tag:theconversation.com,2011:/id/topics/face-masks-49132/articlesFace masks – The Conversation2023-12-04T22:27:20Ztag:theconversation.com,2011:article/2149162023-12-04T22:27:20Z2023-12-04T22:27:20ZPublic health errors: Why it’s crucial to understand what they are before assessing COVID-19 responses<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/public-health-errors-why-its-crucial-to-understand-what-they-are-before-assessing-covid-19-responses" width="100%" height="400"></iframe>
<p>Joe Vipond, a Canadian emergency room physician who was a strong supporter of masking during the pandemic, <a href="https://www.una.ca/1385/worlds-slow-recognition-of-airborne-transmission-of-covid-was-most-egregious-public-health-error-in-modern-history">said in a speech last year</a> that the slow recognition that COVID-19 is spread by airborne transmission resulted in what is likely “the most egregious public health error in modern history.”</p>
<p>The notion that governments can commit public health errors in response to a public health emergency like the COVID-19 pandemic — and that these errors can negatively impact a large number of people — has begun to receive attention from the <a href="https://www.forbes.com/sites/johndrake/2021/05/30/was-covid-19-a-failure-of-policy-or-a-failure-of-information/?sh=7e78786f457a">scientific community and the popular press</a>. Public health measures such as <a href="https://www.nytimes.com/2022/05/31/briefing/masks-mandates-us-covid.html">mask mandates</a>, <a href="https://www.telegraph.co.uk/news/2021/06/10/lockdowns-single-biggest-public-health-mistake-history-says/">lockdowns</a>, <a href="https://vinayprasadmdmph.substack.com/p/anthony-fauci-still-wont-admit-that">school closures</a> and <a href="https://doi.org/10.1136/bmjgh-2022-008684">vaccine mandates</a> are now widely discussed.</p>
<p>However, how can we investigate why governments err without understanding first what a public health error is, and is not? As a public health errors scholar, it strikes me how little research has been done <a href="https://doi.org/10.1097/PHH.0b013e3181bee698">on this topic</a>, and how much confusion exists around <a href="https://doi.org/10.1097/PHH.0b013e3181e030d3">what constitutes a public health error</a>.</p>
<h2>What is a public health error?</h2>
<p>In <a href="https://doi.org/10.1017/jme.2023.67">a new paper</a>, I clarify these issues, offer a new definition of the concept, and explain why studying errors contributes to our understanding of public health policy.</p>
<p>I suggest that a public health error occurs when, in retrospect, a policy choice worsens public health. This decision must either cause direct and significantly greater harm to the public or fail to effectively prevent harm, compared to other available options. Based on those criteria, there are two broad types of errors:</p>
<ol>
<li><strong>Error of action</strong>. Interventions that directly caused harm to population health and were worse than doing nothing at all.</li>
<li><strong>Error of omission</strong>. Failure to take action when measures were needed to protect the health of the population.</li>
</ol>
<h2>Errors of action</h2>
<p>Examples of the first type include public health interventions and campaigns. For instance, <a href="https://theconversation.com/a-generation-of-canadian-children-was-given-radiation-treatment-and-never-warned-of-the-cancer-risks-116403">public health campaigns in the 1950s</a> using low-dose radiation to treat benign illnesses (that is, not for treating cancer), such as acne and <a href="https://global.oup.com/academic/product/ringworm-and-irradiation-9780197568965?cc=ca&lang=en&">ringworm</a>. Children and young adults treated with radiation showed an alarming tendency to develop <a href="https://doi.org/10.2105/AJPH.2018.304763">brain tumours, thyroid cancer and other ailments</a> as adults.</p>
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Read more:
<a href="https://theconversation.com/a-generation-of-canadian-children-was-given-radiation-treatment-and-never-warned-of-the-cancer-risks-116403">A generation of Canadian children was given radiation treatment and never warned of the cancer risks</a>
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<p>Other examples include the approval of a faulty drug, like the drug <a href="https://doi.org/10.1093/toxsci/kfr088">Thalidomide</a> prescribed to pregnant women in the 1950s and 1960s for the treatment of nausea. The drug caused irreversible fetal damage, <a href="https://thalidomide.ca/en/">resulting in thousands of children being born with severe congenital malformations</a>. The painkiller <a href="https://doi.org/10.1503/cmaj.045206">Vioxx</a> that caused heart attacks and strokes is a more recent example of an error of action.</p>
<p>Erroneous guidelines provide yet another example of this type of error. For example, a recommendation in the United States <a href="https://doi.org/10.1056/NEJMms2206281">to give increased radiation doses to Black people</a> compared to other populations during X-ray procedures (a practice called “<a href="https://doi.org/10.1056/NEJMms2004740">race correction</a>”).</p>
<h2>Errors of omission</h2>
<p>The second category of errors includes instances of inaction or cases when public health officials were not doing enough to protect the public. For example, the failure to act against <a href="https://books.google.ca/books/about/The_Cigarette_Century.html?id=yybaN6j4IpEC&redir_esc=y">the harmful effects of tobacco</a>; the delayed action to reduce <a href="https://doi.org/10.1177/0096144215623954">child poisoning caused by lead paint inside U.S. homes</a>; or the time it took for government officials to respond to the <a href="https://doi.org/10.5942/jawwa.2016.108.0195">elevated levels of lead</a> found in the drinking water of residences in Flint, Mich. </p>
<p><a href="https://doi.org/10.1093/phe/phaa031">Health Canada’s delayed and inadequate response to evidence of addiction and misuse associated with the opioid OxyContin</a> is another example of an error of omission.</p>
<h2>The question of blame</h2>
<p>Naturally, when the public is harmed, people want someone to blame, and culpability (such as acts of negligence or carelessness) often becomes our central focus. While understandable, this approach is misguided. Instead, I strongly suggest focusing on the consequences of public health choices — and the systematic factors leading to these outcomes — rather than on blame.</p>
<p>Doing so (removing blame) better aligns with the <a href="https://doi.org/10.17226/1091">goal of public health</a>, which is to maintain and promote the health of populations. In this sense, public health errors of action or omission are contrary to this aim: causing or failing to prevent harm to the public, whether they are culpable or not.</p>
<p>That brings me to a possible definition of error. I <a href="https://doi.org/10.1017/jme.2023.67">define a public health error</a> as “an action or omission, by public health officials, whose consequences for population health were substantially worse than those of an alternative that could have been chosen, regardless of the causal processes involved in the consequences.”</p>
<h2>Back to COVID</h2>
<p>As the COVID-19 pandemic fades, but remains a prominent public health concern, I welcome the debate about whether public health responses could have been better. I suggest we follow four simple rules, rooted in my public health errors lens to better assess our actions:</p>
<ol>
<li><p>Stop focusing on blame (to err is human). Instead, assess the structural factors leading to negative outcomes, such as how science is interpreted, political pressure and decision-making procedures. After all, the goal is to improve and learn from mistakes rather than pointing out blameworthy actors. Allocating blame leads to unnecessary politicization of the process and findings.</p></li>
<li><p>Fight your biases and acknowledge that both the failure to act when measures were needed and <a href="https://doi.org/10.1136/bmj.m4074">the interventions in response to the virus</a> can either cause harm or fail to prevent harm to the public.</p></li>
<li><p>Be humble when interpreting the evidence. It is often difficult to compare different types of harms and benefits. Our actions (or inactions) can have both short-term and long-term effects on health and beyond.</p></li>
<li><p>Assess the impact of our public health measures on the most vulnerable, such as marginalized communities, the poor, disabled individuals and those struggling with addiction disorders. They might be the most susceptible to the consequences of our decisions.</p></li>
</ol>
<p>Moving forward, it is time to set aside our political and <a href="https://www.scientificamerican.com/article/the-covid-science-wars1/">scientific battles</a> so we can work together to examine our mistakes, preventing their recurrence in the future. This task is not easy and requires a thorough and transparent investigation. However, it is essential for protecting the public’s health and rebuilding trust in the medical profession.</p><img src="https://counter.theconversation.com/content/214916/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Itai Bavli does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As the COVID-19 pandemic fades, we may debate whether public health responses could have been better. But first we need to understand what public health errors are — and are not.Itai Bavli, Postdoctoral research fellow, Applied Ethics, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2102462023-09-01T12:43:36Z2023-09-01T12:43:36ZNorth America’s summer of wildfire smoke: 2023 was only the beginning<p>Canada’s <a href="https://theconversation.com/yellowknife-and-kelowna-wildfires-burn-in-what-is-already-canadas-worst-season-on-record-211817">seemingly endless wildfires</a> in 2023 introduced millions of people across North America to the health hazards of wildfire smoke. While Western states have contended with smoky fire seasons for years, the air quality alerts across the U.S. Midwest and Northeast this summer reached <a href="https://www.epa.gov/outdoor-air-quality-data/air-data-daily-air-quality-tracker">levels never seen there before</a>.</p>
<p>The smoke left the air so unhealthy in Philadelphia on June 7, 2023, that the Phillies-Detroit Tigers Major League Baseball <a href="https://www.reuters.com/sports/mlb-wnba-nwsl-games-postponed-due-poor-air-quality-us-2023-06-07/">game was postponed</a>. That same week, New York City residents hunkered down indoors for several days as a smoky haze hung over the city, turning the skies orange and exposing millions of people to the worst air quality in the world.</p>
<p>Smoke also drifted into the Midwest, triggering the highest air quality index levels in the Chicago area in at least 24 years, forcing the cancellation of numerous summer activities and leaving residents with raspy voices. In several states, people woke up to smoky skies day after day.</p>
<figure class="align-center ">
<img alt="A young man rides a rental bike along Chicago's Lake Michigan shore with smoke obscuring the view of the city skyline in the background." src="https://images.theconversation.com/files/545610/original/file-20230830-29-xqvrh9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545610/original/file-20230830-29-xqvrh9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545610/original/file-20230830-29-xqvrh9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545610/original/file-20230830-29-xqvrh9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545610/original/file-20230830-29-xqvrh9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545610/original/file-20230830-29-xqvrh9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545610/original/file-20230830-29-xqvrh9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chicago was under air quality alerts several times during the summer of 2023 as wildfire smoke blew in from Canada.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/wildfire-smoke-clouds-the-skyline-on-june-28-2023-in-news-photo/1503491525">Scott Olson/Getty Images</a></span>
</figcaption>
</figure>
<p>The pressing question on many people’s minds: “Is this the new normal?” From <a href="https://scholar.google.com/citations?user=CKRhPGIAAAAJ&hl=en">our perspective as</a> <a href="https://scholar.google.com/citations?user=MHbvpzAAAAAJ&hl=en">air quality</a> <a href="https://scholar.google.com/citations?user=QdkDnPgAAAAJ&hl=en">scientists</a>, we think the answer is likely “yes.”</p>
<h2>Global warming means more fires</h2>
<p>The wildfire smoke of 2023 highlights an emerging air quality trend. The U.S. had seen <a href="https://www.epa.gov/air-trends/particulate-matter-pm25-trends">decades of falling levels</a> of fine particulate matter pollution, PM2.5, thanks to environmental regulations and cleaner engines, factories and power plants. But wildfires’ contribution to air pollution is increasing again, resulting in flat or rising levels of air pollution in much of the country.</p>
<p>Climate models predicted this reality as global temperatures rise. Hotter, drier conditions, coupled with dry grasses and underbrush that accumulated over decades of fire suppression, have made large wildfires more common. Computer simulations of the <a href="https://doi.org/10.1073/pnas.1112839109">future in a warming climate</a> show more smoky days, higher smoke concentrations, larger burned areas and higher emissions – which further <a href="https://doi.org/10.1139/er-2013-0041">fuel climate change</a>.</p>
<p><iframe id="EtQZH" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/EtQZH/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>While prescribed fire and forest thinning can help reduce the number and intensity of fire outbreaks, <a href="https://doi.org/10.1016/j.scitotenv.2017.12.086">smoke exposure</a> is still likely to increase because of the increases in burned area anticipated as a result of large-scale shifts in temperature and moisture.</p>
<p>In short, people will need to learn to live with wildfire smoke. It won’t be every year, but we’re likely to see summers like 2023 more often.</p>
<p>Fortunately, there are several <a href="https://www.airnow.gov/wildfire-smoke-guide-publications/">tools and strategies for managing</a> a smokier future.</p>
<h2>Preparing for smoky days</h2>
<p>Managing the risk of wildfire smoke starts with making smart personal choices.</p>
<p>Think of smoke waves like heat waves: They’re easier to face if you’re prepared and know they’re coming. That means <a href="https://www.washingtonpost.com/technology/2023/06/07/best-air-quality-apps-wildfire-smoke/">paying attention to forecasts</a> and having face masks, air monitors and clean-air shelters available.</p>
<p><a href="https://theconversation.com/wildfire-smoke-can-harm-human-health-even-when-the-fire-is-burning-hundreds-of-miles-away-a-toxicologist-explains-why-206057">Inhaling PM2.5 and the chemicals</a> in wildfire smoke can exacerbate asthma, worsen existing respiratory and cardiac problems and leave people more susceptible to respiratory infection. People caring for individuals <a href="https://theconversation.com/extreme-heat-and-air-pollution-can-be-deadly-with-the-health-risk-together-worse-than-either-alone-187422">sensitive to smoke</a>, such as young children <a href="https://theconversation.com/extreme-heat-is-particularly-hard-on-older-adults-an-aging-population-and-climate-change-put-ever-more-people-at-risk-210049">and older adults</a>, will need to plan for their needs in particular.</p>
<figure class="align-center ">
<img alt="A baseball player standing beside the field adjusts a black mask over his face." src="https://images.theconversation.com/files/544875/original/file-20230826-29778-8y1qhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544875/original/file-20230826-29778-8y1qhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544875/original/file-20230826-29778-8y1qhv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544875/original/file-20230826-29778-8y1qhv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544875/original/file-20230826-29778-8y1qhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544875/original/file-20230826-29778-8y1qhv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544875/original/file-20230826-29778-8y1qhv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pittsburgh Pirates center fielder Andrew McCutchen wore a face mask to protect against smoke in the air during a Pirates-Padres game on June 29, 2023, in Pittsburgh.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/andrew-mccutchen-of-the-pittsburgh-pirates-puts-on-a-mask-news-photo/1508118494">Nick Cammett/Diamond Images via Getty Images</a></span>
</figcaption>
</figure>
<p>To prepare, read up on the risks and warning signs from public health professionals. Living with wildfire smoke may mean using air filtration devices, wearing N95 or KN95 masks on bad air days, modifying outdoor commuting patterns and activity schedules and changing household ventilation choices.</p>
<h2>What schools and communities can do</h2>
<p>Living with smoke will also require changes to how schools, businesses, apartment buildings and government buildings operate.</p>
<p>Schools can start with <a href="https://www.cde.ca.gov/ls/ep/documents/airqualityguidance.pdf">setting a threshold</a> for canceling outdoor activities and making sure staff are ready to meet the needs of kids with asthma.</p>
<p>Building managers may need to rethink air filtration and ventilation and deploy air quality sensors. Communities will also need contingency plans for festivals and recreation venues, as well as rules for business to protect outdoor workers.</p>
<figure class="align-center ">
<img alt="A school employee wearing a face mask and T-shirt with a big " src="https://images.theconversation.com/files/545608/original/file-20230830-15-p2h5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545608/original/file-20230830-15-p2h5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545608/original/file-20230830-15-p2h5n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545608/original/file-20230830-15-p2h5n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545608/original/file-20230830-15-p2h5n9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545608/original/file-20230830-15-p2h5n9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545608/original/file-20230830-15-p2h5n9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many schools installed better air filters and classroom air purifiers during spikes in the COVID-19 pandemic. Those measures may be necessary against smoky days in the future.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/eastern-h-s-custodian-raymond-woodfork-shows-tour-news-photo/1231802348">Michael S. Williamson/The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p>Decisions on how to deal with smoke can be complicated. For example, selecting an air purifier <a href="https://doi.org/10.1111/ina.13163">can be a daunting task</a>, with over 900 products on the market. The effectiveness of different smoke management interventions are not well known and <a href="https://doi.org/10.1002/14651858.CD013441.pub2">can vary</a> depending on small implementation details, such as <a href="https://doi.org/10.1029/2021GH000482">how a mask fits</a> the wearer’s face, whether exterior doors and windows seal tightly and whether filters are installed properly and are replaced often enough.</p>
<h2>Improving smoke monitoring and forecasting</h2>
<p>The U.S. has an extensive air quality monitoring and forecasting system to help provide some early warning. It uses ground-based air quality monitors, satellite remote sensing systems to detect smoke and fires and <a href="https://fireaq.uiowa.edu">computer systems</a> that <a href="https://portal.airfire.org">tie observations together</a> with wind, <a href="https://fluid.nccs.nasa.gov/wxmaps/chem2d/?region=nam,">chemistry</a> and <a href="https://digital.mdl.nws.noaa.gov/airquality/?element=ozone01_bc&mapcenter=-96.00%2C40.00&mapzoom=5&subregion=CONUS&region=CONUS">weather</a>. These are supplemented by <a href="https://www.fs.usda.gov/research/news/highlights/continued-success-u.s.-interagency-wildland-fire-air-quality-response-program">expert guidance</a> from meteorologists.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A map of North America shows wildfire smoke from fires in Alberta and Ontario, Canada, detected strongly with poor air quality in the Great Lakes region, Northeast and Midwestern U.S." src="https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534612/original/file-20230628-19-5wd03e.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoke from wildfires in Canada was forecast across a large part of the U.S. on June 28, 2023. Dark purple dots indicate hazardous air quality; red is unhealthy; orange is unhealthy for sensitive groups; and yellow indicates moderate risk.</span>
<span class="attribution"><a class="source" href="https://fire.airnow.gov/">AirNow.gov</a></span>
</figcaption>
</figure>
<p>However, for average people trying to make decisions about the safety of outdoor activities, the current forecasting system is wanting. This is especially true when smoke blows in from fires far away, or when rapidly changing smoke emission rates and complex wind patterns lead to conflicting forecasts and advisories.</p>
