As India enters three weeks of nationwide lockdown to address COVID-19, we must plan an exit strategy from this scenario now. An indefinite period of quarantine is simply infeasible for a country like India, where so many live hand-to-mouth in an informal economy. Instead, mitigation strategies — which dampen the rate of spread of COVID-19, while allowing Indians to continue working — must be the next phase of the strategy. An expansion of mask production on a war footing and a call to action for all Indians to wear them is imperative to making this policy work.
One characteristic that sets COVID apart from other corona and flu viruses is that a large number of infected people remain asymptomatic. Masks are most effective at reducing the spread of disease from asymptomatic carriers, who may be unaware they have the illness, by capturing emitted droplets. But they can also reduce airborne infection rates among healthy individuals. Masks can also help reduce the natural tendency to touch one’s face, reducing contact spread. Mask use does require facial touching to put on properly and remove. For this reason, it is essential to encourage handwashing or hand sanitiser use before mask insertion or removal.
Masks have proven very effective in the past at limiting infection rates from influenza-like diseases. A review of several studies concluded that: “Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures.” A range of other randomised trials have reached similar conclusions. Surgical masks are not as protective as N95 masks (which are less comfortable to wear) in a laboratory setting but are no worse at protecting from influenza in a healthcare setting. Even the United States’ Centers for Disease Control has said surgical masks are an “acceptable alternative” to N95 masks. In addition, if everyone wears a mask even when they are healthy, it will double the protection from masks. Everyone will be protected by two masks: The one the other person is wearing and the one you are wearing.
While we do not yet know the impact of mask-wearing on COVID-19 specifically, all East Asian countries where mask use is prevalent have not seen the same rate of disease spread as elsewhere, while also not being subject to the mass quarantine efforts in place in India. Hong Kong officials credit mask-wearing with limiting the coronavirus outbreak there. Taiwan, yet another success story, responded to the epidemic by ramping up its mask production and banning exports of masks.
These findings suggest a clear national policy: Begin wartime mobilisation to drastically increase mask production, and mandate by law their use in public spaces, and in spaces where social distancing is impossible. Obviously, the first priority should be to make sure our health and essential services workers have an adequate supply of masks before the general population starts wearing them. In addition, offering a safe option for individuals to continue working will likely encourage essential services workers to show up. Currently, there are stories of many such workers leaving their posts out of fear of catching COVID-19.
Masks will also be particularly helpful in urban settings, especially slums. Doctors recommend people stay six feet apart from each other while outside. In some places, physical distancing is not possible. Slums have 10 times the population density of other areas of Indian cities. But even there, masks will reduce the risk that large droplets of liquid, such as from a cough, will infect others.
While N95 and surgical masks are preferable, DIY efforts can be a last resort when manufactured masks are unavailable. We need to produce YouTube channels in all Indian languages providing clear introductions for the production of masks, as other countries such as the Czech Republic have done. While cloth masks are less effective than surgical masks, they still provide protective benefits for non-healthcare workers who are asymptomatic. An additional advantage of DIY masks is that many families can make these with scissors, needle and thread even during the lockdown. Homemade masks are a last resort, but they are clearly preferable to no protection at all.
COVID-19 is addressable, but it requires novel thinking and tactics. A combination of large-scale testing, tracing, and widespread use of masks is likely to yield the greatest dividend. It also allows the economy to recover in a controlled manner, while we wait for a vaccine.
Gupta is an assistant professor of finance at NYU Stern School of Business, Malani is a professor at the University of Chicago Law School and Pritzker School of Medicine and Abraham is CEO of IDFC Institute in Mumbai
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