Wearing a mask! Where do WHO and CDC differ and why a San Francisco organisation opposed masks during Spanish flu

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The World Health Organisation in no uncertain terms makes it clear that masks should be used as part of a comprehensive strategy of measures to suppress transmission and save lives.

When the COVID-19 pandemic is raging through the world with varying degrees of severity in different geographical locations, hardly anyone can debate on the most important quality of wearing a mask — it’s life-saving.

Masks are a simple barrier to help prevent your respiratory droplets from reaching others. Studies show that masks reduce the spray of droplets when worn over the nose and mouth. You should wear a mask, even if you do not feel sick. Yet there is no dearth of cynics who contest the very idea of wearing a mask for whatever reasons perhaps to the point of ignoring it as a matter of life and death itself.

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The idea of wearing a mask has always remained a point of acceptance and resistance since the Spanish flu and conflicting guidelines, politicisation of the matter, stress on individualism have complicated it even further only putting huge populations at risk.

Why masking became a political debate

“I don’t wear masks like him. Every time you see him, he’s got a mask. He could be speaking 200 feet away from it, and he shows up with the biggest mask I’ve seen.” This was former US president Donald Trump mocking his then election rival and now US president — Joe Biden — during the first presidential debate in September last year in the run-up to US presidential polls in December 2020.

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In April last year, Trump nearly overruled the recommendations of the Centres for Disease Control and Prevention to wear masks in public by making it optional for citizens rather than mandatory.

The result was of course there to see in the open as the 74-year-old Trump who got infected with COVID-19 in October first week soon after the national debate on stage and was admitted to the Walter Reed Medical Center for treatment. The former president soon recovered from the virus but his opponent Biden who strictly follows the COVID-19 protocol is safe thus far.

The difference of opinion on whether a mask should be worn ran so deep that a Pew Research Center report in June last year found that “Democrats and Democratic-leaning independents are about twice as likely as Republicans and Republican leaners to say that masks should be worn always (63 versus 29 percent). Republicans are much more likely than Democrats to say that masks should rarely or never be worn (23 versus four percent).”

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But then the differences in opinion about mask-wearing were also determined by factors like gender, race, age and geographic differences, the study said.

Similarly in Canada, supporters of the Bloc Québécois, a federal political party dedicated to promoting Quebec nationalism and sovereignty, initially junked the idea of wearing a mask but changed its stance later when cases began to rise in the country.

How history compares with the present times when it is about masking

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On 17 April, 2020, when San Francisco mayor London Breed issued an order that face masks be worn in public as a measure to help prevent the spread of COVID-19 , she repeated a part of history that was not done for 101 years.

The resistance against wearing a mask is nothing new as in November 1918, the Anti-Mask League in San Francisco organised protests against the wearing mask rule. This was at the time of the Spanish flu in San Francisco which killed thousands because of such wilful disobedience.

Brian Dolan in his essay Unmasking History: Who Was Behind the Anti-Mask League Protests During the 1918 Influenza Epidemic in San Francisco? said, “I was intrigued by the “Anti-Mask League.” What struck me was that the individuals who organised the protests and went as far as to establish an organisation, complete with president, secretary, treasurer, and vice-presidents, were all women. It was reminiscent of the fourteen portraits printed on the front page of the Chronicle in November 1918 showing a group of “beaming” faces freed from gauze masks: the revellers were all women.”

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The Red Cross went to the extent of calling “the man or woman or child who will not wear a mask now is a dangerous slacker” but still not all were convinced and around 6,75,000 people died in the US alone because of the Spanish flu.

Authors Valerio Capraro and Hélène Barcelo in their paper The effect of messaging and gender on intentions to wear a face covering to slow down COVID-19 transmission found that more men than women tend to report negative emotions when wearing a face covering.

The researchers discovered that “men more than women disagree with the statement “wearing a face covering is cool” and agree with the statements: “wearing a face covering is not cool” “wearing a face covering is shameful”, “wearing a face coveringis sign of weakness”, and “the stigma attached to wearing a face covering is preventing [them]from wearing one as often as [they]should”.”