<p>A few key improvements would go a long way for <a href="https://wpo.noaa.gov/improving-wildfire-prediction-with-convection-allowing-models/">practical decision making</a> around wildfire smoke, like whether to delay the start of soccer practice:</p>
<ul>
<li><p>Knowledge of how fires evolve hour by hour can improve the smoke estimates going into the <a href="https://doi.org/10.1071%2Fwf18204">forecast models</a>. </p></li>
<li><p>Providing smoke forecasts at neighborhood scale can better inform individuals and cities of pending risks. </p></li>
<li><p>More accurate 10-day forecasts would allow communities to plan. </p></li>
<li><p>Merging seasonal weather forecasts of precipitation, humidity and winds with satellite assessments of fuel conditions could enhance emergency planning for firefighters to help anticipate which regions and periods present the highest risks of fire and smoke.</p></li>
</ul>
<figure><img src="https://images.theconversation.com/files/544874/original/file-20230826-15-1jljmc.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1"><figcaption>Satellite data tracks black carbon from wildfire smoke moving into the U.S. Northeast, June 3-8, 2023. <a href="https://earthobservatory.nasa.gov/images/151442/hazardous-air-chokes-northeastern-states">NASA Earth Observatory video by Lauren Dauphin</a></figcaption></figure>
<p>Maintaining a strong air quality monitoring network is also important. State and local government agencies have reduced the <a href="https://www.gao.gov/assets/gao-21-38.pdf">number of ground monitors by about 10%</a> from its peak in 2001. Smoke estimates from satellites and low-cost portable sensors can help, but they work best when they can be cross-calibrated to a well-maintained network of high-accuracy monitors.</p>
<h2>We still have a lot to learn</h2>
<p>More effective adaptations to smoke will require more research to better understand the factors that make some people <a href="https://pubs.acs.org/doi/10.1021/acs.est.6b06200">more vulnerable to harm from smoke</a>, the effects of cumulative impacts of exposures to environmental stressors and smoke over the life span, and the efficacy and cost-effectiveness of adaptations. </p>
<p>For example, clean-air shelters – the equivalent to a cooling center during extreme heat – are gaining attention, but there is only limited guidance on what constitutes a clean-air shelter and where and when they would be used. A 2023 Government Accountability Office report <a href="https://www.gao.gov/products/gao-23-104723">called for better coordination</a> to help target resources where they can be most effective.</p>
<p>Living with smoke is emerging as a new reality. Next-generation tools need to be both clear and resilient to the compound hazards that develop when smoke <a href="https://theconversation.com/extreme-heat-and-air-pollution-can-be-deadly-with-the-health-risk-together-worse-than-either-alone-187422">hits simultaneously with other challenges</a>, such as extreme heat.</p><img src="https://counter.theconversation.com/content/210246/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles O. Stanier receives funding from the National Science Foundation. </span></em></p><p class="fine-print"><em><span>Gregory Carmichael receives funding from the National Aeronautics and Space Administration.</span></em></p><p class="fine-print"><em><span>Peter S. Thorne receives funding from the U.S. National Institutes of Health and the Burroughs Wellcome Fund. </span></em></p>Thick smoke pouring in from Canada’s wildfires canceled baseball games and pushed air quality in major US cities to the worst in the world.Charles O. Stanier, Professor of Chemical and Biochemical Engineering, University of IowaGregory Carmichael, Professor of Chemical and Biochemical Engineering, University of IowaPeter S. Thorne, University of Iowa Distinguished Chair, Professor of Environmental Health, University of IowaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2032522023-04-13T11:39:36Z2023-04-13T11:39:36ZMicroplastics: 77% more found in River Thames during lockdown may be due to discarded face masks and PPE – research shows<figure><img src="https://images.theconversation.com/files/519852/original/file-20230406-217-pe1o27.jpg?ixlib=rb-1.1.0&rect=7%2C310%2C5168%2C3135&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Oxana A / shutterstock</span></span></figcaption></figure><p>At a first glance the COVID-19 pandemic seemed to have a positive impact on the environment, with significant decreases in greenhouse gas emissions, and transport-related noise, <a href="https://theconversation.com/coronavirus-lockdowns-effect-on-air-pollution-provides-rare-glimpse-of-low-carbon-future-134685">air and light pollution</a>. </p>
<p>However, <a href="https://www.sciencedirect.com/science/article/pii/S0025326X23001947?via=ihub">our research</a> found discarded face coverings and other personal protective equipment (PPE) are likely to be the cause of a rise in microplastics entering the environment. </p>
<p>Microplastics are particles <a href="https://oceanservice.noaa.gov/facts/microplastics.html">less than 5 millimetres long</a> that break off from larger plastics, often consumer products or industrial waste. A few years back, my colleagues and I began investigating how many of these particles were making their way into London’s River Thames. We continued sampling the river every month between May 2019 and May 2021, right through the various lockdowns. We obviously didn’t start the project with COVID in mind, but our work became a useful way to track one environmental impact of the pandemic.</p>
<p>One key finding from <a href="https://www.sciencedirect.com/science/article/pii/S0025326X23001947?via=ihub">our research</a> is that, although there was a 34% decrease in microplastics from pre-COVID levels in the river during lockdown one, levels rose by 77% during the second national lockdown in late 2020 compared to lockdown one.</p>
<p>We suspect this pattern will have been repeated elsewhere, since many of the world’s major rivers pass through rural areas to enter major cities before flowing into the sea. The River Thames can, therefore, be a case study for similar rivers especially within the rest of Europe.</p>
<h2>Measuring microplastics</h2>
<p>We took three one-litre samples each month at high tide at five points along the Thames in and around London. Our sample sites were Teddington Lock, in an upstream suburb, St Katharine Docks and Limehouse, both in built-up urban areas, and Tilbury and Southend-on-Sea, both downstream of the city.</p>
<p>We then filtered the water and scanned it with a <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/light-microscope">microscope</a> to measure the levels of tiny plastic particles. In all, across the two years, five sites and 354 litres, we found a total of 4,480 microplastics. </p>
<p>That works out to an average of 17.6 pieces per litre. The highest levels were during lockdown two when there were 27.1 pieces per litre.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Microscopic images of plastic" src="https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=711&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=711&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=711&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=893&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=893&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519856/original/file-20230406-18-brq8q9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=893&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Examples of microplastics the author found in the Thames. A) Blue and black fibres found at Teddington Lock June 2019. B) Red fragment found at Southend-on-Sea March 2021, C) Blue fragment found at Tilbury Fort February 2021. D) Fibres found at Tower Bridge January 2021, E) Red fragment and black fibres found at Limehouse, November 2020. F) Red fragment found at Southend-on-Sea January 2020.</span>
<span class="attribution"><a class="source" href="https://www.sciencedirect.com/science/article/pii/S0025326X23001947?via=ihub#f0010">Ria Devereux et al</a></span>
</figcaption>
</figure>
<p>Microfibres made up 82% of the microplastics overall, and almost all of those we found during lockdown two. These are the most common form of microplastics and usually come from clothing like socks, T-shirts and jumpers made of polyethylene. </p>
<h2>Rise caused by face masks</h2>
<p>We believe the spike was therefore caused by PPE, especially disposable face masks which are made of a mixture of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381927/">polyethylene and polypropylene</a> and other types of plastics.</p>
<p>One study found these masks release at least <a href="https://www.sciencedirect.com/science/article/pii/S0048969721032010">24,300 microplastic fibres per wash</a>, and if everyone in the UK used one face mask daily for a year, it would produce <a href="https://ucl.scienceopen.com/hosted-document?doi=10.14324/111.444/ucloe.000022">66,000 tonnes</a> of unrecyclable and contaminated plastic waste.</p>
<p>This wouldn’t have been such a problem – at least in terms of microplastic pollution – if the masks had been disposed of properly in bins. But unfortunately face masks littered on pavements or left abandoned on public transport became a common sight, while people often accidentally washed their single-use masks. Even reusable masks, which may also be made from plastics, were supposed to be worn and then washed daily according to <a href="https://www.gov.uk/government/publications/how-to-wear-and-make-a-cloth-face-covering/how-to-wear-and-make-a-cloth-face-covering">government guidelines</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Face masks and gloves in water" src="https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519859/original/file-20230406-217-ceanl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Too many masks were left to shed microplastics into the water.</span>
<span class="attribution"><span class="source">Mikhaylovskiy/Shutterstock</span></span>
</figcaption>
</figure>
<p>Tyre particles decreased consistently over the first two lockdowns as only key workers were permitted to work and travel, and therefore car journeys came down. However, by lockdown three they had risen once again coinciding with hotels, pubs and restaurants reopening.</p>
<p>During the first lockdown, we recorded higher levels of microplastics in Limehouse even as they decreased elsewhere, perhaps as the area is close to a marina with residential and leisure moorings. Teddington recorded high levels of microplastics in between lockdowns, as people were swimming and using boats in the river, which led to authorities <a href="https://richmond.nub.news/news/local-news/beach-on-the-thames-closed-this-weekend">barricading the area and its beach</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Twigs and litter, bridge in background" src="https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519855/original/file-20230406-14-dvlhzv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Plastic pollution at low tide near Hammersmith Bridge in west London.</span>
<span class="attribution"><span class="source">Carina S / shutterstock</span></span>
</figcaption>
</figure>
<p>By the third lockdown overall microplastic levels had reduced to 5.5 pieces found per litre. However, specific microplastics such as polypropylene, the material recommended in <a href="https://theconversation.com/polypropylene-the-material-now-recommended-for-covid-19-mask-filters-what-it-is-where-to-get-it-149613">face coverings and PPE</a>, were higher during lockdown three and the post-COVID sample and may be attributed to existing microplastic pollution continuing to breakdown in the water.</p>
<h2>Blue fibres increased the most</h2>
<p>The most common colours we found throughout this study were blue, black, red and transparent, which is consistent with the microplastics I found when assessing pollution caused by <a href="https://www.sciencedirect.com/science/article/pii/S0025326X22002168">New Year fireworks in London</a> or the particles found in the <a href="https://www.sciencedirect.com/science/article/pii/S0269749116314816">stomachs of fish in the Thames</a>. However, the sorts of blue fibres released by face masks generally increased throughout the two years of our study. For example, blue fibres increased from 2% of those found in Southend pre-COVID to 30% in lockdown two.</p>
<p>We may not see the full impact of the pandemic on plastic pollution for some years as masks and gloves are continuing to degrade and release particles into the environment. But the good news is that our work has shown that changing public behaviour really can help the environment. It’s an extreme example, but just look at how microplastics decreased in lockdown one.</p><img src="https://counter.theconversation.com/content/203252/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ria Devereux does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers took samples of the River Thames for two years to track levels of microplastics.Ria Devereux, PhD Student, Microplastic Pollution, University of East LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1547202022-12-27T19:20:27Z2022-12-27T19:20:27ZHow to protect yourself against bushfire smoke this summer<figure><img src="https://images.theconversation.com/files/498606/original/file-20221202-20-fswf2q.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C1911%2C1279&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Ihsi88KpQkE">Matt Palmer/Unsplash</a></span></figcaption></figure><p>It’s bushfire season. So you might be wondering about the best way to protect yourself from the health impacts of smoke.</p>
<p>Guidelines suggest wearing <a href="https://files-em.em.vic.gov.au/public/Smoke/EMK-01.19-Community-SAQH-Protocol.pdf">respirators</a>, <a href="https://www.health.nsw.gov.au/environment/air/Pages/bushfire-protection.aspx">avoiding</a> outdoor air and avoiding vigorous activity outdoors. Many people use the cheaper option of a surgical mask during bushfires. But there has never been a clinical trial to measure how well these interventions work. That’s why our group is <a href="https://kirby.unsw.edu.au/breathe">looking into it</a>.</p>
<p>In the meantime, here’s what you can do to reduce your exposure to bushfire smoke.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-summer-so-bushfires-and-covid-collide-3-ways-one-affects-the-other-169833">It's summer, so bushfires and COVID collide. 3 ways one affects the other</a>
</strong>
</em>
</p>
<hr>
<h2>Who’s at risk?</h2>
<p>Australia’s 2019/2020 summer bushfires resulted in <a href="https://www.theguardian.com/australia-news/2020/may/26/australias-summer-bushfire-smoke-killed-445-and-put-thousands-in-hospital-inquiry-hears">more than 400 estimated deaths</a> and thousands of hospitalisations from smoke exposure.</p>
<p>You don’t have to have a lung condition to suffer the <a href="https://theconversation.com/smoke-from-bushfires-poses-a-health-hazard-for-all-of-us-11493">ill-effects of bushfire smoke</a>. Breathing difficulties, eye irritation and heart attacks are among the <a href="https://theconversation.com/how-does-bushfire-smoke-affect-our-health-6-things-you-need-to-know-130126">well-documented</a> short-term impacts.</p>
<p>But people with asthma, <a href="https://theconversation.com/explainer-what-is-chronic-obstructive-pulmonary-disease-25539">emphysema</a>, chronic bronchitis and other lung conditions are particularly susceptible to smoke exposure, triggering asthma attacks and breathing difficulties.</p>
<p>This was the typical pattern we saw during our <a href="https://www.atsjournals.org/doi/10.1164/rccm.202012-4471LE?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">own research</a>, conducted during the same bushfire season. We showed smoke exposure caused ill health in people with and without existing lung disease.</p>
<p>However, we found people under 65 had a higher risk of ill health after smoke exposure than older people. This may be because younger people tend to go outdoors more during bushfires.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-bushfire-smoke-affect-our-health-6-things-you-need-to-know-130126">How does bushfire smoke affect our health? 6 things you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>1. Be prepared</h2>
<p>If you live in an area potentially affected by bushfire smoke, the first thing to do is to get an early alert about fires and smoke using one or more apps. Examples include, the <a href="https://www.rfs.nsw.gov.au/news-and-media/stay-up-to-date">Fires Near Me app</a> or the <a href="https://airrater.org">AirRater app</a> for air quality.</p>
<p>You can also use a <a href="https://iser.med.unsw.edu.au/sites/iser/files/_local_upload/Air%20quality%20self-assessment%20guide.pdf">visual method</a> to assess air quality. This involves identifying a landmark on the horizon about 5 kilometres away and noting if it becomes hazy. This would be the trigger for using a respirator or avoiding outdoor air.</p>
<h2>2. Stay inside if it’s safe</h2>
<p>Try to <a href="https://files-em.em.vic.gov.au/public/Smoke/EMK-01.19-Community-SAQH-Protocol.pdf">avoid exposure</a> to smoke, avoiding outside air and staying indoors if it is practical and safe to do so. Vigorous exercise outdoors can be dangerous as it results in greater smoke inhalation and risks to the heart and lungs.</p>
<p>Close all doors and windows, set air-conditioning to recirculate, and seal gaps under or around doors, windows and wall vents with towels, blankets or plastic. </p>
<p>Unfortunately, these instructions are the opposite of what to do if there is COVID at home, when you would want fresh air in the house. If that is the case, wear a mask indoors in common areas and social distance from the person with COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-buildings-arent-made-to-keep-out-bushfire-smoke-heres-what-you-can-do-129367">Our buildings aren't made to keep out bushfire smoke. Here's what you can do</a>
</strong>
</em>
</p>
<hr>
<h2>3. Wear a respirator (not just a surgical mask)</h2>
<p>Most people who need to go outside during a bushfire can use some type of disposable respirator to filter the smokey air.</p>
<p>You will have seen people wearing these P2, P3 or N95 <a href="https://theconversation.com/how-to-get-the-most-out-of-your-n95-mask-or-other-respirator-177229">respirators</a> to protect themselves and others from SARS-CoV-2, the virus that causes COVID.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1496730465981640708"}"></div></p>
<p>These and <a href="https://www.addler.com.au/differences-p1-p2-p3-n95-respirators/">other types of disposable respirators</a> filter very fine particles and fit closely around the face. Choose one with a full band around the back of the head (rather than ear loops) as these provide a better fit.</p>
<p>Some disposable respirators have valves, which means they filter inhaled air but allow you to exhale more comfortably. This option may help people with asthma or lung disease to breathe more comfortably. If you have COVID, though, wearing a respirator with a valve does not reduce the risk of you infecting others, because the air you breathe out through the valve is unfiltered and contaminated.</p>
<p>Respirators will filter particles <a href="https://www.aiha.org/news/201022-osha-addresses-claims-that-n95s-do-not-protect-against-sars-cov-2">larger than 0.3 microns</a> (micrometres). However, they may not filter smaller particles contained in smoke, which is why avoiding outside air is still important.</p>
<p>People who live in bushfire-prone areas may want to consider a type of respirator they can clean and re-use when needed, known as <a href="https://healthcareworkersaustralia.com/elastomeric-mask/">an elastomeric respirator</a>. Their filters need to be changed at specified intervals.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Elastomeric face mask" src="https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499478/original/file-20221207-24-nezay8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An elastomeric mask, such as this one, can be re-used.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/reusable-halfface-elastomeric-respirator-air-purification-2196383995">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you have trouble getting one of the mentioned respirators, you can use a disposable <a href="https://breathesafeair.com/mask-ratings/">KN95 respirator</a>. However, these have ear loops and do not fit well around the face, so air can leak through. </p>
<p>Surgical masks are not likely to protect you because they are so loose. But medical-grade ones provide good filtering. For this to be effective, wear one with a <a href="https://www.insider.com/ways-to-make-your-face-mask-more-effective-2021-2">mask brace or clip</a> to provide a better fit and to help prevent air leaking in from the sides.</p>
<h2>In a nutshell</h2>
<p>Be prepared by downloading an app to monitor bushfires and air quality near you, and stocking up on good quality respirators ahead of time if you can. You can re-use these if they are not visibly soiled or damaged.</p>
<p>Staying out of the smoke is also important, particularly if you have asthma, emphysema and other lung disease. Young people may be less aware of the health effects of smoke exposure, and even people without lung disease can experience ill health due to smoke.</p>
<hr>
