Mask up Guyana – save lives and flatten the curve!

Dear Editor,
With every new virus that emerges as a pandemic, there is a learning curve about the virus itself: its mode of transmission; symptoms; complications; treatment, if any; and yes, based on these, how to prevent and contain it.
The Novel Coronavirus (COVID-19) has evolved into a pandemic and continues to overwhelm many of the more developed countries. Three months after the alarm was sounded by China, there have been more than 100,000 deaths from the pandemic.
There is a tiny window to learn. As the world grapples with the shortage of personal protective equipment (PPEs) for health workers and life-saving machines and ventilators, enough time has elapsed for Guyana to learn from other countries about what is effective to “flatten the curve”. We currently know of over 140 cases under surveillance, 2 deaths and 12 confirmed cases in three short weeks, coupled with limited testing and information.
We needed to act decisively yesterday, as unknowns remain unknown and the numbers climb. Using knowledge of what drove wide-scale transmission and what countries with fewer cases did differently, and implementing the most effective of those measures within our economic or accessibility limitations are necessary.
We can, in addition to handwashing, social distancing and cleaning surfaces, emphasize that persons stay at home; but there must be some movement towards partial lockdowns of non-essential places to prevent large congregations or liming. Many countries have moved to total or partial lockdowns for 14-21 days to contain spread.
The Czech Republic has enforced the compulsory wearing of masks outdoors; Taiwan, Japan and South Korea pushed large public mask use – the effect smaller numbers of deaths relative to population. In the absence of the controversial shutdown and a national call for self-isolation and social distancing, compulsory public masking is emerging as a quiet hero! The Centre for Disease Control (CDC) is considering widespread masking.
WHO maintains that only sick persons, caregivers and health workers should wear masks. The point is: what we know of the COVID-19 virus is evolving, so guidelines will also change. People move, and the COVID-19 virus moves with them.
Guyanese have not been implementing social distancing, have not been staying at home, or self-isolating on a large scale for many reasons, including financial or disbelief. Guyana, like any country, faces the practical reality that healthy individuals, especially those with essential jobs, who cannot avoid public transportation or close interaction with others, are out there on a daily basis and are at risk.
Identifying and isolating people with infections plays a major role in breaking the chain of transmission. People who do not have any symptoms, or do not develop symptoms until later, may continue to inadvertently spread the disease. As many as 6 in 10 people infected with the coronavirus may be unaware they have the disease, according to a number of papers studying the outbreak. It is difficult to determine conclusively who is truly asymptomatic, as many asymptomatic persons go on to develop symptoms a few days later.
Asymptomatic cases are silent carriers of COVID-19. A third of China’s positive cases were asymptomatic. Of the 700 passengers tested positive on the Diamond Princess cruise ship,18% of those never showed symptoms. Iceland, where a high proportion of citizens in the country have been tested, have found similarly high percentages of asymptomatic infection.
Of 13 infected Japanese citizens evacuated from Wuhan in early February, four of them had never developed symptoms. Individuals can shed the virus about 48 hours before they develop symptoms, and masking can prevent transmission from those individuals. Droplet transmission occurs when persons cough or sneeze, yes; but also does when persons speak.
One sneeze gives out 1000+ particles. People standing less than 6 feet away may become covered with these virus particles while they are still in the air. After the droplets fall, the virus particles can remain active for up to nine days on some surfaces. Infection occurs when someone breathes in airborne droplets, or when they touch their mouth, nose or eyes with hands covered in virus particles that have fallen out of the air onto counters, hand rails, floors, or other surfaces.
Newer data suggests that compulsory masking when leaving the home can help to cope with this grim reality, even by using self-made masks. Self-made masks, while not definitive or without risk, provide protection to the public. Wearing a mask can reduce the likelihood of transmission from early asymptomatic cases or asymptomatic cases. This is practical and necessary for individuals working in certain essential industries, where they still have to go out every day.
Wearing a face mask stops people from becoming infected by blocking most airborne droplets filled with virus from being inhaled. Protection only comes when the masks are used properly. They must be put on clean, taken off carefully, and paired with rigorous hand washing, and the discipline not to touch the face.
If people have well-constructed masks with appropriate materials that fit well, there are benefits. With the shortage of medical grade PPEs for healthcare personnel who desperately need them, leaving the manufactured disposable masks for them and making our own masks is our contribution to flattening the curve. It is cost effective and requires fabric we may already have. Sneeze and cough droplets are usually between 7 and 100 microns. Surgical masks and some cloth masks will block 7-micron particles. The COVID-19 virus particles are 0.06 to 0.14 microns.
Homemade masks with certain materials may capture as much as 50% of those virus particles, and they are also reusable as they can be washed. Fabrics that are best for virus-capture include vacuum cleaner bags (95%), 100% tightly woven cotton or poly-fabric or cotton blends (70-75%) and two layers of dish cloths (called tea-towels in the UK) in the 90% range.
In addition to protection, one must breathe and be comfortable to wear the mask for long periods; so, after much testing, the advice is that the best fabric to use is 100% tightly woven cotton found in pillowcases, bedsheets and 100% cotton t-shirts. As you stay at home, get the family together and make masks for all the adults and children.
In the event you become sick, having a supply of masks to use will give some level of protection to family, and if you go out, to others around you while you seek medical advice.
For N95 masks: While homemade masks are not a substitute for N95 masks, or other medical/surgical grade masks, they will certainly be better than no mask at all. Let us call for compulsory masking outdoors, and let us start the movement ourselves, one person and one household at a time.

Dr Vindhya Vasini Persaud