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Researcher Antoine Bristielle, who studied a French survey of 800 members of anti-mask Facebook groups, was surprised to find that 52 percent of the sample believed that the compulsory wearing of masks is part of a global Zionist plot. Edward D Vargas and Gabriel R Sanchez while writing for the Brookings in August last year derived a conclusion that American individualism emerged as an obstacle to wider mask-wearing in the US.

Reluctance to wear masks in the West as opposed to sincerity in the East also came from the cultural point of view.

“For Asian observers, not wearing face masks represents the lack of social cohesion, failure of effective government prevention strategies and comprehensive solidarity. In the eyes of many Westerners, wearing a face mask indicates a high chance of personal illness and is closely associated with Asian culture, where the first wave of the virus began, and thus potential danger,” wrote Jeremy Van Der Haegen in EU Observer.

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During the 17th Century in Europe, physicians who tended to plague victims wore a costume that covered them head to toe and wore a mask with a long bird-like beak.

How does the mask make a difference

Reacting quickly when COVID-19 began to spread, the Asian societies responded with measures — like widespread mask-wearing and thermal screening — while the Western societies were still dilly-dallying about it. The consequence was that the curve in the East was flatter than the curves in western countries.

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The swift response that Asian countries like South Korea, Taiwan, Japan and Singapore mounted unlike many Western nations including the United States spared them of the horrifying mass outbreaks that the world witnessed in Italy, Spain or New York.

“The big mistake in the US and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role—you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others,” George Gao, head of the Chinese Center for Disease Control and Prevention had told Science in March 2020 itself.

While the Spanish flu was the catalyst for the adoption of masks in Japan, it became a practice in Hong Kong after the SARS outbreak in 2003.

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There is no doubt that the West and the US got serious about mask-wearing only towards end of April last year probably believing COVID-19 will be mostly limited to Asia and also the original CDC guidelines were to some extent based on an assumption that it was low disease prevalence pandemic.

The delay in adopting the mask culture during a pandemic situation can be devastating as was found in the study Implications of Delay in Compulsory Mask Wearing – A What-if Analysis by Brandon Tay Kaihenga, Carvalho Andrea Robya, Jodi Wu Wenjianga and Da Yang Tanb by taking Singapore as a context.

“At present, compulsory mask wearing has been widely accepted as a means of controlling COVID-19 infection by reducing the infection rate through aerosol means. With this study, we hope to shed some light on whether the delay in enforcement of compulsory mask wearing will have detrimental effects on infection control. Based on our results, it appears that a delay of 100 days and above would result in a point of no return, where enforcement of public masking would result in little effect on controlling the Maximum Infected Value,” the study said.

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What does WHO, CDC say on wearing a mask

The World Health Organisation in no uncertain terms makes it clear that masks should be used as part of a comprehensive strategy of measures to suppress transmission and save lives.

“Masks should be used as part of a comprehensive ‘Do it all!’ approach including physical distancing, avoiding crowded, closed and close-contact settings, good ventilation, cleaning hands, covering sneezes and coughs, and more,” the WHO states it unequivocally.

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The US Centers for Disease Control and Prevention also vouches for a similar approach. “When you wear a mask, you protect others as well as yourself. Masks work best when everyone wears one. A mask is NOT a substitute for social distancing. Masks should still be worn in addition to staying at least 6 feet apart, especially when indoors around people who don’t live in your household,” it says.

However, the latest point of concern is that the US regulator is in disagreement with WHO over wearing masks for fully vaccinated people.

In a revised set of guidelines, the CDC says, “Fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.”

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The WHO is however is not on the same page on this with the US body. In June itself, the world health body stressed the need for fully vaccinated people to “continue to be appropriately cautious” and observe social distancing measures, mask-wearing as the highly infectious Delta variant rages across the globe. Of late, new variants like Kappa and Lambda have also emerged and COVID-19 is far from over.

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