other people do, but you can always do your part to protect yourself and others.

-- BERNAMA

Dr Nuruliza Roslan is Deputy Director of the Islamic Science Institute at Universiti Sains Islam Malaysia.