Liberia: The Looming Danger Beyond the Use of the Face Masks - Let's Take Action Now

opinion

After the government's April 24th statement, mandating that everyone should wear face masks in public areas, I tried it for the first time on Saturday (April 26, 2020). I had stepped out of home get some foodstuffs for the family, at which time I bought one of the locally-made face masks. In less than three minutes after putting it on, I felt rather uncomfortable. I was breathing hot air in it - from my nostrils to my mouth and the opposite -- while two elastic strings were lightly pulling my ears from the back. It was hots inside but I got used to it, however, after a while. I have been "correctly" using facemasks since, in "public places". Now that I am one of the facemask users, looking like one ninja from Gbandi Land in Lofa County, I thought to share a point of observation.

The use and production of face masks have increased since late last week, after the Liberian Government extended by two weeks its State of Emergency to combat the Coronavirus. The extension was amended to include compulsory use of face masks, which the government said it would work to provide. Already, walking down the streets of Monrovia and many other parts of the city, you will see multiple types of face masks in different shades, sizes and colors. Nobody wants to be arrested!

How effective are these face masks in fighting the coronavirus is the question left for health experts; however, research tells me that there are three kinds of facemasks.

1. A MEDICAL FACE MASK (also known as surgical or procedure mask) is a medical device covering the mouth, nose and chin ensuring a barrier that limits the transition of an infective agent between the hospital staff and the patient. They are used by healthcare workers to prevent large respiratory droplets and splashes from reaching the mouth and the nose of the wearer and help reduce and/or control at the source the spread of large respiratory droplets from the person wearing the face mask.

2. NON-MEDICAL FACE MASKS (or 'community' masks - the ones being sold in the streets) include various forms of self-made or commercial masks or face covers made of cloth, other textiles or other materials. They are not standardized and are not intended for use in healthcare settings or by healthcare professionals.

3. RESPIRATOR OR FILTERING FACE PIECE (FFP), is designed to protect the wearer from exposure to airborne contaminants (e.g. from inhaling infectious agents associated with inhaling small and large particle droplets) and is classified as personal protective equipment (PPE).

All in all, medical or non-medical face masks are recommended as a means of source control for persons who are symptomatic in order to prevent the spread of respiratory droplets produced by coughing or sneezing.

On a more serious note, the government's pronouncement is good as part of the measures to defeat the coronavirus pandemic. Conversely, from my lockdown corner, and based on what I have seen in the public, I think more needs to be done not just to compel people to use facemasks, but to use them more "appropriately", if they are available, for the desired result: halting the spread of the coronavirus.

Since the government's order, I have seen thousands of people wearing non-medical or 'community' masks. Without mincing a word, many people are blundering in using/wearing these facemasks. Some are wearing it only because their friends are. Others are wearing it in public places either willingly or reluctantly because the government has mandated it so; while there's another group of people are wearing it for fashionable reasons. Oh, yes! For these people, it must suit their clothes--to look spike and spine. For medical practitioners and healthcare givers, it is mandatory to prevent them from getting infected of infectious diseases, aside from the coronavirus. There are still other reasons.

Of all these reasons or purposes of wearing the facemasks, I see more danger beyond the use of the masks. The vulnerability I see lies in the proper uses of the facemasks and the sources of the locally-made masks. Therefore, instead of being a source of reducing the infection, it might just help to spread the virus more rapidly, and we know what that means.

Initially, many persons, including myself, had declined to wear facemasks based on advice from health experts including the World Health Organization (WHO)--that facemasks were best suited for healthcare providers or sick people including those with coughs and constant sneezing.

Now that it's a MUST that we use face masks in public areas, it is time (belatedly, though) that our health authorities create a massive awareness among our people on how to use (wear, adjust/readjust, take down and discard) facemasks. Don't take this for granted! I see people shrinking, pulling aside and twisting their facemasks to talk and cough. They use unclean hands to touch or scratch (itch) the very parts of their faces covered by the masks. I mean they are not washing or sanitizing hands--probably not knowing that this makes them more exposedto the virus and counter the use of the very facemask. The WHO forbids that.