<p><em>Do you have asthma, emphysema, chronic bronchitis or bronchiectasis? Do you live in an area in Australia affected by bushfires or bushfire smoke (including metropolitan areas)? You may be eligible to be part of <a href="https://kirby.unsw.edu.au/breathe">our study</a> into the best way to protect yourself from bushfire smoke.</em></p><img src="https://counter.theconversation.com/content/154720/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C Raina MacIntyre has consulted for mask companies including Detmold and Ascend. She receives funding from the NHMRC and the MRFF currently.</span></em></p>Be prepared. Download an air quality app, stock up on respirators and stay inside if you can.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1947262022-11-20T15:22:34Z2022-11-20T15:22:34ZWith COVID, flu and RSV circulating, it’s time to follow the evidence: Return to mask mandates<figure><img src="https://images.theconversation.com/files/495816/original/file-20221117-13-u0jyep.JPG?ixlib=rb-1.1.0&rect=0%2C10%2C3190%2C2069&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ontario Premier Doug Ford and Health Minister Sylvia Jones in conversation at Queen's Park, the day after Ontario’s chief medical officer of health ‘strongly recommended’ mask wearing.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/with-covid--flu-and-rsv-circulating--it-s-time-to-follow-the-evidence--return-to-mask-mandates" width="100%" height="400"></iframe>
<p>The number of children and babies with respiratory illnesses currently <a href="https://globalnews.ca/news/9273442/mcmaster-childrens-hospital-patient-crisis-grows/">exceeds the capacity of our health system</a> to care for them. More adult Canadians will die directly of COVID-19 this year <a href="https://public.tableau.com/app/profile/bill.comeau/viz/CanadaCovid19_16636261617930/Dashboard1">than died last year or in 2020</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph showing deaths from COVID in Canada" src="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=260&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=260&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=260&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=326&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=326&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495812/original/file-20221117-23-1isdxx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=326&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">COVID deaths in 2022 outnumber those in 2020 or 2021.</span>
<span class="attribution"><span class="source">(Bill Comeau)</span></span>
</figcaption>
</figure>
<p>Eight per cent of vaccinated people with COVID infections that don’t require hospitalization <a href="https://doi.org/10.1038/s41591-022-01840-0">end up with long COVID</a>, with each subsequent infection <a href="https://doi.org/10.1038/s41591-022-02051-3">repeating the risk</a>. COVID increases the risk of <a href="https://doi.org/10.1038/s41591-022-01689-3">cardiovascular</a> <a href="https://doi.org/10.1016/S0140-6736(22)01214-4">and</a> <a href="https://www.ecdc.europa.eu/sites/default/files/documents/Prevalence-post-COVID-19-condition-symptoms.pdf">other health</a> <a href="https://doi.org/10.1038/s41591-022-01840-0">problems</a>, enough to cause a stark rise in <a href="https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm">excess deaths</a> and to <a href="https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf">shorten life expectancy</a>.</p>
<p>In 2020, when adult intensive care units were at risk of being overwhelmed, we wore masks and accepted restrictions. With pediatric intensive care now at risk, will leaders follow the evidence and tell us to mask up? While federal officials and <a href="https://www.cbc.ca/news/canada/toronto/ontario-dr-kieran-moore-announcement-1.6650571">several provinces are now recommending masks in all indoor public settings</a> — although <a href="https://toronto.ctvnews.ca/ontario-s-top-doctor-goes-against-own-advice-while-maskless-at-toronto-party-1.6159050">Ontario’s Chief Medical Officer of Health Kieran Moore was seen without one at a party</a> — <a href="https://www.ctvnews.ca/canada/what-provinces-and-territories-are-saying-about-mask-mandates-as-covid-19-rsv-flu-cases-rise-1.6157262">there are no returns to mandates for the public yet</a>.</p>
<h2>Wear the best mask available</h2>
<p>We now know that <a href="https://doi.org/10.1073/pnas.2014564118">masks prevent the spread of respiratory diseases</a>; some better than others. </p>
<figure class="align-right ">
<img alt="A young woman wearing a white face masks with overhead ties" src="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=536&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=536&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495815/original/file-20221117-16-6d6tbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=536&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Vitacore CaN99 respirator with overhead elastic; N95s, CaN99 and FFP3 typically provide greater than 90 per cent filtration without formal fit testing.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The most effective masks, and the only ones recognized as respiratory protection by formal standards, are respirator masks: N95s, CaN99s, FFP3s and reusable elastomeric respirators. In workplaces, respirators are fit-tested to the individual, resulting in greater than 99 per cent protection. </p>
<p>Even without fit testing, respirator masks prevent <a href="https://doi.org/10.1093/annhyg/meq085">more than</a> <a href="https://doi.org/10.1371/journal.pone.0245688">90 per cent</a> <a href="https://doi.org/10.1097/MD.0000000000023709">of particles</a> smaller than one micron from reaching the wearer (submicron particles, the smallest among <a href="https://doi.org/10.1016%2FS2213-2600(20)30323-4">those thought</a> <a href="https://doi.org/10.1080/23744235.2022.2140822">to be</a> <a href="https://doi.org/10.1038/s41564-021-01047-y">relevant</a>).</p>
<p>Respirator masks are relatively expensive — typically a few dollars each — but thanks to Canadian manufacturers, they are <a href="https://www.clothmasks.org/">available</a> and there are no longer concerns about supply chains for front-line workers. They can be safely <a href="https://www.clothmasks.org/extended-use">reused, with good retention of their filtration</a>. New designs are comfortable and fit most faces. </p>
<figure class="align-left ">
<img alt="A young woman wearing a black face mask with ear loops" src="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495818/original/file-20221117-14-4riq8j.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A KN95/KF94 mask with ear loops typically provides about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>N95s are secured with overhead attachments, providing a good seal at the edges. KN95s and KF94s have excellent filtration material, but their ear loops do not provide as secure a seal, and <a href="https://doi.org/10.1371/journal.pone.0258191">their filtration</a> is <a href="https://doi.org/10.1371/journal.pone.0245688">around 70 per cent</a>. A certified medical mask with a well-fitted cloth mask over it, preferably with overhead ties, provides <a href="https://doi.org/10.1038/s41591-022-01840-0">comparable</a> <a href="https://doi.org/10.1016/j.ajic.2021.10.041">filtration</a> at lower cost.</p>
<figure class="align-right ">
<img alt="A young woman wearing a cloth face mask over a surgical mask" src="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495821/original/file-20221117-27-lavqq2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A well-fitting cloth mask over a certified medical mask typically produces about 70 per cent filtration.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Certified Level 1 medical masks alone do not fit well, which affects their filtration ability because unfiltered air passes around the edges with every breath. In tests on humans, these have <a href="https://doi.org/10.1371/journal.pone.0264090">typically </a><a href="https://doi.org/10.1371/journal.pone.0245688">filtered </a><a href="https://doi.org/10.1001/jamainternmed.2020.8168">at around 50 per cent</a>, similar to <a href="https://doi.org/10.1016/j.mayocp.2020.07.020">well-designed</a> <a href="https://doi.org/10.1371/journal.pone.0264090">two-layer cotton cloth masks, ideally with overhead ties</a>; both are around 50 per cent.</p>
<p>Poorly fitting <a href="https://doi.org/10.1016/j.ajic.2021.10.041">cloth masks</a> and non-certified procedure masks are likely worse than 50 per cent, but better than nothing. The World Health Organization advises: “<a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks">Make wearing a mask a normal part of being around other people</a>,” to which we would add: wear the best mask available.</p>
<figure class="align-left ">
<img alt="A young woman wearing a blue surgical face mask" src="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495823/original/file-20221117-23-agh7u5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Level 1 certified mask provides filtration around 50 per cent because of visible gaps and poor fit. To test fit, breathe out rapidly and feel for air leaks around the mask with your hands.</span>
<span class="attribution"><span class="source">(Gurleen Dulai, Ranmeet Dulai)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The filtration data above are mirrored by epidemiologic data showing that <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">protection correlates with mask type</a>. In studies of source control (prevention of contamination of the air by respiratory particles), the same hierarchy of efficiency is seen, with N95s at the top. N95s with exhalation valves are an exception and should not be used to prevent spread of respiratory diseases.</p>
<p><a href="https://doi.org/10.1136/bmj-2021-068302">Masks protect </a><a href="https://doi.org/10.1073/pnas.2014564118">against COVID-19</a> and other respiratory infections. They are also an <a href="https://doi.org/10.7326/M20-6625">ideal tool to counter COVID variants</a>, as well as <a href="https://theconversation.com/influenza-and-covid-19-whats-in-store-for-the-fall-winter-respiratory-virus-season-193076">RSV and influenza</a>. Working on basic physical principles — <a href="https://doi.org/10.7326/M20-6625">impaction, sedimentation and diffusion</a> — they protect regardless of the variant or strain. </p>
<p>Staying home when sick is helpful, but many people are infectious <a href="https://doi.org/10.1186/s12879-022-07440-0">before they have symptoms, or never have symptoms</a>. Wearing a mask to prevent infected particles from reaching the environment is basic pollution management: control is best at the source. </p>
<p>Wearing a mask to protect the individual, once controversial, is now settled by <a href="https://www.clothmasks.org/mask-hierarchy">filtration science</a> and <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">epidemiology</a>. The impact of mask mandates in countries where spontaneous mask wearing was low was repeatedly demonstrated, proving that masks protect us all.</p>
<h2>Why people aren’t wearing masks</h2>
<p>Why aren’t people wearing masks? Some remember the <a href="https://doi.org/10.1111/1467-9566.13525">inconsistency of the advice</a> early in the pandemic. Masks may be conflated with closures and capacity restrictions and the resulting hardships. Whatever the reason — <a href="https://www.theguardian.com/world/2021/oct/26/the-great-cover-up-why-the-uk-stopped-wearing-face-masks">stigma, peer pressure or concern about virtue signalling</a> — countries outside Asia do not have a mask-wearing culture. </p>
<figure class="align-center ">
<img alt="Infographic summarizing the literature on filtration properties of respirators and masks." src="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=976&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=976&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495814/original/file-20221117-27-xjcwhn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=976&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Infographic summarizing the literature on filtration properties of respirators and masks.</span>
<span class="attribution"><span class="source">(Shiblul Hasan)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Under these circumstances, it will likely take more than strong recommendations to achieve the <a href="https://doi.org/10.1073/pnas.2014564118">high uptake of mask use that will be most effective</a> in reducing transmission of respiratory viruses. Masks protect individuals, imperfectly. Mask mandates (or high voluntary use of masks) protect populations.</p>
<p>Bringing back mask mandates with unequivocal signalling from governments about the effectiveness of both masks and mask mandates would be the best immediate response to our current crisis. <a href="https://doi.org/10.1038/s41398-022-01814-3">Confidence that mask-wearing is effective correlates geographically with willingness to wear a mask</a>: in time, we hope knowledge will change culture. Strong communication from political and public health leadership would increase community understanding that the minor inconvenience of wearing a mask in public indoor spaces is justified by the death and disability prevented. </p>
<p>In North America, the strategy of using masks according to personal judgment has predictably failed, the strategy of strongly recommending masks is unproven, and it’s too late to experiment. Mask mandates, however, are backed by strong evidence of effectiveness in <a href="https://www.nber.org/papers/w27891">both Canada</a> and the <a href="https://doi.org/10.1377/hlthaff.2020.00818">United States</a>. </p>
<p>Mask mandates are less damaging to a recovering economy than physical distancing and capacity limits, and less damaging to learning than a return to remote schooling.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two line graphs showing relationship between school openings, mask use and community COVID 19 cases and deaths" src="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=249&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=249&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=249&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=313&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=313&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495824/original/file-20221117-25-ga6i04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=313&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The relationship between mode of school opening (remote, hybrid and in-person) and mask use at school with community cases and deaths, based on county-level data in the U.S.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1073/pnas.21034201">(Chernozhukov et al, PNAS 2021:118;e2103420118)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Schools and universities represent a particularly important opportunity. COVID spreads between children in schools <a href="https://doi.org/10.1073/pnas.2103420118">to infect the whole population; this is mitigated by mask wearing</a>. After Massachusetts lifted its mask mandate, school boards did so at different times, creating a natural experiment: <a href="https://doi.org/10.1056/NEJMoa2211029">transmission was higher among students and staff where mandates were lifted</a> compared with where they were still in place. </p>
<p>There is <a href="https://web.archive.org/web/20220826213955/https:/healthychildren.org/English/health-issues/conditions/COVID-19/Pages/Do-face-masks-interfere-with-language-development.aspx">no convincing</a> <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html">evidence</a> to date that masks reduce social or language skills. Decreasing spread in schools would increase learning by reducing student and teacher sick days and preserving in-person instruction. Keeping children in schools <a href="https://www.washingtonpost.com/business/2022/11/15/work-absences-childcare/">keeps parents at work</a>.</p>
<p>Mask mandates will not produce a rapid fix of our current problems with respiratory viruses. Indicators will lag by weeks. Until we have a <a href="https://doi.org/10.1038/s41586-022-05398-2">whole-of-society approach</a> that recognizes that <a href="https://doi.org/10.1016/S0140-6736(21)00869-2">COVID is airborne</a>, mask mandates offer us the best immediate opportunity to preserve our health-care system, mitigate death and disability from respiratory viruses, support the economy and safely maintain social contacts in our private lives. </p>
<p><em>Rebecca Rudman, co-founder of the Windsor Essex Sewing Force and member of McMaster’s Cloth Mask Knowledge Exchange, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/194726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Clase is editor-in-chief of clothmasks.org and a member of the Cloth Mask Knowledge Exchange, a research and knowledge translation group that includes industry stakeholders. Industry stakeholders contribute to the Cloth Mask Knowledge Exchange by contributing to grant funding, and through in-kind contributions of time and expertise. Industry stakeholders make masks and distribute polypropylene and other fabrics. They may potentially benefit from this article. She is a member of McMaster's Centre of Excellence in Protective Equipment and Materials. Catherine has received consultation, advisory board membership or research funding from the Ontario Ministry of Health, Sanofi, Pfizer, Leo Pharma, Astellas, Janssen, Amgen, Boehringer-Ingelheim and Baxter. In 2018 she co-chaired a KDIGO potassium controversies conference sponsored at arm's length by Fresenius Medical Care, AstraZeneca, Vifor Fresenius Medical Care, Relypsa, Bayer HealthCare and Boehringer Ingelheim. Catherine Clase receives funding from CIHR, and is a member of the Green Party, the American Society of Nephrology, the Canadian Society of Nephrology, the American Association of Textile Chemists and Colorists and ASTM International.</span></em></p><p class="fine-print"><em><span>Charles-Francois de Lannoy receives funding from the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Global Water Futures (GWF) Research organization, Ontario Centres of Excellence (OCE), Federal Economic Development Agency for Southern Ontario (FedDev), Canadian Foundation for Innovation (CFI), the French Embassy, and McMaster University. He has received funding in partnership with Pall Water, Trojan Technologies, Hatch Ltd., and PW Fabrication. He has engaged in various research projects and testing/validation of facemasks for several private companies in Ontario. He is affiliated with the Cloth Mask Knowledge Exchange as an expert advisor.</span></em></p><p class="fine-print"><em><span>Ken G. Drouillard receives funding from Natural Sciences and Engineering Research Council (NSERC) of Canada, Environment and Climate Change Canada, Ontario Ministry of Environment, Conservation and Parks and Mitacs. He is affiliated with the WE-Spark Health Institute, Detroit River Canadian Cleanup Committee, International Association of Great Lakes Research, Editor of Bulletin of Environmental Contamination and Toxicology and science advisor for Windsor-Essex Sewing Force. </span></em></p>In 2020, with adult ICUs at risk of being overwhelmed, we wore masks and accepted restrictions. Now pediatric intensive care is at risk. Will leaders follow the evidence and tell us to mask up?Catherine Clase, Professor of Medicine, Epidemiologist, Physician, McMaster UniversityCharles-Francois de Lannoy, Associate Professor, Chemical Engineering, McMaster UniversityKen G. Drouillard, Professor, Great Lakes Institute for Environmental Research, School of the Environment, University of WindsorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1912652022-10-23T19:02:26Z2022-10-23T19:02:26ZWhat should rich countries do with spare masks and gloves? It’s the opposite of what the WHO recommends<figure><img src="https://images.theconversation.com/files/490496/original/file-20221018-9021-5rvd4z.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/due-shortage-medical-supplies-coronavirus-covid19-1685561587">Shutterstock</a></span></figcaption></figure><p>Most developed countries hold significant quantities of medical supplies in reserve to respond in an emergency. </p>
<p>For example, Australia has its <a href="https://www.health.gov.au/initiatives-and-programs/national-medical-stockpile">National Medical Stockpile</a>, which stocks personal protective equipment, such as masks and gloves, among other items. New Zealand has its <a href="https://www.health.govt.nz/our-work/emergency-management/national-reserve-supplies">national reserve supplies</a>.</p>
<p>If these supplies are not used in an emergency, such as a pandemic, they typically stay in the stockpile until their use-by date, then are sent to landfill. </p>
<p>Surely there’s a better way, especially with some developing nations short of medical supplies. Donating surplus stock to developing countries seems an obvious solution. </p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/poms.13828">Our study</a> looked at the likely impact of donating excess stock to developing countries – dated items close to or past their labelled use-by date. We found this a viable option, even better than donating fresh items.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-were-on-a-global-panel-looking-at-the-staggering-costs-of-covid-17-7m-deaths-and-counting-here-are-11-ways-to-stop-history-repeating-itself-190658">We were on a global panel looking at the staggering costs of COVID – 17.7m deaths and counting. Here are 11 ways to stop history repeating itself</a>
