To the editor:
We read with great interest the review conducted by Nicola et al., which summarised the socio-economic impact of social distancing measures during the COVID-19 pandemic [1]. Policies such as lockdowns, home quarantines, and travel restrictions have been shown to be effective in reducing the transmission of COVID-19 [2,3]. However, as demonstrated by Nicola et al., these restrictive measures are not sustainable solutions in the long run. Businesses were shut down, jobs were lost, and schools were closed. In many parts of the world, the economy has plummeted to a historic low and urgently needs to re-open. However, relaxation of lockdown and social distancing strategies without complementary measures may risk a second wave of COVID-19 infection [4].
Universal masking may be a feasible complementary, non-pharmaceutical measure to re-open the economy yet keep the Coronavirus under control. Even though there have been scanty evidence from clinical trials showing the effectiveness of mask in reducing the spread of COVID-19 in the community, epidemiological evidence seems to support the widespread use of mask. Taiwan and Hong Kong both adopted community-wide masking early in the pandemic. Without resorting to lockdowns and restrictive social distancing measures, they maintained low rates of COVID-19 infections throughout the pandemic (19 and 141 per million population respectively, as of 17 May). Their infection rates are significantly lower compared with other countries that did not adopt this practice [5]. The US and the UK, which did not recommend mask wearing until April, have infection rates of 4594 and 3603 per million population, respectively. Even Singapore, which was widely recognized to have good control over the pandemic, experienced a surge of cases in early April and was forced into a nationwide lockdown [6]. It did not recommend the use of mask in the general population until then.
An illustration of how universal masking, when combined with other measures, can help open the economy while keeping the Coronavirus in check is South Korea. The country experienced a surge of cases in February that was related to religious mass gatherings, in which participants did not wear masks. Other than implementing temporary workplace and school closures, the Korean government employed large-scale testing, isolation and contact tracing, and recommended wearing masks in public [7]. The number of cases quickly stabilized. South Korea had just 214 per million population cases, as of 17 May, despite having numerous clustered outbreaks. The country did not implement nationwide lockdowns throughout the entire pandemic.
There have been several arguments against universal masking. For example, there are concerns that people do not wear mask correctly, which may increase the odds of infection. Another argument is that universal masking may limit the amount available to healthcare workers. However, improper wearing of mask can be overcome through educating the correct technique of mask wearing. Similarly, the limited supply of mask can be solved through a combination of increasing mask production and rationing of mask [8].
The WHO emphasized that all countries must strike a balance between protecting health, preventing economic and social disruption, and respecting human rights. When implemented early and combined with other coordinated control measures, universal masking in East Asia provided a feasible solution to keep infection rates low and the economy open. These approaches are in contrast to restrictive social distancing policies that have forced the economy into recession in many parts of the world. It is time to consider universal masking as we re-open our economy and continue the battle against COVID-19.
Ethical approval
Not applicable.
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Author contribution
Cho-Hung Chiang: data collection, data analysis, writing - original draft, review & editing.
Cho-Hsien Chiang: data collection and data analysis.
Cho-Han Chiang: Conceptualization, data analysis, writing - original draft, review & editing.
Guarantor
Cho-Han Chiang.
Sources of funding
No funding.
Disclosures
No competing interests.
Provenance and peer review
Not Commissioned, internally reviewed.
Data statement
All data are from open access sources and can be shared on request.
Declaration of competing interest
There are no competing interests.
References
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