WHO Urges Demonstrators To Protect Themselves From COVID-19, Issues New Mask Guidelines
Peaceful protestors in front of the Brooklyn Public Library in New York City

In the wake of widespread demonstrations in the United States against police brutality, catalyzed by the death of George Floyd while being pinned under an officer’s knee, the World Health Organization has urged protestors to protect themselves against COVID-19.

“We have certainly seen a lot of passion this week, we’ve seen people who’ve felt the need to be out and express their feelings, but we ask them to remember: still protect yourself and others, the coronavirus is all around, protect yourselves and others while expressing yourselves,” said WHO spokesperson Margaret Harris at a briefing in Geneva. “So, all the things we have been saying (still) apply.

“The best precaution is being able to stay one metre away from each other, being able to wash your hands, being able to ensure that you don’t touch your mouth, nose and eyes.”

Meanwhile, in a separate press briefing, WHO also released updated guidance on June 5 for the use of masks to prevent COVID-19 transmission in the general public and healthcare settings.

April Baller, infection prevention & control expert in WHO’s Health Emergencies team, shows how to properly wear a mask – making sure to cover the nose, mouth, and chin.

Governments in areas with widespread COVID-19 transmission should encourage the use of non-medical masks on public transport, in shops and in other locations where physical distancing is difficult, WHO recommends in updated guidance published on Friday.

Additionally, people over 60, or who have underlying health conditions, should wear medical masks in these settings, while all workers in clinical areas of health facilities should also use them – not just those who deal with COVID-19 patients.

For the first time, WHO also released instructions on how to make fabric masks for use by the general public that would provide adequate protection against onwards transmission of the virus, based on scientific research commissioned by the agency.

“What is really new in the guidance, is the research that we requested to be done on looking at which types of materials can actually be used in making these non-medical fabric masks,” said WHO COVID-19 Technical Lead Maria Van Kerkhove.

Masks should consist of an inner layer of absorbent material like cotton, a middle layer of non-woven materials such as polypropylene – a filtering material, and a non-absorbent outer layer made of a polyester or a polyester blend, said Van Kerkhove.

“WHO has developed this guidance through a careful review of all available evidence and extensive consultation with international experts and civil society groups,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I wish to be very clear that the guidance we’re publishing today is an update of what we have been saying for months – that masks should only ever be used as part of a comprehensive strategy. Masks on their own will not protect you from COVID-19.”

WHO Director-General introducing new mask guidelines at the 5 June WHO COVID-19 press briefing

The slow move towards issuing specific guidelines for the broader use of facial coverings comes after an independent Strategic Technical Advisory Group for Infectious Hazards (STAG-IH) released a note supporting the broader use of masks in the community. Earlier in the week, the Lancet had also published a WHO-sponsored meta-analysis that found mask use decreased the risk of infection, although this reduced risk applied only to the use of N95s, surgical masks, and 12-16 layer cloth masks.

Still, WHO experts emphasized that masking will be an important tactic as countries begin to lift stay-at-home orders.

“In many urban areas in India, it’s impossible to maintain physical distancing, and therefore it will be very important that people wear appropriate face coverings when they are out and about, in office settings where physical distancing cannot be maintained, in public transport, and in educational institutions as some states are thinking about opening,” said Soumya Swaminathan, WHO chief scientist. Swaminathan was formerly director-general of the Indian Council of Medical Research.

Masks are mainly used as a form of “source control,” said WHO Health Emergencies Executive Director Mike Ryan. Ryan emphasized that the proper use of masks is mainly recommended to help prevent an asymptomatic or presymptomatic persons from transmitting the virus to others.

WHO Updates Guidance For Surgical Mask Use In Healthcare Settings, But No Changes In N95 Use Recommendations

In areas with widespread transmission, WHO recommended that any person working in a clinical, be it healthcare worker, janitor, or administrative staff, should wear a medical mask at all times, even while working in wards with no COVID-19 patients.

However, the use of N95 masks should still be restricted to use by healthcare workers conducting aerosolizing procedures.

“Evidence shows that there might be a greater reduction in risk by respirators, but this is still limited evidence, with many limitations due to the fact that these are only observational and small studies,” said Benedetta Allegranzi, coordinator of WHO’s infection prevention global unit. “Respirators may also have more side effects than surgical masks, such as skin lesions or difficulty breathing, etc. Also, assessing recommendations for the global level, [we have] to consider many different contexts in different countries where it’s important to assess resource availability… and equitable access.

“All together, these elements led our experts to consider that there is no strong reason for changing our recommendations [for N95 use].”

Benedetta Allegranzi speaking at the June 5 WHO COVID-19 press briefing
How To Mask Properly, According to the WHO

WHO had previously released lukewarm recommendations supporting countries’ public masking policies in areas where physical distancing is not possible.

But the new recommendations are much more specific, including guidance for different age groups, settings; instructions on how to DIY a fabric mask using materials around the house; and instructions on how to properly use and maintain a fabric mask.

“People can potentially infect themselves if they use contaminated hands to adjust a mask or to repeatedly take it off and put it on, without cleaning hands in between,” said Dr Tedros.

A properly worn mask should cover the nose, mouth, and chin. Care to only touch the earloops when removing a mask will help prevent contamination of the hands, and hands should always be washed before putting a mask on and after taking one off, according to a new instructional video featuring WHO expert on infection prevention and control, April Baller.

WHO experts also emphasized that wearing fabric masks is not protective in itself against getting infected. Maintaining physical distancing and frequent handwashing is important to protect oneself against the virus, said larger public health measures such as contact tracing, quarantining and treating cases, and isolating suspected cases must not be abandoned, said Ryan.

“Wearing a mask in a community level is more about protecting others if you happen to be infected rather than protecting yourself. So it’s an altruistic act,” said Ryan. “[We need a] well educated, empowered community, caring for their own personal hygiene and protection, caring for the rest of their community in terms of protection.

“[They need to be] supported by a public health service that’s capable of finding the virus, isolating and quarantining cases, and health system that’s capable of treating people successfully.

“And all of that in the context of good coordination, good governance being implemented. Then [add] the appropriate and targeted use of masks at community level, in order to reduce transmission within the community in areas where physical distance cannot be maintained.”

 

Image Credits: GF Ginsberg/HP-Watch.