</strong>
</em>
</p>
<hr>
<h2>What’s in the stockpile?</h2>
<p>In 2011, Australia’s stockpile <a href="https://www.anao.gov.au/sites/default/files/AuditReport_2013-2014_53.pdf">contained about</a> 3,000 pallets of expired stock, the bulk of which was personal protective equipment, including 98 million latex gloves. </p>
<p>While some of the reserves have been used during COVID, items are being restocked. So these too will likely expire if not used. For instance, we know surgical masks in the stockpile are <a href="https://www.anao.gov.au/sites/default/files/Auditor-General_Report_2020-21_22.pdf">already expiring</a>.</p>
<p>Similar issues have been seen in other developed countries such as the <a href="https://www.oig.dhs.gov/reports/2014-08/dhs-has-not-effectively-managed-pandemic-personal-protective-equipment-and">United States</a>, <a href="https://oag.parliament.nz/2020/ppe/docs/ppe.pdf">New Zealand</a> and <a href="https://globalnews.ca/news/6651402/ontario-coronavirus-masks-medical-supplies-expired/">Canada</a>, before and during the current pandemic.</p>
<h2>Why not donate surplus stock?</h2>
<p>This expiration and waste is in sharp contrast to the situation in some developing countries. Some are forced to reuse <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932219/">normally disposable items</a>, such as surgical gloves, masks and <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-8-4">syringes</a>.</p>
<p>While donation of surplus stock seems an obvious solution, donations of dated medical supplies are <a href="https://daisi.com.au/category/dr-gary-mckay-deregistered-expired-products-will-not-be-included-in-daisi-donations/">typically discouraged</a>. </p>
<p>The World Health Organization (WHO) <a href="https://www.who.int/publications/i/item/9789241501408">recommends against it</a>. It expects donations to arrive in another country with an expiry date of:</p>
<blockquote>
<p>at least one year, or half the shelf life if the expiry date is less than one year.</p>
</blockquote>
<p>The idea is to protect recipients from degraded or faulty stock.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/wealthy-nations-starved-the-developing-world-of-vaccines-omicron-shows-the-cost-of-this-greed-172763">Wealthy nations starved the developing world of vaccines. Omicron shows the cost of this greed</a>
</strong>
</em>
</p>
<hr>
<h2>We found a pragmatic option</h2>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/poms.13828">Our study</a> modelled the impact of donating stock, in particular personal protective equipment and similar low-risk products. We did not look at donating dated vaccines or medicines, which come with higher safety risks. </p>
<p>We found dated donations close to or recently past their use-by date was the best option. This benefited the recipient country the most, as it was least likely to push local suppliers out of business.</p>
<p>The next best option was donating fresh stock. The least preferable option was donating very dated stock, such as items out of date by more than a year.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Open cardboard box of hand sanitiser" src="https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490493/original/file-20221018-16-mqo4r8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The best option was donating stock, such as hand sanitiser, close to or slightly past its use-by date.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-sanitizer-container-box-delivery-self-1686800215">Shutterstock</a></span>
</figcaption>
</figure>
<h2>How could old stock be better?</h2>
<p>It’s easy to assume that donating large volumes of fresh, excess stock, still within its use-by date, would be the best option. But we showed how this can distort the local market.</p>
<p>Flooding the local market with free, fresh products can force local suppliers to lower their products’ market price, and make them potentially stop making or supplying these products.</p>
<p>This discourages any further attempts to develop local supply capacity, and makes the recipient country more reliant on donations. </p>
<p>This may be compounded by corruption. If corrupt officials siphon donated products and sell them on the black market, this too may force local suppliers out of business. This may also drive prices up on the black market, putting an extra strain on already stretched health-care systems.</p>
<p>Whether or not such corruption is involved, somewhat dated supplies could enable the local supplier to stay in business and supply the country’s health-care system.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-get-more-people-to-pay-taxes-indonesia-should-stamp-out-corruption-by-officials-at-the-top-57512">To get more people to pay taxes, Indonesia should stamp out corruption by officials at the top</a>
</strong>
</em>
</p>
<hr>
<h2>What should happen next?</h2>
<p>Some surplus medical supplies <a href="https://globallinks.org/our-programs/medical-surplus-recovery/">are being donated</a>. But
these programs are small scale and face many restrictions and challenges. These include a <a href="https://knowledge.insead.edu/operations/supply-chain-solutions-healthcare-inequality">limited and unpredictable supply</a> of donated items and relying heavily on <a href="https://naturallymodernlife.com/how-this-non-profit-health-system-is-reducing-waste/">volunteers and community partners</a> to distribute donated stock.</p>
<p>So donating surplus stock could be better coordinated at a larger scale.</p>
<p>Our evidence calls us to rethink what we do with dated donations of low-risk medical supplies.</p>
<p>Masks, respirators, syringes and hand sanitisers from national stockpiles would be a good start. Such products can continue to be useful even when dated, especially if the products are stored well.</p>
<p>Indeed, even in developed countries, personal protective equipment has been distributed past its expiration date <a href="https://www.bbc.com/news/uk-england-nottinghamshire-52025950">when needed</a> <a href="https://abcnews.go.com/Health/wireStory/mask-day-doctors-virus-epicenter-washington-69653568">during the pandemic</a>.</p>
<p>It would be prudent to run a pilot program to donate dated, surplus stock, possibly with a single product. </p>
<p>Medical suppliers could also get on board. They may be willing to pay the costs of such a donation program if it allows them to regularly restock national stockpiles and similar reserves with fresh items. </p>
<p>Many countries were <a href="https://www.cbc.ca/news/politics/ppe-pandemic-covid-coronavirus-masks-1.5645120">surprised</a> at the start of the pandemic to find how much expired stock was in their reserves. A donation program would prevent this happening again and help us better prepare for the next pandemic.</p><img src="https://counter.theconversation.com/content/191265/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>During COVID, rich countries have used masks and gloves from their medical stockpiles. But not all countries are so fortunate. We found the best way to help. It may not be what you think.Spring Zhou, Lecturer, operations and supply chain management, University of WollongongTava Olsen, Professor of Operations and Supply Chain Management, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1885132022-09-22T20:05:52Z2022-09-22T20:05:52ZWhy children’s ‘choice’ about COVID-19 masking at school needs far more discussion<figure><img src="https://images.theconversation.com/files/485313/original/file-20220919-14-n1gi4c.jpg?ixlib=rb-1.1.0&rect=0%2C886%2C3338%2C1760&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Who is determining children's capacity to decide whether or not to wear a mask and what's at stake in their decision?</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>Public health pandemic responses across Canada continue to be fluid. Like other provinces, Nova Scotia has moved away from <a href="https://novascotia.ca/coronavirus/restrictions-and-guidance/">mandatory</a> masking protocols in public spaces toward individual choice and <a href="https://novascotia.ca/coronavirus/avoiding-infection/">recommendations</a>, including in schools. </p>
<p>Communication to families of school-aged children directs students, teachers, and staff <a href="https://backtoschool.ednet.ns.ca/public-health-guidance">to make their own choice</a> about masking. </p>
<p>Can a five-year-old make such a health-related decision on their own behalf? What about an 11-year-old?</p>
<p>From our vantage point as academics who work <a href="https://www.msvu.ca/academics/faculty-of-education/faculty-profiles/dr-krista-ritchie/">at intersections</a> <a href="https://www.msvu.ca/academics/faculty-of-education/faculty-profiles/dr-sara-king/">of education and health care</a>, public health recommendations and provinces’ removal of clear masking requirements don’t appear to consider a child’s capacity to make decisions that affect their health.</p>
<p>How this “individual choice” approach plays out for students in schools needs to be carefully considered. </p>
<figure class="align-center ">
<img alt="A teacher wears a mask next to a list of pandemic rules in the classroom about keeping one's mask on and washing hands." src="https://images.theconversation.com/files/485326/original/file-20220919-24-42yat0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485326/original/file-20220919-24-42yat0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=430&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485326/original/file-20220919-24-42yat0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=430&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485326/original/file-20220919-24-42yat0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=430&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485326/original/file-20220919-24-42yat0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=540&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485326/original/file-20220919-24-42yat0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=540&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485326/original/file-20220919-24-42yat0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=540&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">When provinces mandated wearing masks at school in earlier stages of the pandemic, teachers were responsible for leading and enforcing mask wearing.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<h2>Who is responsible for children’s health?</h2>
<p>As children’s rights advocates have noted throughout the pandemic, it is unethical to <a href="https://theconversation.com/world-childrens-day-young-people-deserve-to-be-heard-during-covid-19-149904">exclude children from conversations</a> about issues that affect them.</p>
<p>However, the child’s right to be heard does not necessarily translate into being capable of making complex health-related decisions for themselves.</p>
<p><a href="http://www.emro.who.int/entity/child-adolescent-health/home.html">The World Health Organization</a> leads global initiatives to protect the health of children and supports countries who want assistance developing their own national policies.</p>
<p>The <a href="https://www.canada.ca/en/health-canada/corporate/health-portfolio.html">federal government</a>, in large part through <a href="https://www.canada.ca/en/health-canada.html">Health Canada</a>, is responsible for maintaining and improving the health of Canadians in line with the <a href="https://www.canada.ca/en/health-canada/services/health-care-system/canada-health-care-system-medicare/canada-health-act.html">Canada Health Act</a>.</p>
<p>Each <a href="https://www.canada.ca/en/health-canada/services/canada-health-care-system.html">provincial government</a> is responsible for the management and delivery of health-care services.</p>
<p>Adult guardians hold decision-making responsibility on behalf of their children’s health.</p>
<p>Why, then, are students deciding for themselves whether or not to wear a mask in enclosed public spaces during a pandemic? </p>
<h2>Ethical decision-making capacity?</h2>
<p>For ethical reasons, fields like <a href="https://doi.org/10.1001/archpsyc.1982.04290080061009">clinical psychology</a>, health care and law are concerned with a person’s capacity to make decisions.</p>
<p>Medical researchers and doctors Craig Barstow and colleagues <a href="https://www.aafp.org/pubs/afp/issues/2018/0701/p40.html">argue that patients have medical decision-making capacity if they can</a> “demonstrate understanding of the situation, appreciate the consequences of their decision and reasoning in their thought process, and if they can communicate their wishes.”</p>
<p>The work on specifically understanding a child’s competency to make choices that affect one’s health and development is widely known in <a href="https://apps.who.int/iris/handle/10665/350208">health-care</a> and <a href="https://books.google.ca/books?hl=en&lr=&id=XNrbMMGWi6gC&oi=fnd&pg=PA1&dq=Evaluating+competencies:+Forensic+Instruments&ots=_jNl_78h6y&sig=0JYWimDLNGNuvYxGPGQHILKEOTQ#v=onepage&q=Evaluating%20competencies%3A%20Forensic%20Instruments&f=false">legal settings</a> serving children and adolescents. Unfortunately, there is a paucity of research on a child’s capacity to make decisions in school settings. </p>
<p>Fundamentally, the criteria for being capable to make a decision are the same for children as adults. </p>
<figure class="align-center ">
<img alt="Children standing outside a school wearing masks." src="https://images.theconversation.com/files/485331/original/file-20220919-24-gbfp47.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485331/original/file-20220919-24-gbfp47.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485331/original/file-20220919-24-gbfp47.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485331/original/file-20220919-24-gbfp47.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485331/original/file-20220919-24-gbfp47.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485331/original/file-20220919-24-gbfp47.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485331/original/file-20220919-24-gbfp47.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Can children appreciate the consequences of a decision to mask or not to mask?</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<h2>What adults need to ask</h2>
<p>Key questions adults need to ask themselves when determining a child’s capacity to decide include:</p>
<ol>
<li>What supports does the child have, and what unique risk factors might need to be considered in each context?</li>
<li>Does the child understand and can they communicate the question being asked in their own words? </li>
<li>Does the child have the autonomy needed to make a decision for themselves?</li>
<li>Is there an established relationship with an adult whereby a child can feel comfortable asking questions to clarify understanding of the decision and potential short- and long-term consequences? Which adult is responsible for this in classrooms?</li>
<li>Do guardians expect teachers to be responsible for enforcing choices parents want children to make? If so, how will teachers manage this?</li>
<li>Will peer-comparison or other social pressures unduly influence the child? </li>
<li>Do the responsible adults in that child’s life (guardians, teachers, school leadership, politicians establishing recommendations) understand that they are ultimately responsible for any risks that children take regarding their own health? </li>
</ol>
<p><a href="https://novascotia.ca/dhw/phia/documents/chapters/4-Consent-Capacity-and-Substitute-Decision-Makers.pdf">In Nova Scotia</a>, unlike the legislated age to drive (16), or to vote (18), there is no specified age a child must reach before they are able to make decisions that relate to their health. </p>
<p>Where psychologists, social workers or physicians are involved with children’s health and wellness, the treating psychologist, social worker or physician must determine, on a case by case basis, whether a child is capable of making decisions in their best interest. </p>
<p>Teachers are not trained to determine capacity to decide. Have we given children a choice that they cannot make? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teachers-are-on-the-front-lines-with-students-in-the-coronavirus-pandemic-149896">Teachers are on the front lines with students in the coronavirus pandemic</a>
</strong>
</em>
</p>
<hr>
<h2>Difficult to assess</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A box of masks seen on a school table." src="https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=608&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=608&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=608&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=764&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=764&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485632/original/file-20220920-3640-jtvdmj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=764&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">How are children thinking about possible futures and evidence when they consider whether or not to mask?</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Andrew Vaughan</span></span>
</figcaption>
</figure>
<p>Decision-making capacity is difficult to assess <a href="http://www.nsbep.org/downloads/Age_of_consent_position_statement.pdf">in children</a>, and develops from early to late childhood and into adolescence. </p>
<p>As explained in <a href="https://www.britannica.com/biography/Jean-Piaget">the psychologist Piaget’s</a> theory of cognitive development, a child who has not yet reached <a href="https://www.youtube.com/watch?v=hvq7tq2fx1Y">adolescence </a> is unlikely to have the capacity to think about possible futures. </p>
<p>This would include a child’s capacity to consider evidence in a way that helps them decide whether or not to wear a mask. </p>
<p>The issue for public education can be framed within one question: Who is determining students’ capacity to decide?</p>
<h2>Adults ultimately responsible</h2>
<p>It is critical that adults <a href="https://doi.org/10.1007/s00431-014-2462-8">responsible for the health of children understand the complexity of decision-making capacity</a>, so as to decide whether it is developmentally appropriate to allow students in elementary and high schools to engage in health-related decision-making. </p>
<p>To be clear, we are not advocating for or against any particular health recommendation or mandate. Experts in infectious diseases and public health should lead that conversation. </p>
<p>However, our hope is this article raises awareness that, whereas children deserve agency in decisions that affect them, it is adults who are are ultimately responsible for fully considering the implications of federal and provincial mandates and policies on children’s rights and well-being — and subsequently for making decisions in children’s best interests.</p><img src="https://counter.theconversation.com/content/188513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children deserve agency in decisions that affect them, but adults are ultimately responsible for making decisions in children’s best interests.Krista C Ritchie, Associate Professor, Faculty of Education, Mount Saint Vincent UniversitySara King, Associate Professor, Faculty of Education, Mount Saint Vincent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1894362022-09-05T13:09:47Z2022-09-05T13:09:47ZThe PPE used throughout the COVID-19 pandemic is getting tangled up in wildlife<figure><img src="https://images.theconversation.com/files/481952/original/file-20220831-14-b7noe0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Used masks threaten urban wildlife.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Throughout the COVID-19 pandemic, masking has been one of the key public health measures put in place to combat the disease. Since March 2020, billions of disposable surgical masks have been used around the world, raising the question: What happens to all those used masks?</p>
<p>As researchers in single use plastic and microplastic pollution, the onset of a global wave of plastic debris pollution became evident to us in the early days of the pandemic — we could see the evidence even during lockdowns when exercise was limited to short daily walks in the neighbourhood. Masks and gloves were on the ground, fluttering in the wind and hanging on fencing. </p>
<p>As ecologists, we were also aware of where the debris would end up — in nests, for example, or wrapped around the legs or in the stomachs of wildlife.</p>
<p>In Canada, a team of researchers led by conservation biologist Jennifer Provencher <a href="https://doi.org/10.1139/er-2018-0079">studied how plastic debris impacts wildlife</a>. In a study conducted during a canal cleanup in The Netherlands, biologists at the Naturalis Biodiversity Center documented <a href="https://doi.org/10.1163/15707563-bja10052">that Personal Protective Equipment (PPE) debris would interact with wildlife in the same way as other plastics</a>. </p>
<h2>Effects on wildlife</h2>
<p>There’s <a href="https://www.reddit.com/r/RATS/comments/i4nv66/face_masks_for_the_win/">a cartoon circulating on the internet</a> that goes like this: a rat comes home carrying bags of groceries to see two rats laying in bunk beds made from medical grade masks. The rat in the bottom bunk exclaims, “Free hammocks, all over town. It’s like a miracle!”</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1294320425099571202"}"></div></p>
