Science-Wise: Fine or No Fine, Masks Are Here to Stay as India Battles Fresh Surge in Covid-19 Graph

Covid-19 is surging again. Just weeks after India lifted all pandemic restrictions, including the mandatory usage of masks, the country is witnessing a sudden spike in infections.

As many as 2,067 new cases were reported on Wednesday across states, with over 632 cases in Delhi alone. As the Covid-19 positivity rate jumped three-fold in the national capital within a week, it sparked a knee-jerk reaction from the government of its neighbouring states.

Both Uttar Pradesh and Haryana enforced mask mandates in selected districts, with a fine on people who are found not wearing masks in public places. Meanwhile, the cases have doubled in Maharashtra, and the Centre has called for increased surveillance. The Delhi Disaster Management Authority (DDMA) is also set to hold a crucial meeting on Wednesday to take a call on whether to impose fines yet again to ensure strict compliance.

At first glance, the mask mandate seems clearly in sync with the country’s urgent need to step up guard in wake of the rising infections. Apart from being an effective deterrent, perhaps it also signals a sense of urgency among people. Especially considering that most people had stopped using masks altogether, soon after they were made optional on April 1.

But with most restrictions practically tossed off, and people seemingly getting used to a life without masks over the past few weeks, it is difficult to say how plausible it will be to ensure its due compliance through strict government mandates.

Mask Up When Indoors

I spoke to noted physician-scientist Dr Anurag Agrawal, former Director CSIR-IGIB who specialises in lung diseases, and he concurs that though it’s important to encourage people to wear masks, it must be done reasonably. Forcing people to wear masks all the time, even when they are outdoor, may not be practical in the long run.

“We have to get on with life. The pragmatic way is to let people know, that the mask is for their own protection, rather than forcing them to wear it in places when they are least at risk, for instance, outdoors. People are advised to wear masks when they are indoors, in fully-enclosed spaces, which are congested, crowded or poorly ventilated,” says Agarwal who is now Dean, Biosciences and Health Research, at Ashoka University.

As some of India’s top scientists contend, the need is to adopt a pragmatic approach. After surviving the onslaught of multiple Covid-19 waves, we now know the risk factors involved and must use masks accordingly. The threat of infections is high when the cases are rising in one’s neighbourhood or city/town. Also, while travelling by public transport, sitting in a poorly ventilated workspace, or visiting a crowded market or any public offices where social distancing might go for a toss, we must wear a mask.

“Ultimately, the idea is to make mask-wearing a personal behaviour,” asserts eminent virologist Gagandeep Kang, professor of Microbiology at the Christian Medical College (CMC) in Vellore. “Compare it to an umbrella that you take, when you think it might rain. If the cases going up in your neighbourhood, then wear a mask. Forcing people to do something has very limited benefit, and causes a lot of blowbacks.”

It is also important for people to acknowledge that at a time when uncertainty has dominated our lives, masks and vaccines are the only handy tools that can help us protect the ones we care about — most importantly, the ones who are already immunocompromised, or vulnerable to getting infected with a virus that is notorious for mutating and spreading faster than its counterparts.

According to Professor Kang, people will have to internalise it first, in order to induce a sustainable behaviour change, and this is not something that can be fixed by imposing fines. “Do you want the whole world to wear a mask all the time? No. When the risk is low, you don’t need a mask, but you definitely need it when the risk is high. When the risk is rising, then you want people to think about using the mask depending on the situation they are going to put themselves into,” says the scientist, who is also a member of several advisory committees for vaccines and research for the WHO.

The Science Is Clear

The science behind masks is clear. There is robust scientific evidence to prove that using masks provides the first line of defence against the infection and, accompanied by massive immunisation, could help the country ride out any fresh wave.

Eventually, as all restrictions go away, social mixing increases and immunity wanes, well-fitted masks will help reduce potential transmission. A recent Lancet study showed that maintaining face mask use in public indoor spaces and on public transportation weeks after the vaccine threshold is reached could save lives and reduce hospitalisation.

Latest studies have emphasised the use of masks indoors, and also while travelling within or outside the country when there is a high risk of seeding more transmission.

Robust Strategy For Mask Usage

Another major problem is that mask mandates are marred by haphazard implementation and ambiguity. It’s difficult to say how plausible it will be to compel people to wear masks in this sweltering heat, when the country is reeling under a severe heatwave, with the mercury sizzling above 40℃ on most days. It will not be surprising to find most people with their masks hanging down their chin, or dangling from their ears, just to avoid the fine.

It is pertinent to note that India may have benefitted from its hybrid immunity of prior infection and vaccination during the third wave but the pandemic is still raging in several parts of the world. The novel coronavirus is mutating faster and raring to break through the population immunity. We cannot let our guard down.

Therefore, the vaccination drive must be supported by a robust strategy on mask usage that cultivates a sustained behavioural change over time, rather than a knee-jerk reaction of imposing periodic fines that may face resistance. Either way, at least for the time being, masks are here to stay.

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