Many people do not know that except the ones made locally, most face masks are used once. Even the ones made locally needs to be washed immediately they are taken down. Our people need to know this through radio dramas, jungles and other public programs. Our media entities need to be empowered to provide these kinds of education. Yes, there's a need, and it wont cost much as compared to the looming calamity if we don't do it at all.

Another worrying situation I have observed is with the locally-made face masks that have dominated the local markets and communities. I can't tell how safe they are from where they are made. How are the tailors handling these cloths? Are the tailors observing the safety rules? Ae they covering their mouths and noses when they bend over their machines while having conversations and sewing these masks? Are they using some of the very masks to cover their faces, when they sneeze? Are they sneezing in their palms and saying "blessing" as has been traditionally done by many? There are too many questions.

Okay, what's about those selling it in the streets? I mean those children, some as young as 10. What safety measures do they know or employ? At Bardnersville Junction yesterday morning (April 28), I stood adjacent the police tent and observed two adults buying facemasks from two girls who aren't yet in their teens. Each of them tried several of the masks on before they selected theirs-- what fitted them. Mind you, the Coronavirus is spread from contaminated hands and objects including the very facemasks being sold in the streets--that is, if it has been polluted by a virus-infected hand. I have told all of my closest friends (and I am telling them via this means, again) not to use any of these street masks without first washing them.

With reports circulating on social media that the police will begin enforcing the use of facemasks in public places (good idea) this week, we must try to answer the questions above and ensure safer facemasks are available.

According to the European Centre for Disease Prevention and Control (ECDC), the use of face masks in the community (public) may primarily serve as a means of source control. This measure, the ECDC says, can be particularly relevant in epidemic situations when the number of asymptomatic but infectious persons in the community can be assumed to be high. Wearing a face mask should be considered, especially

-when visiting busy, closed spaces, such as grocery stores, shopping centers, etc.;

-when using public transport; and

-for certain workplaces and professions that involve physical proximity to many other people (such as members of the police force, cashiers - if not behind a glass partition, etc.) and when teleworking is not possible.

Our people need to understand clearly that use of face masks in public areas, as mandated, should be considered only as a complementary measure. They need to understand that using the masksis not a replacement of the core preventive measures that are recommended to reduce coronavirus transmission including social (physical) distancing, staying home (or calling 4455) when ill, teleworking (working from home) if possible, respiratory etiquette, meticulous hand hygiene and avoiding touching the face, nose, eyes and mouth.

The public should be told that appropriate use of face masks is important. The face mask should completely cover the face from the bridge of the nose (not under the nose) down to the chin. They need to understand that they must clean hands with soap and water or alcohol-based hand sanitizer before putting on and taking off the face mask, and when taking off the face mask, they should remove it from behind, avoiding to touch the front side.

As I close, I strongly believe that media or publicity campaigns for the appropriate use of face masks may improve the effectiveness of the measure. Otherwise, research informs me that:

1. The use of face masks may provide a false sense of security leading to suboptimal physical distancing, poor respiratory etiquette and hand hygiene - and even not staying at home when ill.

2. There is a risk that improper removal of the face mask, handling of a contaminated face mask or an increased tendency to touch the face while wearing a face mask by healthy persons might actually increase the risk of transmission.

For communication purposes, as per the ECDC advice, it is important to emphasize that the people who use face masks in the community want to protect their fellow citizens in case they are infected. They do not want to unknowingly spread the virus, and wearing a mask should not be misconstrued that they want to protect themselves from others. Wearing a mask is not an act of selfishness and should be promoted as an act of solidarity.

Now, please use your face mask correctly, follow all the rules and stay safe. I want us to live and write the story of how we made it, after corona.

The Author, D. Kaihenneh Sengbeh is Manager for Communications, Media and Public Affairs at the Liberia Revenue Authority and Member of the African Tax Media Network. He's former Secretary General of the Press Union of Liberia and practiced mainstream journalism for 15 years. Contact: dakasen1978@yahoo.com /kaihenneh.sengbeh@lra.gov.lr +231886586531/+231777586531

Editor's note: The view above is that of the author and not of this paper. Every inquiry should be directed to the author.By D. Kaihenneh Sengbeh

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