<p>We shared this cartoon with our colleagues at the beginning of the pandemic, while we were conducting surveys of PPE litter around Toronto streets and parking lots. </p>
<p>We found that within the area that we were surveying — which covered an area of Toronto equivalent to about 45 football fields — over 14,000 disposable masks, gloves or hand wipes accumulated by the end of the year. That’s a lot of rat hammocks.</p>
<p>We set out to understand the breadth of the harm that PPE is doing to wildlife. What we learned is just how many other people were equally concerned. </p>
<h2>Jarring images</h2>
<p>We conducted a global survey using social media accounts of wildlife interactions with PPE debris. The images are jarring: A hedgehog wrapped in a face mask, the earloops tangled in its quills. A tiny bat, with the earloops of two masks wrapped around its wing. A nest, full of ivory white eggs, insulated with downy feathers and a cloth mask. </p>
<p>Many of these animals are dead, but most were alive at the time of observation. Some were released from their plastic entanglement by the people who captured the photo.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CDAB4MQBCKO","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>In total, we found 114 cases of wildlife interactions with PPE debris as documented on social media by concerned people around the world. Most of the wildlife were birds (83 per cent), although mammals (11 per cent), fish (two per cent), invertebrates such as an octopus (four per cent) and sea turtles (one per cent) were also observed. </p>
<p>The majority of observations originated in the United States (29), England (16), Canada (13) and Australia (11), likely representing both the increase in access to mobile devices and our English-language search terms. Observations also came from 22 other countries, with representation from all continents except Antarctica. </p>
<h2>Weighing costs and benefits</h2>
<p>With an <a href="https://doi.org/10.1021/acs.est.0c02178">estimated 129 billion face masks</a> <a href="https://doi.org/10.1016/j.jece.2021.105222">used monthly around the world</a>, how do we, as ecologists and environmental researchers, tell a global population experiencing a global pandemic to use fewer masks? We don’t. </p>
<p>N95 masks have been essential in reducing the transmission of COVID-19 and, although they are more environmentally harmful than cloth masks, <a href="https://doi.org/10.1021/acs.chas.1c00016">the benefit to health is demonstrably superior</a>.</p>
<p>So, what could we have done better? One thing we noted during our PPE litter surveys is the abundance of discarded masks and gloves in close proximity to public garbage bins. </p>
<p>We hypothesize that a lack of clear messaging from municipalities and provinces about safe ways to dispose of PPE, along with our reluctance to gather near sources of discarded PPE, may have contributed to this global pollution event.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a public rubbish bin filled with PPE and surgical masks to the point of overflow" src="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Developing better ways for people to get rid of their PPE waste may help prevent used surgical masks from ending up in the environment.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>These are lessons that can still be implemented as we continue to cycle through waves of this pandemic; the use of masks is not yet behind us. Our surveys continue as we track an accumulation of PPE debris that will likely find its way into more nests and tangled around the bodies of more animals.</p>
<p>The rise of single use plastic use due to COVID-19 may not have been avoidable. But the rise in plastic pollution could have been mitigated with some investment in public outreach and modifications to waste management infrastructure to allow for masks and other PPE to be disposed of and processed correctly with minimal leakage to the environment.</p><img src="https://counter.theconversation.com/content/189436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Billions of face masks and other personal protective equipment have been used throughout the pandemic. Containing plastic, these items are damaging wildlife and their environments.Shoshanah Jacobs, Associate Professor, Integrative Biology, University of GuelphJackie Saturno, Research Associate, Dalhousie UniversityJustine Ammendolia, PhD Student, Resource and Environmental Studies, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1859792022-07-19T13:17:08Z2022-07-19T13:17:08ZFace masks affect how children understand speech differently from adults – new research<figure><img src="https://images.theconversation.com/files/474590/original/file-20220718-16-c16rv4.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5463%2C3628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-black-teacher-her-students-wearing-1798363270">Drazen Zigic/Shutterstock</a></span></figcaption></figure><p>While mask-wearing is no longer required in many locations, it remains in use as a way to limit the spread of COVID-19. One of the criticisms of masks has been that they make communication more difficult. A recent report by the <a href="https://www.gov.uk/government/publications/evidence-summary-covid-19-children-young-people-and-education-settings">UK Department for Education</a>, for example, suggests that mask wearing during the pandemic caused communication difficulties in classrooms. </p>
<p>However, our <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2022.879156/abstract">new research</a> shows that for people without hearing and language difficulties, the effects of face masks on the understanding of speech are in fact mild. </p>
<p>Although face masks slow down our understanding of speech, they rarely lead to misunderstandings. Masks also do not affect our understanding in all situations. They generally only have an effect when the topic of the conversation is unpredictable. </p>
<p>26 children (aged eight to 12) and 26 adults without hearing or language difficulties took part in our study. We showed them videos of a person speaking while wearing a cloth face mask and asked them to repeat back the last word of each sentence they had heard. This allowed us to measure how quickly and how accurately people understand face-masked speech. </p>
<p>As well as testing our participants’ understanding of masked versus non-masked speech, we also manipulated the video in order to test the audio and visual effects of the mask separately. This meant that, for instance, the video showed a non-masked speaker but played audio recorded with the mask on. </p>
<p>We found that children process masked speech up to 8% less accurately and 8% more slowly than normal speech, while adults process masked speech up to 6.5% less accurately and 18% more slowly. </p>
<p>In general, adults responded to speech faster than children in the study - about 23% faster (148 milliseconds) when listening to face mask speech and 29% faster (176 milliseconds) when listening to normal speech. Adults’ highly efficient processing of normal speech could be one reason why the effect of face masks on their speed is more pronounced.</p>
<h2>The impact of face masks</h2>
<p>Face masks change our use of language in two ways. <a href="https://theconversation.com/the-science-of-how-you-sound-when-you-talk-through-a-face-mask-139817">They change what a speaker sounds like</a> and may give the impression that their speech is muffled. Most masks also block the view of the speaker’s lips.</p>
<p>Surprisingly, our research shows that the way masks change the sound when we speak affects children more than the visual obstruction of the speaker’s lips. The reason for this could be that <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9568.2011.07685.x">children are not as good</a> at combining visual information with sound as adults are when hearing and seeing a speaker. As a result, seeing the speaker’s lip movements while hearing masked speech does not improve how accurately they understand what is being said. </p>
<p>This is different from adults, who find masked speech more difficult to understand because of the unique combination of visual blocking and sound changes. We found that acoustically muffled masked speech does not affect adults’ understanding when they can see the speaker’s lip movements. Similarly, concealing the talker’s mouth does not have an effect when the speech sound is clear. However, most masks conceal the mouth and change the speech sound at the same time.</p>
<h2>What we’re talking about matters</h2>
<p>Interestingly, the topic of conversation matters. Face masks affect our understanding less when we can anticipate what our conversation partner is going to say. </p>
<figure class="align-center ">
<img alt="Two people wearing masks sat on park bench" src="https://images.theconversation.com/files/474599/original/file-20220718-71797-l5lav4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/474599/original/file-20220718-71797-l5lav4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/474599/original/file-20220718-71797-l5lav4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/474599/original/file-20220718-71797-l5lav4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/474599/original/file-20220718-71797-l5lav4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/474599/original/file-20220718-71797-l5lav4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/474599/original/file-20220718-71797-l5lav4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The combination of blocked visuals and muffled sound affects how adults understand masked speech.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/photo-young-attractive-couple-sitting-on-1726550038">Irene Castro Moreno/Shutterstock</a></span>
</figcaption>
</figure>
<p>This is because knowing the conversation context helps us to understand language quickly and effortlessly. For example, in the sentence “For your birthday I baked this cake”, the words “birthday” and “baked” are related in meaning to the last word “cake” and often occur together. Our brains can use this information to predict what a speaker is going to say. </p>
<p>Our study shows that giving this type of contextual information reduces the difficulties in understanding masked speech. When given high contextual information, both children and adults process masked speech only 1% less accurately than normal speech. This explains why communicating with masks causes difficulties in some situations but not others. </p>
<p>While there have been fears that masks would affect children’s learning, in the classroom teachers use many techniques that increase contextual information. They design lessons in a way that builds upon students’ existing knowledge and use images, keywords and written text. All of these techniques support children’s understanding of what is being said and help them to compensate for face mask effects. </p>
<p>Listeners also use other clues that reduce mask effects. For example, most masks do not cover the upper part of the face. This is good news because seeing the speaker’s eyes and upper face helps us to understand <a href="https://theconversation.com/the-science-of-how-you-sound-when-you-talk-through-a-face-mask-139817">masked speech better</a>. As a result, our comprehension of language is remarkably robust.</p>
<p>However, participants in our study did not have any <a href="https://theconversation.com/face-masks-are-a-challenge-for-people-with-hearing-difficulties-137423">hearing or speech difficulties</a>, and only listened to an adult speaker <a href="https://cognitiveresearchjournal.springeropen.com/track/pdf/10.1186/s41235-021-00314-0.pdf">in quiet conditions</a>. We don’t know how mask wearing has affected children’s communication with their peers, or its impact on other aspects of their learning and <a href="https://www.mind.org.uk/information-support/coronavirus/mask-anxiety-face-coverings-and-mental-health/">wellbeing</a>.</p><img src="https://counter.theconversation.com/content/185979/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Schwarz has received funding from the Cambridge Language Sciences Incubator Fund, the ESRC, and the Gates Cambridge Trust.</span></em></p>New research explores how face masks affect our understanding of speech.Dr. Julia Schwarz, PhD Candidate in Linguistics, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1811322022-04-19T14:55:13Z2022-04-19T14:55:13Z‘Living with COVID-19’ must be more than an empty phrase: Individuals need tools to manage BA.2 and future waves<figure><img src="https://images.theconversation.com/files/458247/original/file-20220414-24-xhspoa.JPG?ixlib=rb-1.1.0&rect=18%2C119%2C3300%2C2527&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ontario Chief Medical Officer of Health Kieran Moore arrives to speak at a press conference at Queen’s Park on April 11, 2022. Ontario lifted most COVID-19 restrictions in March.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/-living-with-covid-19--must-be-more-than-an-empty-phrase--individuals-need-tools-to-manage-ba-2-and-future-waves" width="100%" height="400"></iframe>
<p>When Ontario lifted public health protective measures in March, the expectation was that we might see a <a href="https://www.ctvnews.ca/mobile/health/coronavirus/bump-in-covid-19-cases-not-unexpected-as-public-health-measures-lifted-tam-says-1.5825004?cache=/5-things-to-know-for-monday-september-30-2019-1.4616452">small but manageable bump in COVID-19 cases</a>. At the same time, Canadians were being told that it was time to learn to “<a href="https://www.cbc.ca/news/canada/toronto/ontario-covid19-march-8-2022-1.6376793">live with COVID</a>.” </p>
<p>The decision to lift the public health protective measures happened while many countries in Africa, <a href="https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---15-february-2022">Europe and South Asia</a> were going through another Omicron-like surge, caused by one of its subvariants, BA.2. Many of these countries also removed their public health protective measures. In <a href="https://arstechnica.com/science/2022/04/cdc-study-spotlights-utter-failure-of-chinas-covid-zero-policy-in-hong-kong/">Hong Kong</a>, while the restrictions were being removed, BA.2 hit like a tsunami with massive casualties among people age 60 years and over. <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7115e1.htm?s_cid=mm7115e1_w">China</a> was also dealing with an Omicron BA.2 surge. </p>
<p>In Ontario, authorities had hoped the BA.2 wave would somehow pass by. However, instead of the <a href="https://beta.ctvnews.ca/local/toronto/2022/4/5/1_5849600.amp.html">expected small bump in cases</a>, current predictions are at <a href="https://toronto.ctvnews.ca/ontario-likely-seeing-100k-to-120k-new-covid-19-cases-each-day-head-of-science-table-says-1.5851187">100,000 cases per day</a>, which is likely an underestimation due to lack of wider testing. <a href="https://www.cbc.ca/news/canada/toronto/ontario-daily-covid-file-april-5-2022-1.6408672">COVID-19 hospitalizations have surpassed 1,000 in Ontario</a>. </p>
<p>Although Ontario is now better prepared to handle higher cases of <a href="https://news.ontario.ca/en/release/1001411/ontario-continues-to-add-hospital-beds-and-build-up-health-workforce">hospitalization and intensive care admissions</a>, its challenge may now be to handle large absenteeism in health care and other sectors. The recent chaos in <a href="https://www.thetimes.co.uk/article/covid-chaos-at-uk-airports-spreads-to-border-officials-b0h0x5vqm">British airports</a> and at other borders illustrates the potential impact of BA.2.</p>
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Read more:
<a href="https://theconversation.com/why-its-normal-for-covid-19-vaccine-immunity-to-wane-and-how-booster-shots-can-help-171786">Why it's normal for COVID-19 vaccine immunity to wane, and how booster shots can help</a>
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<p>The surge of BA.2 cases in Ontario is related not only to the subvariant’s characteristics, but also to the <a href="https://www.scientificamerican.com/article/vaccines-remain-effective-against-ba-2-but-protection-from-infection-wanes-over-time/">waning of vaccine-induced immune protection</a> against the infection (including in those that had a booster late last year) and, above all, the removal of public health protective measures, such as the mask requirement. </p>
<h2>What do we know about the BA.2 subvariant?</h2>
<figure class="align-right ">
<img alt="A watercolour illustration of a light blue coronavirus with red spikes" src="https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458266/original/file-20220414-9085-huglhv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Omicron BA.2 is now the dominant variant worldwide.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>BA.2 is believed to have emerged around the same time as the other Omicron variants. The significance of BA.2 became clear with the release of a <a href="https://en.ssi.dk/-/media/arkiv/subsites/covid19/risikovurderinger/2022/risk-assesment-of-omicron-ba2.pdf?la=en">report from Denmark</a> in late January, indicating that this subvariant is 30 per cent more transmissible than Omicron, but with the same virulence (the potential to cause severe disease). </p>
<p>By early April, the World Health Organization reported that BA.2 was the <a href="https://www.who.int/docs/default-source/coronaviruse/situation-reports/20220405_weekly_epi_update_86.pdf?sfvrsn=3f01a460_4&download=true">dominant variant worldwide</a>. A few more Omicron subvariants have already made their debuts, such as BA.1.1, BA.3 <a href="https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-who-press-conference-13-April-2022">BA.5</a> and BA2+. Cases of recombination among Omicron subvariants and Delta, such as <a href="https://www.forbes.com/sites/williamhaseltine/2022/04/06/two-more-members-of-the-omicron-family-to-keep-an-eye-on/?sh=5076c6664fea">Omicron XE</a>,<a href="https://nationalpost.com/news/who-says-it-is-analyzing-two-new-omicron-covid-sub-variants">BA.4</a> <a href="https://theconversation.com/deltacron-what-scientists-know-so-far-about-this-new-hybrid-coronavirus-179442">XD</a> and XF, have emerged. </p>
<p>Omicron XE is getting a lot of attention, as its <a href="https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---5-april-2022">transmissibility is 10 per cent greater</a> than that of BA.2 (or approximately 50 per cent more transmissible than the original Omicron variant, BA.1). It was first detected on <a href="https://time.com/6165297/xe-variant-what-to-know/">Jan. 19 in the United Kingdom</a>.</p>
<p>Research awaiting peer review indicates that <a href="https://doi.org/10.1101/2022.02.19.22271112">re-infection by BA.2</a> is low. However, in those who are re-infected with BA.2, one in four had a prior BA.1 infection. The emergence of variants such as Omicron XE, which results from <a href="https://www.forbes.com/sites/williamhaseltine/2022/03/10/a-new-process-of-sars-cov-2-variation-uncovered-intragenomic-recombination/?sh=66b151a3c8cd">recombination of the genomes of Omicron BA.1 and BA.2</a> in addition to new mutations, suggests that wide circulation of BA.2 among BA.1 impacted populations can significantly contribute to the evolution of SARS-CoV-2. The BA.4 subvariant is the result of <a href="https://www.forbes.com/sites/williamhaseltine/2022/03/16/an-omicron-omicron-recombinant-ba4/?sh=7f1065a059b0">recombination</a> between Omicron BA.1 and BA.3. </p>
<p>Reports that have not yet been peer-reviewed indicate that BA.2 has a slightly higher (30 per cent) <a href="https://arxiv.org/pdf/2202.05031.pdf">immune evasion capability</a> (ability to bypass immunity from vaccines or previous infections) and higher <a href="https://doi.org/10.1101/2022.03.26.22272984">viral shedding</a> (release of virus particles by an infected person) than Omicron. These factors could explain its higher transmissibility than Omicron, while the severity and symptoms remain similar to <a href="https://www.theguardian.com/world/2022/apr/07/omicron-variant-does-cause-different-symptoms-from-delta-study-finds?CMP=oth_b-aplnews_d-1">Omicron</a>.</p>
<h2>What does it mean to ‘live with COVID-19?’</h2>
<p>Two years into the pandemic, there’s a lot that experts have learned about SARS-CoV-2. However, humans keep enabling its circulation, <a href="https://theconversation.com/how-new-covid-19-variants-emerge-natural-selection-and-the-evolution-of-sars-cov-2-176030">giving the virus the chance to evolve</a>. We are not in a position to predict the future of this pandemic, just yet. </p>
<p>Since the beginning of the pandemic, the public was asked to listen to the advice of experts and public health officials. Now the public is being told to learn to live with COVID-19. At the same time, <a href="https://www.thewhig.com/news/covid-19-testing-remains-limited-as-sixth-wave-hits-ontario">testing has become limited</a> and little to no <a href="https://globalnews.ca/news/8753953/covid-19-canada-6th-wave-risk-assessment-challenges/">information on daily COVID-19 cases</a> is now provided in some parts of Canada. So, any chance for the public to check the COVID “weather,” get a forecast and prepare for it is diminished. We are now living in a COVID fog.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three people in face masks and shields carrying bags and packages." src="https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/458268/original/file-20220414-18-zqvagf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Hong Kong Chief Executive Carrie Lam, left, holds a package of coronavirus prevention materials to be delivered to people during an event on April 2, 2022. Hong Kong authorities asked the entire population to voluntarily test themselves for COVID-19 at home for three days in a row.</span>
