Masked faces: The new normal and COVID-19 – Part 2

Prolonged wearing of face masks like we have had to do during this pandemic would also have some yet-to-be-discovered psychological effects. It would take years before we can tell what the long-term psychological effects of mask-wearing will have had on us especially on very young children that have just started secondary socialization. These are the children who recently started school.

Masks should be changed daily even if they do not appear to be dirty and must never be shared. Fabric masks that have been worn should be washed daily. Fabric masks should be washed in gentle soaps that lather and spread under the sun.

The coronavirus has been known to be “killed” by the sun’s heat. Constant washing of fabric masks will weaken the tightness of the cloth fibers thereby reducing their filtering properties. Therefore, it is good to change your fabric mask after a few months or after several washes.

We’ve had the virus with us for about nine months now. We should not become mask-fatigued because the virus has not bidden goodbye. Wearing of our face masks is a sign of personal social responsibility. We protect ourselves as well as anyone around us. We have three things that we are personally responsible for; washing of hands, keeping social distance and wearing of masks. Washing of our hands and social distancing may not be totally under our control. The availability and accessibility of water to wash our hands can depend on resources beyond our control. Social distancing may not be totally under our control because while trying to keep our distance, crowds can meet us where we are. However, wearing of face masks, for the most part, depends on our own control and shows our personal responsibility.

Well, whether you’re wearing a face mask to make a statement or you’re wearing it to assail your fears, consider how you remove and dispose of that mask. You must carefully remove the face mask once worn and dispose properly if it’s the disposable type. Dispose in a grocery or trash bag and make a knot with the trash bag so that the mask does not end up being “recycled” by garbage collectors. You can cut off the strings of the used disposable masks to make sure it will not be worn by other persons. Since we are to wear our masks daily when going to public spaces, it is a good idea to have at least two fabric face masks.
Disposed surgical and fabric masks are being seen everywhere like the empty pure water bags that have become ubiquitous in our environment. As we are in the rainy season, these ill-disposed masks may end up clogging our waterways complicating the flow of rainwater that could end up as floods. While trying to take care of one problem, let’s not create another. We all have to get accustomed to a new normal so we can as well get used to wearing face masks and make some beautiful statements while at it.

This is not the time to become user-fatigued in mask-wearing. It’s difficult to keep all the COVID-19 protocols because we all cherish our freedoms but we need to collectively look at the end result of our behaviours to stop the virus. We need to be personally responsible in maintaining the COVID-19 protocols especially mask-wearing, social distancing, respiratory and hand hygiene.

When three-quarters of the global population was on one form of a lockdown or the other, Sweden with its population of 10 million people did not go on a severe lockdown. There was a mutual trust between the Nordic country and its people. The Government of Sweden refrained from mandatory lockdowns and mask-wearing. Rather, it depended on people’s personal social responsibility. It only recommended that they increase their hand and respiratory hygiene, work from home and keep social distancing. The wearing of face masks was voluntary and those who wore them did not do so out of compulsion although it was not worn by all. The schools were open for children less than 16 years old. The universities were closed. It also banned the gathering of more than 50 people. The point of the voluntary wearing of mask till now meant that they were intrinsically motivated as opposed to extrinsic motivation.

When a behaviour is intrinsically motivated and not forced, it is more likely to be sustainable over long periods. When behaviors are extrinsically motivated like governments making face masks mandatory with insufficient health messaging, they are not sustainable. However, with effective health education and consistent messaging, extrinsic motivation can be increased and the desired mask-wearing behaviour achieved. It is difficult to maintain extrinsically motivated behaviours. If we look at countries that had the severest form of lockdown, in the first wave of the pandemic, those countries are now having inklings of a second wave with new daily cases in some countries being more than thirteen thousand.

An explanation can be found in human behaviour. Human behaviour that was extrinsically motivated with inadequate health education was not sustainable such that as soon as the lockdown was relaxed, people consciously or unconsciously went back to their old ways and threw away all COVID-19 protocols. They unconsciously rebelled against the many restrictions that had been imposed on their liberties most especially the mask-wearing and social distancing.

Amongst the Nordic countries, Sweden now has the lowest number in daily cases. However, during the first wave of the pandemic compared to its neighbours, it had the highest deaths. More than half of those deaths were from the elderly care homes; five times higher than those in Denmark. This blight in the Swedish approach also appeared to be disadvantaged to the weak. It invariably plays out for the survival of the fittest; the old people died while the younger ones survived.

My analysis of the Swedish approach has shown that the alien behaviour of mask-wearing is not sustainable on the long run but mutual trust between the government and the governed has allowed the Swedish to voluntarily choose to wear or not to wear face masks. It has also reduced the probability of overwhelming their hospital beds. In this month of September, while many countries in Europe are having a second spike, Sweden has actually had a drop in the number of cases with only 1.2 percent of its 120,000 tests being positive by the 9th of September. The 1.2 percent is a good pointer to the control of the disease. For COVID-19 to be considered under control, less than 5 percent of test results must be positive.

One possible explanation for the dip in the number of cases in Sweden could be herd immunity. Since some of the Swedish were not wearing masks at the peak of the pandemic, the infected ones amongst them were able to infect others and over several months, a moderate level of immunity had been achieved in the population. Without actually testing their blood for antibodies to SARS-CoV-2, one cannot definitively confirm that there’s herd immunity but it appears to be so. Antibody tests examine the blood for antibodies indicating a previous infection. Antibodies are proteins present in the blood. The presence of antibodies is a marker informing us that the person has been infected and most likely recovered from the novel coronavirus. Antibody tests are different from diagnostic tests. Diagnostic tests normally determine the presence of the virus indicating an ongoing, present infection. Nasal swabs are usually taken for diagnostic tests. The daily numbers of confirmed cases presented by NCDC are results from diagnostic tests.

Similarly, in Nigeria, most people stopped wearing their masks some months ago. And around the same time, the number of new cases began to drop from 603 on the 4th of July to 354 on the 6th of August and 189 new cases on the 19th of September. The drop in the number of new cases could also be because we’re not doing enough tests. Although the number of tests conducted on 19th of September and 4th of July were approximately the same; 2,850 tests on 19th September and 2,933 tests on 4th of July. On the 6th of August, 3,835 tests were conducted. The number of confirmed cases decreased markedly from 603 on 4th of July to 189 on the 19th of September. And it could be that most people have asymptomatically had the disease, recovered and never even knew they had had the disease. It’s also true that those whose immunity were not strong enough were taken down by the disease.

However, it’s also possible that these asymptomatic persons are infecting unsuspecting people. Could we possibly be having a herd immunity or are there other factors to consider? These are all possibilities we’ll never know unless the blood of random persons in the cities are taken and tested for SARS-CoV-2 antibodies. We don’t know definitively if we’re having a herd immunity, but we do know undeniably that wearing of masks will protect us so we should intrinsically motivate ourselves so that without much effort we can once again begin to wear our facial badge of responsibility. The only true test of one’s immune system is if one gets the disease and survives but it’s not a path we want to take. Therefore, our governments can ginger up and extrinsically motivate the people with consistent and sustainable health messages. And we too should intrinsically motivate ourselves to return to wearing of our masks. Who knows? Post pandemic we can start celebrating a “wear your face mask day” in commemoration of the pandemic. No one knows when that day would come, but we must remain hopeful.

Concluded.

Obilade, a medical doctor and an Associate Professor of Public Health wrote from Abuja.