<span class="attribution"><span class="source">(AP Photo/Kin Cheung)</span></span>
</figcaption>
</figure>
<p>In the summer of 2020, as Ontario was contemplating lifting lockdowns, public health experts looked for key indicators to sustain such measures. A <a href="https://globalhealth.harvard.edu/evidence-roundup-why-positive-test-rates-need-to-fall-below-3/">three per cent positivity rate</a> was considered to be a sufficiently safe community transmission rate to remove the public health protective measures. We are in a better position now with around <a href="https://covid19tracker.ca/vaccinationtracker.html">86 per cent vaccine coverage</a> among those over five years old, and many people have grown accustomed to face masks, so it’s likely that we can handle a higher positivity rate. The question is, how much higher? </p>
<p>The answer would be a useful indicator for the public to make COVID-19 protection choices. This is not about living with a <a href="https://nationalpost.com/opinion/rupa-subramanya-doug-ford-must-resist-covid-zero-zealots">zero-COVID policy</a>. It is about empowering the public with up-to-date information and providing the right tools to weather a COVID-19 storm. Individuals cannot protect themselves on their own, nor should they have to.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-next-with-face-masks-keep-wearing-them-in-public-wear-the-best-mask-available-and-pay-attention-to-fit-177237">What's next with face masks? Keep wearing them in public, wear the best mask available and pay attention to fit</a>
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<p>We do have vaccines, but their protection against infection wanes with time. In addition, it does not seem like <a href="https://www.reuters.com/article/us-health-coronavirus-israel-study-idCAKCN2LY06B">we can boost our way out</a> of this pandemic. We have the antiviral medications, such as <a href="https://covid-vaccine.canada.ca/info/paxlovid-en.html">Paxlovid</a>, but they need to be administered in the early days of an infection. But without testing, how would one know when to take it? </p>
<p>In addition, <a href="https://www.theglobeandmail.com/canada/article-covid-19-antiviral-drug-paxlovid-being-dispensed-at-low-rates-across/">distribution and administration</a> of this medication has hit a wall in Canada. We have the masks that work very well, but the empty phrase “<a href="https://www.ctvnews.ca/health/coronavirus/get-used-to-it-outbreaks-give-americans-taste-of-living-with-virus-1.5854754">living with the virus</a>” has muddled the significance of this simple, and yet protective, measure.</p>
<p>Instead of minimizing or dismissing this new wave of COVID-19, as well as future waves, we need for strategies to deal with new COVID-19 waves in an efficient way. The U.S. <a href="https://www.popsci.com/health/fda-advisors-meet-future-vaccine-strategy/">Food and Drug Administration</a> recently held a meeting to brainstorm new ways to provide sustainable immune protection in the face of an ever-changing SARS-CoV-2 virus. Canada should follow suit. </p>
<p>Governments should follow the science and provide the means to live with virus: information about the emergence of new variants, number of daily cases, access to testing and solutions for longer-lasting immune protection with different vaccine technologies. Then we can all live a healthy life with COVID-19.</p><img src="https://counter.theconversation.com/content/181132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dasantila Golemi-Kotra does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Instead of minimizing current or future waves of COVID-19, we need strategies to deal with new variants efficiently. Only then can we live with the virus in a healthy way.Dasantila Golemi-Kotra, Professor, Biology, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772372022-03-29T20:06:14Z2022-03-29T20:06:14ZWhat’s next with face masks? Keep wearing them in public, wear the best mask available and pay attention to fit<figure><img src="https://images.theconversation.com/files/454820/original/file-20220328-13-18zbelz.jpg?ixlib=rb-1.1.0&rect=338%2C206%2C2960%2C1681&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fit, fabric and design affect mask effectiveness. </span> <span class="attribution"><a class="source" href="https://wesf.ca/">(Windsor Essex Sewing Force)</a>, <span class="license">Author provided</span></span></figcaption></figure><p>Early in the pandemic, mask-wearing policies were <a href="https://www.clothmasks.org/masks-in-context">consistently associated</a> with decreased transmission of SARS-CoV-2. At that time, the masks worn were generally made of cloth and often improvised.</p>
<p>The highly-transmissible Omicron variant <a href="https://www.publichealthontario.ca/-/media/documents/ncov/voc/2021/12/omicron-variant-community-masking.pdf?sc_lang=en">focused attention on mask performance</a>. </p>
<p>Although most provinces are lifting official mask mandates, we agree with <a href="https://globalnews.ca/news/8692613/covid-phac-omicron-mask-province-mandate/">public health authorities</a> in recommending that people <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html">wear the best mask available</a>. We have been working to improve and test reusable masks for community use. </p>
<p>We are an interdisciplinary group of engineers, scientists, a doctor and a community mask-maker. We test novel personal protective equipment (PPE), advocate for mask use and summarize the best available evidence at <a href="https://www.clothmasks.org/">clothmasks.org</a>.</p>
<h2>Hierarchy of mask performance</h2>
<p>There is an accepted <a href="https://www.clothmasks.org/mask-hierarchy">hierarchy of mask performance</a> based on mask materials, certification standards and use, confirmed by a <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">2022 California population health study</a>. The best protection is obtained by wearing a respirator such as an N95, CAN95 or CAN99, or in Europe, an FFP2 or FFP3. Performance is typically lower for KN95s, KF94s and certified medical masks meeting ASTM <a href="https://www.astm.org/products-services/standards-and-publications/covid-19.html">levels 1 to 3</a>. (ASTM is <a href="https://www.astm.org">an international standards organization</a>.)</p>
<figure class="align-center ">
<img alt="A man wearing a cloth face mask with a tube extending from it to a machine on the table in front of him" src="https://images.theconversation.com/files/451676/original/file-20220311-13-pxlo75.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451676/original/file-20220311-13-pxlo75.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451676/original/file-20220311-13-pxlo75.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451676/original/file-20220311-13-pxlo75.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451676/original/file-20220311-13-pxlo75.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451676/original/file-20220311-13-pxlo75.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451676/original/file-20220311-13-pxlo75.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Testing Essex-pleated cotton masks using a PortaCount fit tester at McMaster University.</span>
<span class="attribution"><a class="source" href="https://wesf.ca/">(Windsor Essex Sewing Force)</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The materials used in all these masks offer similar, excellent, aerosol filtration, but the masks differ in their fit and seal on the face, with KN95s and KF94s fitting better than certified medical masks. </p>
<p>Cloth masks are typically ranked lower in their performance and may or may not be certified (for example, meeting <a href="https://www.astm.org/f3502-21.html">ASTM-F3502 standard</a>). However, <a href="https://doi.org/10.1371/journal.pone.0264090">we recently showed</a> that well-fitted cloth masks comprising high quality two-ply cotton material can perform as well as Level 1 medical masks.</p>
<h2>Fabric types</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Six squares showing highly magnified images of different fabrics" src="https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=836&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=836&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=836&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1050&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1050&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451678/original/file-20220311-3190-1uhvdng.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1050&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some examples of the variations in fabric structure seen with scanning electron microscopy: A) Bandana, B) High quality quilting fabric, C) Tea towel, D) Bed sheet, E) Outer layer L1 nonwoven medical mask, F) Middle layer of L1 nonwoven medical mask. We found that pore diameter (the size of the gaps) and fabric weight predicted filtration, however consumers would not know the pore diameter for retail or wholesale cloth. For this reason, we focus on the categories used when cloth is sold, and recommend 100 per cent cotton quilters’ fabric, fashion fabric and T-shirt fabric.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1371/journal.pone.0264090">(Drouillard et. al. PLOS)</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>When health-care professionals are issued N95s or other certified respirators, they are fit tested to verify mask performance on the wearer. But fit testing is typically not an option for the public. </p>
<p><a href="https://doi.org/10.1371/journal.pone.0264090">Our research</a>, explained in <a href="https://www.clothmasks.org/cotton-fabrics-community">plain language here</a>, underscores that fit can be achieved by good design and is as important as mask materials. For our research, we adapted the same method used in quantitative mask fit testing: a PortaCount fit tester that counts particles inside and outside the mask.</p>
<p>We tested 16 different cottons from nine recognizable categories. All except bandana cotton showed filtration equivalent to a medical mask. These findings apply to the carefully designed two-layer cloth mask with ties we used — other masks that fit less well will not provide the same protection.</p>
<p>Our results show that two-layer cotton masks made from quilters’ cotton, fashion fabric and T-shirt fabric filtered 55 to 60 per cent of aerosol particles measuring one micron or smaller, the size relevant for infectious aerosol particles. This was similar to the performance of a Level 1 medical mask. The breathability of the two-layer cotton masks was also acceptable as per medical mask standards. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph showing filtration rates for nine types of fabric." src="https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=560&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=560&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451675/original/file-20220311-14-12gyjj6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=560&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This graph shows the filtration of two-layer masks, all the same design, worn by a human volunteer. All except bandana cotton showed filtration equivalent to a medical mask. Mass market QC = mass market quilting cotton, HQ QC = high quality quilting cotton, HQ Batik = high quality batik quilting fabric. The medical masks we tested are represented by dotted lines showing their 50 to 60 per cent filtration.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1371/journal.pone.0264090">(Drouillard et. al. PLOS)</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Filtration in the same range was provided by batiks, home décor fabric and bed-sheet fabric, but some examples of these materials failed the breathability testing. Tea towel fabrics also filtered well, but some were too thick to sew. Bandana fabrics performed worst at 46 per cent filtration. </p>
<h2>Fit and design</h2>
<figure class="align-center ">
<img alt="Close-up of an ear showing improper and proper fit of a blue face mask" src="https://images.theconversation.com/files/454819/original/file-20220328-19-645813.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454819/original/file-20220328-19-645813.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454819/original/file-20220328-19-645813.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454819/original/file-20220328-19-645813.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454819/original/file-20220328-19-645813.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454819/original/file-20220328-19-645813.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454819/original/file-20220328-19-645813.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A close fit at the ear prevents unfiltered air from entering the mask at the sides.</span>
<span class="attribution"><a class="source" href="https://wesf.ca/">(Windsor Essex Sewing Force)</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our research showed that cloth masks performed similarly to medical masks because they fit better, were <a href="https://www.clothmasks.org/patternsinstruction"> designed thoughtfully</a> and had overhead ties. Although medical masks are composed of materials with better filtration performance, they exhibit greater leakage, with completely unfiltered air passing around the mask.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar graph showing breathability of different fabrics." src="https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=575&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=575&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451677/original/file-20220311-23-10vpv26.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=575&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As a test of breathability, we measured the pressure across fabrics using the same methods that are used for testing certified medical masks. The threshold for medical masks is shown with dotted lines.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1371/journal.pone.0264090">(Drouillard et. al. PLOS)</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The cloth masks included in past studies may have been haphazardly selected: their filtration, using the same methods that we used, was found to be <a href="https://doi.org/10.1016/j.ajic.2021.10.041">between 23</a> and <a href="https://doi.org/10.1371/journal.pone.0245688">52 per cent</a>. A thoughtfully designed two-layer T-shirt mask with overhead ties, tested on human volunteers, filtered <a href="https://dx.doi.org/10.1017%2Fdmp.2013.43">50 per cent of aerosols</a>, in keeping with our study, and again highlighting the importance of fit. </p>
<p>To compare like with like, when we looked at other studies, the filtration percentages that we quote above were taken from studies using a similar design: protection of a human wearer, using particles <a href="https://doi.org/10.1001/jamainternmed.2020.8168">0.02 to 3 microns</a>, <a href="https://doi.org/10.1371/journal.pone.0264090">0.02 to 1 microns</a> <a href="http://doi.org/10.1017/dmp.2013.43">and</a> <a href="https://doi.org/10.1371/journal.pone.0245688">0.02</a> <a href="https://doi.org/10.1080/15459624.2021.1925124">to 0.1</a> <a href="https://doi.org/10.1097/MD.0000000000023709">microns</a>. Other studies examining <a href="https://doi.org/10.1016/j.ajic.2021.10.041">source control</a>, using <a href="https://doi.org/10.1128/mSphere.00637-20">mannikins</a> and using <a href="http://dx.doi.org/10.15585/mmwr.mm7007e1">larger particles</a> come to similar conclusions.</p>
<p>Good masks fit well, with minimal obvious leaking at the edges. <a href="https://doi.org/10.1001/jamainternmed.2020.8168">Nosewires, overhead ties</a> or <a href="https://doi.org/10.1016/j.ajic.2021.10.041">earloop adjusters</a> all <a href="https://www.clothmasks.org/getting-best-fit">contribute to fit</a>. <a href="https://www.clothmasks.org/summary-of-advice">Two layers</a> or more, and a middle layer of non-woven <a href="https://www.clothmasks.org/polypropylene">polypropylene</a> improve overall filtration. </p>
<p><a href="https://wwwn.cdc.gov/PPEInfo/RG/FaceCoverings">Masks meeting the new U.S. Centers for Disease Control and Prevention standard</a> for community masks, <a href="https://www.astm.org/f3502-21.html">ASTM-F3502</a>, are likely to filter well, though generally not as well as respirators.</p>
<h2>N95 masks</h2>
<p>Hospitals report that the current supply of N95-type masks meets but doesn’t exceed demand, and supply of these masks is insufficient for the general population. Access and cost issues require public health and economic solutions along with consideration of <a href="https://doi.org/10.1007/s11356-021-17430-5">environmental impact</a> of disposable PPE. </p>
<p>If <a href="https://www.clothmasks.org/finding-n95-masks">buying respirators</a> for personal use, we recommend buying only what you need and practising <a href="https://www.clothmasks.org/extended-use">extended reuse</a>. If buying KN95s and equivalent certified medical masks, we advise paying close attention to the fit of the mask. We recommend <a href="https://www.clothmasks.org/double-masking">double masking</a> medical masks or using minor modifications or <a href="https://www.clothmasks.org/mask-hacks">mask hacks</a> that enhance fit and reduce leakage. </p>
<figure class="align-center ">
<img alt="A completed blue cloth mask, two masks in progress and a piece of green fabric" src="https://images.theconversation.com/files/454821/original/file-20220328-17770-13vyoj3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/454821/original/file-20220328-17770-13vyoj3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/454821/original/file-20220328-17770-13vyoj3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/454821/original/file-20220328-17770-13vyoj3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/454821/original/file-20220328-17770-13vyoj3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/454821/original/file-20220328-17770-13vyoj3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/454821/original/file-20220328-17770-13vyoj3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pattern and instructions for the Essex pleated mask — a two-layer, three-pleat design created by the Windsor-Essex Sewing Force — are available from West Essex Sewing Force or from clothmasks.org/patternsinstruction.</span>
<span class="attribution"><a class="source" href="https://wesf.ca/">(Windsor Essex Sewing Force)</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="https://www.clothmasks.org/patternsinstruction">Carefully designed</a>, <a href="https://www.clothmasks.org/getting-best-fit">well-fitting</a>, multilayer reusable cloth masks still have an important ongoing role in reducing transmission of SARS-CoV-2, especially in lower risk settings.</p>
<p>Protection is highest and transmission is lowest when <a href="https://www.clothmasks.org/masks-in-context">everyone wears masks</a>, because masks both protect the wearer while also <a href="https://doi.org/10.1016/j.ajic.2021.10.041">reducing the number of contaminated particles reaching the environment</a> (source control). There are important reductions to individual risk from wearing any mask, which have been <a href="http://dx.doi.org/10.15585/mmwr.mm7106e1">observed in the community</a> and <a href="https://doi.org/10.1371/journal.pone.0264090">quantified in the lab</a>. We can protect ourselves, others and vulnerable people. Let’s all wear the best mask available.</p>
<p><em>Rebecca Rudman, co-founder of the <a href="https://wesf.ca/">Windsor Essex Sewing Force</a> and member of McMaster’s Cloth Mask Knowledge Exchange, and Amanda Tomkins, an undergraduate student in engineering at McMaster University, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/177237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Clase is a member of the Cloth Mask Knowledge Exchange, a research and knowledge translation group that includes industry stakeholders. Industry stakeholders contribute to the Cloth Mask Knowledge Exchange by contributing to grant funding, and through in-kind contributions of time and expertise. Industry stakeholders make masks and distribute polypropylene and other fabrics. They may potentially benefit from this article. She is a member of McMaster's Centre of Excellence in Protective Equipment and Materials, and editor-in-chief of clothmasks.org. Catherine has received consultation, advisory board membership or research funding from the Ontario Ministry of Health, Sanofi, Pfizer, Leo Pharma, Astellas, Janssen, Amgen, Boehringer-Ingelheim and Baxter. In 2018 she co-chaired a KDIGO potassium controversies conference sponsored at arm's length by Fresenius Medical Care, AstraZeneca, Vifor Fresenius Medical Care, Relypsa, Bayer HealthCare and Boehringer Ingelheim. Catherine Clase receives funding from CIHR, and is a member of the Green Party, the American Society of Nephrology, the Canadian Society of Nephrology, the American Association of Textile Chemists and Colorists and ASTM International.
</span></em></p><p class="fine-print"><em><span>Charles-Francois de Lannoy receives funding from the Natural Sciences and Engineering Research Council (NSERC) of Canada, the Global Water Futures (GWF) Research organization, Ontario Centres of Excellence (OCE), Federal Economic Development Agency for Southern Ontario (FedDev), Canadian Foundation for Innovation (CFI), the French Embassy, and McMaster University. He has received funding in partnership with Pall Water, Trojan Technologies, Hatch Ltd., and PW Fabrication. He has engaged in various research projects and testing/validation of facemasks for several private companies in Ontario. He is affiliated with the Cloth Mask Knowledge Exchange as an expert advisor.</span></em></p><p class="fine-print"><em><span>Ken G. Drouillard receives funding from Natural Sciences and Engineering Research Council of Canada (NSERC), Ontario Ministry of Environment, Conservation and Parks, Environment and Climate Change Canada, Great Lakes Fisheries Commission, WE-SPARK Health Discovery Institute, University of Windsor, City of Windsor. He is affiliated with the Detroit River Canadian Clean-Up Committee and holds membership with International Association for Great Lakes Research. </span></em></p><p class="fine-print"><em><span>Scott Laengert does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We tested well-fitting cloth masks made from 16 kinds of cotton, on human participants, to see how many provided filtration comparable with a certified medical mask. Most of them did.Catherine Clase, Physician, epidemiologist, professor, McMaster UniversityCharles-Francois de Lannoy, Assistant Professor, Chemical Engineering, McMaster UniversityKen G. Drouillard, Professor, Great Lakes Institute for Environmental Research, University of WindsorScott Laengert, PhD Student, Chemical Engineering, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772382022-03-10T20:57:37Z2022-03-10T20:57:37ZShould public health measures like masking continue beyond the pandemic? Data on viral infections shows their benefits<figure><img src="https://images.theconversation.com/files/450321/original/file-20220307-84100-jira1v.jpg?ixlib=rb-1.1.0&rect=166%2C98%2C2717%2C1675&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman wears a face mask as she walks by the sculpture ‘The Illuminated Crowd’ on a street in Montréal. Vulnerable people may benefit from measures like face masks even after the COVID-19 pandemic.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span></figcaption></figure><p>Public health measures, such as masking and physical distancing, that have been a high-profile part of the COVID-19 response for the past two years <a href="https://www.cbc.ca/news/canada/edmonton/jason-kenney-copping-alta-covid-restrictions-lift-1.6368297">are now</a> <a href="https://www.cbc.ca/news/canada/toronto/covid19-ontario-march-9-mask-mandates-1.6378148">beginning to lift</a>. However, surprisingly little attention has been paid to the remarkable effects of these measures on other respiratory illnesses that are caused or exacerbated by viral infections.</p>
<p>These effects are a valuable research discovery from the pandemic. It’s a discovery that suggests that selective, non-mandated use of public health measures like masking, physical distancing and hand-washing may have a continued role as we enter the endemic phase of COVID-19. Collectively, these measures are known as non-pharmacologic public health interventions (NPIs).</p>
<h2>Decreases in acute care</h2>
<p>Following the onset of the pandemic in March 2020, many regions around the world reported a dramatic decrease in demand for <a href="https://doi.org/10.1371/journal.pone.0252441">acute health-care services</a>, including urgent care visits to emergency departments and inpatient hospital stays.</p>
<p>Early on, this was likely driven by stringent lockdown measures, patients avoiding health-care settings due to fears of contracting COVID-19 or the perception that hospitals were overwhelmed and unable to accommodate non-emergency cases. </p>
<p>However, as public health measures were relaxed over the following months, there was a rapid rebound in health-care services for conditions such as heart disease and appendicitis. Meanwhile, the decrease persisted for respiratory illnesses attributed to <a href="http://doi.org/10.1007/s11739-022-02932-y">non-COVID-19 viruses</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign above a row of sinks shows an image of a man washing his hands with the message 'Clean hands keep you healthy. Wash your hands with soap and water for at least 20 seconds. Life is better with clean hands.'" src="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450460/original/file-20220307-126102-ix8ztx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public health measures such as masking, hand-washing and physical distancing are collectively known as non-pharmacologic public health interventions (NPIs).</span>
<span class="attribution"><span class="source">(AP Photo/David Zalubowski)</span></span>
</figcaption>
</figure>
<p>In Canada, the usual annual surge in influenza infections has not occurred during the <a href="https://doi.org/10.1016/j.lana.2021.100015">two winters since the beginning of the pandemic</a>. </p>
<p>Our research group — all front-line health-care workers — analyzed nationwide admissions data. Our analysis revealed that hospital admissions for major respiratory illnesses dropped sharply in the year following the start of the first lockdown. </p>
<p>Specifically, flare-ups of chronic obstructive pulmonary disease (COPD), a severe lung disease related to long-term smoking, and community-acquired non-COVID-19 pneumonia decreased by nearly 40 per cent across Canada <a href="http://doi.org/10.1007/s11739-022-02932-y">following the implementation of NPIs like masking and physical distancing</a>. </p>
<p>These findings were supported by another study of 15,677 patients from nine countries. That study reported a 50 per cent reduction in the hospital admissions for COPD <a href="https://doi.org/10.1371/journal.pone.0255659">following the onset of the pandemic</a>. This is not entirely surprising as <a href="https://doi.org/10.1111/resp.12780">both COPD and non-COVID-19 pneumonia</a> are often triggered by <a href="https://doi.org/10.1007/s10741-017-9614-7">common cold viruses</a>. If you are like most Canadians, you have not caught a cold in nearly two years. </p>
<h2>Impact on vulnerable patients</h2>
<p>So, what’s the big fuss about a few runny noses and colds? While a viral infection such as the common cold or influenza is unlikely to significantly harm a healthy individual, it can be <a href="https://doi.org/10.1503/cmaj.201748">debilitating and sometimes deadly</a> for someone who is <a href="https://dx.doi.org/10.1016%2FS2213-2600(18)30496-X">elderly, immunocompromised or suffering from a lung disease</a>. It can result in the need for acute care in the hospital, or even the ICU in severe cases, and some patients do not survive. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people in masks sitting on a park bench." src="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=456&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=456&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=456&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=573&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=573&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450462/original/file-20220307-84591-12fhn71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=573&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A viral infection, such as the common cold or influenza, is unlikely to significantly harm a healthy individual, but it can be debilitating and sometimes deadly for someone who is elderly, immunocompromised or living with a lung disease.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>In Canada, acute and chronic respiratory diseases are the third greatest cause of death, trailing behind only <a href="https://www150.statcan.gc.ca/n1/daily-quotidien/201126/t001b-eng.htm">cancer and heart disease</a>. This also means virally linked respiratory illnesses place a substantial burden on limited health-care resources. </p>
<p>There were several periods during the pandemic when our <a href="https://cmajnews.com/2022/01/11/covid-update-beds-duong-1095984/">health-care systems</a> were <a href="https://www.cbc.ca/news/health/tam-omicron-more-restrictions-better-masks-1.6293347">over capacity</a>, and there was a fear that hospitals would need to <a href="https://www.theglobeandmail.com/canada/article-alberta-preps-critical-care-triage-plan-amid-surge-in-covid-19-cases/">triage resources</a> and deny ICU care to some critically ill patients. </p>
<p>Thankfully, this did not come to pass, and it seems that the likely reason was the significant additional capacity that became available due to hospitalizations avoided for other <a href="http://doi.org/10.1007/s11739-022-02932-y">virally linked respiratory illnesses</a>.</p>
<h2>Ending COVID-19 prevention measures</h2>
<p>As the pandemic drags on, people have become fatigued with ongoing public health restrictions. With <a href="https://ourworldindata.org/covid-vaccinations">vaccination rates in Canada among the highest in the world</a> and expected to reach even higher with the <a href="https://www.canada.ca/en/public-health/services/vaccination-children/making-decisions-5-11-years-age.html">approval of vaccinations for pediatric populations</a>, many are looking forward to a time when NPIs may no longer be needed. </p>
<p>However, before dispensing with the measures entirely, it is important to consider whether their demonstrated benefits warrant continued use. The fact that hospitalizations for non-COVID-19 respiratory illnesses have remained low, despite the relaxation of stringent lockdown measures, suggests that these benefits may be sustained with the use of masking and practices such as frequent hand-washing. </p>
<figure class="align-center ">
<img alt="Close-up image of a red social distancing circle on asphalt, with two shoe-prints and the message 'Please keep 2M distance'" src="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450465/original/file-20220307-109743-4ln58a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">There is no consensus on which specific NPIs may be most effective in preventing disease spread.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
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</figure>
<p>Even prior to the pandemic, <a href="https://www.asiapacific.ca/publication/great-mask-divide-lessons-asia">public masking was a common practice</a> in many Asian countries. With this now being the norm in Canada as well, continuing these practices may have significant merit and offer protection to the most vulnerable demographics of our society. </p>
<p>This will certainly be challenging given <a href="https://www.reuters.com/world/americas/canadian-cities-brace-more-anti-vaccine-mandate-protests-2022-02-05/">opposition from a vocal minority</a> and the lack of awareness among the general public about the benefits of continuing use of NPIs. Currently, most available evidence is largely observational, as no randomized trials have yet evaluated the efficacy of NPIs for reducing non-COVID-19 viral respiratory illnesses at a population level. </p>
<p>Additionally, there is no consensus on which specific NPIs may be most effective in preventing disease spread. It’s also unknown whether reductions in acute care use have translated into a reduction in mortality rates for specific conditions. </p>
<h2>Future prevention</h2>
<p>These limitations are currently being addressed in a large-scale Albertan study of over 500,000 patients. The preliminary results — which will be published in the proceedings of the 2022 American Thoracic Society International Conference — show that NPIs are an effective strategy for preventing both acute care visits and mortality related to respiratory illnesses. </p>
<p>However, in the interim, public policy-makers should consider this compelling evidence and weigh in on whether the continued use of masking and other NPI measures is warranted, especially for individuals at high-risk for serious illness from viral respiratory infections and those close to them. </p>
<p>Recommendations, policies or, if deemed necessary, mandates can be amended in the future as new evidence emerges. Until then, NPI use, even on an interim basis, may reduce the strain on our health-care system and help protect the most vulnerable members of our society.</p><img src="https://counter.theconversation.com/content/177238/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Decreases in respiratory infections during the pandemic suggest there may be a continued role for the selective, non-mandated use of measures like masks and social distancing even post-COVID-19.Rutvij A. Khanolkar, Medical Student, University of CalgaryEddy S. Lang, Professor, Cumming School of Medicine, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1766312022-03-02T22:07:51Z2022-03-02T22:07:51ZMask or no mask: Stop using fat people in political cartoons<figure><img src="https://images.theconversation.com/files/447345/original/file-20220218-49159-qjskhu.jpg?ixlib=rb-1.1.0&rect=27%2C9%2C6011%2C4001&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Political cartoons and memes have made it clear that if there’s something to agree about on all sides of the political spectrum, its that fat people are an easy target.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p><a href="https://www.nydailynews.com/opinion/ny-bramhall-editorial-cartoons-2020-jul-20200708-zl4mvvuoejbv5ai32nsg32hjki-photogallery.html">Political cartoons and memes</a> have made it clear that if there’s something to agree about on all sides of the political spectrum, it’s that fat people are an easy target.</p>
<p>At the beginning of the vaccine rollout, <a href="https://www.syracuse.com/opinion/2021/05/editorial-cartoons-for-may-9-2021-herd-immunity-liz-cheney-help-wanted.html">a political cartoon was circulated</a> that pictured a thin, vaccinated person, trying to reach herd immunity but unable to do so because of the ball and chain on his ankle; a fat man who had “anti-vaxxers” written on his back.</p>
<p>Now that the pandemic has dragged on, those who <a href="https://www.standard.co.uk/news/uk/anthea-turner-twitter-fat-shaming-covid-face-mask-b919526.html">are against mask mandates have circulated a cartoon</a> that pictures a pro-mask and presumably pro-vaccine fat person who uses a mobility aid, asking the thin person wear a mask to protect their health.</p>
<p>What’s a person who is against <a href="https://www.bmc.org/glossary-culture-transformation/fatphobia">fat loathing</a> to do?</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/discrimination-against-fat-people-is-so-endemic-most-of-us-dont-even-realise-its-happening-94862">Discrimination against fat people is so endemic, most of us don’t even realise it’s happening</a>
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<p>In these cartoons, it’s clear that both sides of the political spectrum use fat bodies to represent <a href="https://doi.org/10.1007/s40656-021-00477-5">ignorant people who are holding back the “good citizens.”</a> If you criticize the fat loathing in these cartoons, you risk political disloyalty and being gobbled up by whatever side of the political debate finds your protest useful.</p>
<h2>Under the radar</h2>
<p>These “comedic stigmas” are not limited to political cartoons; they are <a href="https://doi.org/10.1023/A:1007054618340">pervasive on television</a> and across various forms of media. </p>
<p>Fat loathing often goes under the radar in supposed “progressive” left circles, where those might think of themselves as holding higher moral ground for body positivity and for being pro-diversity. However, most <a href="https://theweek.com/articles/981296/5-scathingly-funny-cartoons-about-antivaxxers-jeopardizing-herd-immunity">anti-fat cartoons</a> are from “progressive” <a href="https://www.nydailynews.com/opinion/ny-bramhall-editorial-cartoons-2020-jul-20200708-zl4mvvuoejbv5ai32nsg32hjki-photogallery.html">pro-vaccine and pro-science</a> viewpoints. </p>
<p>Left-leaning politics consistently hold up <a href="https://yaleclimateconnections.org/2021/03/cartoonists-have-their-say-on-texas-freeze-and-power-outage/">fat people as the harbingers</a> of difficult times and environmentalists disproportionately lump them as the <a href="https://cjee.lakeheadu.ca/article/view/1224">cause of climate change</a>. They are represented as an <a href="https://www.nutritionunplugged.com/2009/08/lose-the-blubber-ad-is-low-blow-from-peta/">embodiment of animal cruelty by PETA</a> — <a href="https://doi.org/10.1080/21604851.2017.1242359">marginalizing fat vegans</a> who want to join the movement. </p>
<p>How can fat people, as well as critics of fat loathing, be expected to align with political movements using rhetoric that maligns their bodies?</p>
<h2>An evolutionary backslide</h2>
<p>Fat loathing has crossed political divides for over a century in the United States. In her book, <a href="https://nyupress.org/9780814727690/fat-shame/"><em>Fat Shame: Stigma and the Fat Body in American Culture</em></a>, Amy Farrell details how both sides of women’s suffrage portrayed their opponents as fat over a century before any “<a href="https://www.routledge.com/The-End-of-the-Obesity-Epidemic/Gard/p/book/9780415489881">obesity epidemic</a>” was created through <a href="https://doi.org/10.1093/ije/dyi052">shifting and flawed BMI designations</a>. </p>
<p>Proponents of suffrage portrayed themselves as slight, whimsical and feminine while those who opposed were portrayed as old, fat and sour-faced. These cartoons sent the message that if women got the vote, they would still be feminine and <a href="https://doi.org/10.1080/09581596.2010.523680">proper white mothers</a>.</p>
<p>Opposition cartoons went in the reverse: pro-suffrage women were portrayed as large, muscular and domineering (they don’t need the vote — they already have too much power in the home!). </p>
<p>Some of these cartoons even represented suffrage proponents in ways that evoked blackface, implying that white women garnering the vote would upset racial hierarchies. When white women get the vote, the story goes, it will upset gender roles, <a href="https://doi.org/10.1080/09581596.2010.523680">understood as women getting big and fat, signifying an evolutionary backslide</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1047309572606578690"}"></div></p>
<h2>‘Fit’ for citizenship</h2>
<p>These representations and those related to COVID-19 demonstrate who is considered <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9780203079751-49/political-economy-obesity-fat-pay-alice-julier">“fit” for a nation’s progress</a>. In this case, progress is how people properly navigate the pandemic.</p>
<p>Political rhetoric, as demonstrated in cartoons, focuses on who’s a trustworthy citizen acting in the best interests of the nation. Fat is not just a shorthand for <a href="https://www.saltwire.com/atlantic-canada/opinion/grant-frost-a-whirl-into-anti-vaxxer-world-where-credulity-trumps-credentials-100603228/">being misinformed or ignorant</a>, it pertains to whose bodies are <a href="https://doi.org/10.1080/21565503.2017.1354039">considered ideal</a> and who should reproduce to produce more citizens.</p>
<p>Think of high-profile politicians who have disagreeable ideas. They are consistently portrayed as fatter than they are as a way of demonstrating that they are not “fit” for citizenship, the nation, or respectable public debate. </p>
<p>It should be possible to point out the problems behind fat loathing without being politically aligned with the person whose body is being lampooned. One doesn’t need to think too deeply to conjure <a href="https://doi.org/10.1080/21604851.2021.2014121">fat politicians whose ideas they disagree with</a> — but, should people keep silent about these rhetorical techniques?</p>
<h2>Effects of fat loathing</h2>
<p>Fatness has also been used to signify other “disordered desires” that need to get back under control through proper discipline. Community health researcher Lynn Gerber’s book, <a href="https://press.uchicago.edu/ucp/books/book/chicago/S/bo12079657.html"><em>Seeking the Straight and Narrow: Weight Loss and Sexual Reorientation in Evangelical America</em></a>, details how conversion therapy and weight-loss movements of the mid-20th century had overlapping goals to punish appetites for both food and sex on the grounds that fatness and queerness offend a particular interpretation of a Christian God. </p>
<p>Given these connections, many people who would consider themselves pro-sexual diversity would never think that diet and weight-loss industries are connected. <a href="https://doi.org/10.1002/(SICI)1098-108X(199609)20:2%3C135::AID-EAT3%3E3.0.CO;2-H">Yet gay men have significantly higher levels of bodily dissatisfaction</a> than straight men, and fat loathing in political cartoons continues to be a way to <a href="https://twitter.com/albertaNDP/status/1111375940032946176">lampoon anti-gay politicians</a>.</p>
<p>I haven’t even discussed the concrete effects of continued fat loathing in <a href="https://doi.org/10.1016/j.jada.2006.07.016">accessing nutritional care</a>, <a href="https://doi.org/10.1353/sof.0.0004">socialization in high school</a>, <a href="https://doi.org/10.1093/ajcn/20.4.352">academic performance</a>, <a href="http://dx.doi.org/10.1080/00221309.2012.726288">post-secondary education</a>, <a href="https://doi.org/10.1037/0735-7028.22.3.223">mental health support</a>, <a href="https://heinonline.org/HOL/LandingPage?handle=hein.journals/calr90&div=11&id=&page=">employment</a>, <a href="https://doi.org/10.1016/j.jvb.2008.09.008">career advancement</a>, <a href="https://doi.org/10.1038/oby.2005.168">dating</a>, <a href="https://doi.org/10.1371/journal.pone.0048448">health care</a> and <a href="https://doi.org/10.1300/J013v20n02_04">cancer screening</a>. Or how fat people are subject <a href="https://doi.org/10.1111/j.1746-1561.2011.00646.x">to harassment</a> <a href="https://www.degruyter.com/document/doi/10.18574/9780814777435-016/html">and bullying</a>. Fatness compounds <a href="https://www.penguinrandomhouse.com/books/670607/belly-of-the-beast-by-dashaun-harrison/">racialized police brutality</a> and <a href="https://doi.org/10.1300/J013v20n02_04">racial disparities</a>. </p>
<p>Representation matters in forming political solidarities. These issues require attention that will only come about if fat people are empowered to critique the very groups so willing to instrumentalize their bodies for political gain.</p><img src="https://counter.theconversation.com/content/176631/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kristin Rodier does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fat people need to be empowered to critique the very groups so willing to instrumentalize their bodies for political gain.Kristin Rodier, Assistant Professor of Philosophy, Athabasca UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1767502022-02-24T16:36:27Z2022-02-24T16:36:27ZChildren struggle more than adults to recognize masked faces<figure><img src="https://images.theconversation.com/files/447669/original/file-20220221-28422-lavtez.jpg?ixlib=rb-1.1.0&rect=23%2C0%2C5161%2C2487&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Public health measures to curb the spread of COVID-19 require face masks in many settings.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Face perception is one of the most important visual abilities for humans. A quick glance at a person’s face provides us with rich and socially relevant information, including race, age, gender and emotional state. </p>
<p>Humans typically process faces as a unified whole instead of relying on specific facial features like eyes, nose or mouth. Scientists refer to this type of processing as “<a href="https://doi.org/10.1177/0956797611401753">holistic processing</a>,” and believe that it is essential to recognizing faces quickly and accurately. </p>
<p>Our research explores how mask wearing — the new reality imposed by the COVID-19 pandemic — changes how children and adults process and perceive faces.</p>
<h2>Facing difficulties</h2>
<p>Scientists have promoted mask-wearing as <a href="https://doi.org/10.1073/pnas.2014564118">one of the most important and effective tools to reduce COVID-19 transmission</a>. Many governments around the world required face masks in public places, especially when physical distancing is less feasible. Wearing a mask became prevalent in diverse social settings including on public transportation, in schools and at sporting events and concerts. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/masking-in-schools-a-doctor-and-covid-19-researcher-explains-how-it-keeps-children-safe-177239">Masking in schools: A doctor and COVID-19 researcher explains how it keeps children safe</a>
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<p>However, because face masks conceal the lower part of the face, <a href="https://doi.org/10.1038/s41598-020-78986-9">our research group was not surprised to find a reduced ability to learn to recognize new faces when they are masked</a>. Notably, we found that when people had difficulty recognizing masked faces, there were changes in how faces were recognized. Masked faces were processed in a less holistic manner, and more in a feature-by-feature way. </p>
<p>Sensitivity to faces appears early in life. In fact, <a href="https://doi.org/10.1111/1467-9280.00179">newborns are already sensitive</a> to the spatial arrangement of a face, and stare more at visual patterns that resemble this organization (two eyes above a nose above a mouth). Despite this early sensitivity, face perception develops slowly, and some studies suggest that this ability is not fully matured even in teenagers. Given that their face processing system is not fully developed, we wondered if children might have even greater difficulties recognizing masked faces compared to adults. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A ridiculously adorable baby looks at their mother" src="https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447702/original/file-20220222-28-1lix8sd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Infants show signs of facial recognition and are drawn to visual representations of how facial features are organized.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Impaired recognition</h2>
<p>To test this question, <a href="https://doi.org/10.1186/s41235-022-00360-2">we conducted a study using a version of the face recognition test used in adults, but specially designed for children</a>. This test includes increasing levels of difficulty: The child participants are presented with photographs of other children’s faces, and they need to choose which face they had seen during the study phase. To make the test more challenging, the faces are presented from different viewpoints, and external cues, like hair, are removed. </p>
<p>We tested 72 children. Half of them completed the regular version of the test, while the other half completed a “masked” version of the test, where the children in the photographs appeared to be wearing masks. Each child completed the test twice, once with faces presented upright and once with faces presented upside down. </p>
<p>Turning a face upside down stops people from processing the faces in a holistic way because the typical spatial organization of the face (two eyes above a nose above a mouth) is distorted. When we try to recognize faces without masks, we are much worse at doing so when the face is upside down. This is because we are no longer able to rely on our natural holistic processing system and, instead, we rely on a weaker feature-based strategy. </p>
<p>We assumed that if participants were just as poor at recognizing upright faces with masks as they were at recognizing upside-down faces with masks, it would mean that these masked faces are no longer being processed in a holistic way.</p>
<p>The results of the study were clear. First, we found that children were impaired in recognizing masked faces. The group of children who completed the masked version showed a 20 per cent reduction in their test score. This was even worse than what we had originally found in adults (15 per cent reduction), suggesting that children might find it even more difficult to recognize faces with masks than adults. </p>
<p>We also found evidence for a smaller “upside-down” effect for masked faces. This finding indicates that children processed the masked faces in a more feature-to-feature fashion, which might explain some of their difficulty in recognizing masked faces.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A girl wearing a surgical mask hangs upside down in a swing" src="https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447703/original/file-20220222-27005-1qcsa24.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It takes us longer to process upside-down faces because features aren’t where they’re supposed to be.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Children’s recognition cues</h2>
<p>These new findings raise a number of important questions that scientists could address in the future. First, do children learn to use other cues to recognize friends and teachers — for example, by relying on people’s voices or movements? Second, would children become better at recognizing masked faces as they gained more experience with such faces? </p>
<p>This seems likely because previous research found that children’s brains are more adaptable and that experience can shape their visual abilities. Third, do difficulties recognizing masked faces affect children’s ability to communicate with others and form meaningful social relationships? </p>
<p>It is important to emphasize again that masks are one of the most effective tools in our effort to reduce the spread of COVID-19 and keep people safe and healthy. Despite the difficulties that adults and children experience with recognition of masked faces, any decisions about mandatory mask wearing should be informed by public health experts. </p>
<p>At the same time, it’s important to understand how masks may change how children perceive faces so that we can determine whether children are better able to adapt to masks, and which cues or strategies help to improve recognition of masked faces.</p><img src="https://counter.theconversation.com/content/176750/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erez Freud receives funding from the Natural Sciences and Engineering Research Council and from the Vision Science to Applications (VISTA) program funded by the Canada First Research Excellence Fund (CFREF, 2016–2023) . </span></em></p><p class="fine-print"><em><span>Shayna Rosenbaum receives funding from the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC), and from the Vision Science to Applications (VISTA) program funded by the Canada First Research Excellence Fund (CFREF, 2016–2023) .</span></em></p>We rely on the spatial arrangement of facial features to process faces, and wearing masks interferes with that — especially for children.Erez Freud, Assistant Professor, Psychology, York University, CanadaR. Shayna Rosenbaum, Professor and York Research Chair, Psychology, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1767892022-02-23T19:13:39Z2022-02-23T19:13:39ZMasks, RATs and clean air – how people with disability can protect themselves from COVID<figure><img src="https://images.theconversation.com/files/447695/original/file-20220222-28345-orcmh1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-daughter-wearing-surgical-face-1801763143">Shutterstock</a></span></figcaption></figure><p>People with disability bear a disproportionate burden of COVID <a href="https://www.medrxiv.org/content/10.1101/2021.02.08.21250525v1">infections</a>, <a href="https://www.bmj.com/content/374/bmj.n1592">serious disease</a> and <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(21)00206-1/fulltext">death</a>. Every time a support worker enters their home, people with disability risk COVID exposure. </p>
<p>But while Australian states have evidence-based measures to reduce the spread of COVID in schools and hospitals – such as improving <a href="https://www2.education.vic.gov.au/pal/ventilation-air-purification/policy">ventilation</a>, mandating <a href="https://www.nsw.gov.au/covid-19/stay-safe/rules/face-mask-rules">masks</a>, and using rapid antigen tests to detect cases – few strategies exist to reduce transmission to people with disability in their homes.</p>
<p>Last Thursday, Australia’s disability royal commission released a “<a href="https://disability.royalcommission.gov.au/news-and-media/media-releases/disability-royal-commission-raises-serious-concerns-about-responses-omicron">statement of ongoing concern</a>” about how Omicron is impacting the health, safety and well-being of people with disability. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1494072645025157120"}"></div></p>
<p>So what do governments need to do to protect people with disability from COVID? And what can people with disability do to mitigate their risk in the meantime?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lets-heed-the-warnings-from-aged-care-we-must-act-now-to-avert-a-covid-19-crisis-in-disability-care-144669">Let's heed the warnings from aged care. We must act now to avert a COVID-19 crisis in disability care</a>
</strong>
</em>
</p>
<hr>
<h2>Free RATs and regular testing for disability workers</h2>
<p>When community prevalence of COVID is high, rapid antigen tests (RATs) are an <a href="https://theconversation.com/how-accurate-is-your-rat-3-scenarios-show-its-about-more-than-looking-for-lines-175515">important tool</a> to identify cases of COVID and prevent transmission. </p>
<p>But RATs are not freely available to all Australians with disability. And there is no clear advice about how RATs should be used by people with disability or support workers who enter their home. </p>
<p>While National Disability Insurance Scheme (NDIS) participants <a href="https://www.ndis.gov.au/news/7308-ndis-participants-can-use-plan-funds-claim-rapid-antigen-tests">can claim</a> the cost of RATs in their NDIS plans, they’re <a href="https://www.health.gov.au/news/ahppc-statement-on-rapid-antigen-testing-for-current-high-community-prevalence-environment">not currently recommended</a> for surveillance of workers, except those working in group homes. </p>
<p>But not all Australians with disability are on the NDIS. Nor are all people with disability on health care cards and <a href="https://www.servicesaustralia.gov.au/get-free-rapid-antigen-tests-rats-if-you-hold-concession-card">entitled to ten free RATs</a> every three months. </p>
<figure class="align-center ">
<img alt="Person takes RAT test out of a packet." src="https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447921/original/file-20220222-21-1f1dxoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">RATs should be free for people with disability and their support workers.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/process-coronavirus-testing-examination-home-covid19-1816884032">Shutterstock</a></span>
</figcaption>
</figure>
<p>Given the risks of COVID and the high levels in the community, free RATs should be provided to all people with disability and support workers who come into their homes. </p>
<p>This should come with clear guidance on how frequently to test workers and other people who come into contact with a person with a disability.</p>
<p>In the absence of clear guidelines, support workers should test at least twice a week. But daily testing might be required where a worker is in contact with many people and when someone with a disability is at high risk of serious disease or death if they catch COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-accurate-is-your-rat-3-scenarios-show-its-about-more-than-looking-for-lines-175515">How accurate is your RAT? 3 scenarios show it's about more than looking for lines</a>
</strong>
</em>
</p>
<hr>
<p>However some caution is needed. When there are high levels of community transmission, one negative RAT in someone with symptoms may well be a false negative. So someone with symptoms <a href="https://www.health.gov.au/sites/default/files/documents/2020/07/coronavirus-covid-19-guidance-for-people-tested-for-covid-19.pdf">should isolate</a> irrespective of the RAT result. </p>
<h2>Mandate N95 masks for disability workers</h2>
<p>Cloth and surgical masks are <a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">not enough</a> to prevent the spread of Omicron. </p>
<p>Respirators, also called N95, P2, FFP2 and KF94 masks, offer substantially better protection. Respirators <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0258191">cut transmission 2.5 times as much as surgical masks</a>, even when they haven’t been professionally fit-tested. And there are <a href="https://www.youtube.com/watch?v=9hgZKABt9QM">good online videos</a> and <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+programs+and+practice+guidelines/infectious+disease+control/coronavirus+disease+2019+information+for+health+professionals/infection+control+and+personal+protective+equipment+%28ppe%29+advice">infographics</a> to help people ensure their respirators have a good fit. </p>
<figure class="align-center ">
<img alt="Man wearing an N95 mask." src="https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447923/original/file-20220222-25053-1rq0l9p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Respirators should be well-fitted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-shown-wearing-protective-n95-white-1661460151">Shutterstock</a></span>
</figcaption>
</figure>
<p>Respirators can also be re-used, <a href="https://ozsage.org/wp-content/uploads/2022/01/We-urgently-need-better-masks-respirators-OzSAGE-text-only-31-January-2022.pdf">rotating daily over five days</a>, as independent scientific advisory group <a href="https://ozsage.org/wp-content/uploads/2022/01/We-urgently-need-better-masks-respirators-OzSAGE-text-only-31-January-2022.pdf">OzSAGE recommends</a>. </p>
<p>The United States government is <a href="https://www.nbcnews.com/politics/white-house/white-house-says-it-will-distribute-400-million-free-n95-n1287672?cid=sm_npd_ms_tw_ma">providing free respirators to the public</a>, yet Australian governments only recommend respirators in the disability sector when someone with disability is COVID-positive or a worker is a close contact. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/time-to-upgrade-from-cloth-and-surgical-masks-to-respirators-your-questions-answered-174877">Time to upgrade from cloth and surgical masks to respirators? Your questions answered</a>
</strong>
</em>
</p>
<hr>
<p>Given the obvious benefits, and relatively few downsides of respirators, it’s critical they are mandated for disability workers when supporting people with disability indoors. </p>
<p>In the absence of guidelines, people with disability should get workers to wear well-fitted respirators when they are supporting them indoors.</p>
<h2>Improving ventilation</h2>
<p>Good natural or mechanical ventilation can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189751/">reduce COVID transmission</a>. </p>
<p>This can involve simple measures such as opening doors and windows – preferably at the opposite ends of an indoor space to ensure a cross-breeze – and using ceiling fans or pedestal fans placed near a window. </p>
<p>Sometimes it’s not possible to open doors or windows because it’s too hot or cold, especially given some people with disability, such as those with <a href="https://pubmed.ncbi.nlm.nih.gov/30865188/">spinal cord injury</a> or <a href="https://www.tandfonline.com/doi/full/10.1080/23328940.2020.1769007">multiple sclerosis</a> have greater difficulties regulating their temperature. </p>
<p>Spaces like toilets, bathrooms, lifts, and stairwells are also hard to ventilate. </p>
<figure class="align-center ">
<img alt="Man opens window." src="https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447926/original/file-20220222-19-lv25no.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Opening a window can improve ventilation, but that’s not always possible.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-hand-opens-window-204104473">Shutterstock</a></span>
</figcaption>
</figure>
<p>You can check the quality of the air inside using <a href="https://journals.sagepub.com/doi/10.1177/1420326X211043564">CO2 monitors</a>. The concentration of CO2 is higher in areas that are poorly ventilated, while outside it’s around 400 ppm. If the level is <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/928720/S0789_EMG_Role_of_Ventilation_in_Controlling_SARS-CoV-2_Transmission.pdf">below 800 ppm</a>, the risk of infection is relatively low.</p>
<p>In situations where CO2 levels are high, a <a href="https://ozsage.org/media_releases/beware-the-air-you-share-ozsage-advice-on-safe-indoor-air-ventilation-for-australia-september-6th/">portable HEPA air purifier</a> could be used. The HEPA filter helps remove very small particles from the air, including the SARS-CoV-2 virus that causes COVID. They <a href="https://pursuit.unimelb.edu.au/articles/which-air-cleaners-work-best-to-remove-aerosols-that-contain-viruses">range in price</a> from A$200 to A$2,000.</p>
<p>CO2 monitors <a href="https://ozsage.org/media_releases/beware-the-air-you-share-ozsage-advice-on-safe-indoor-air-ventilation-for-australia-september-6th">vary in design and cost</a>, with prices starting from around A$50. </p>
<p>CO2 monitors and air purifiers should be available to people with disability requiring support in their own homes for free, potentially through NDIS plans. </p>
<p>In group settings, such as day programs and disability residential settings, services should be required to audit CO2 levels and purchase air purifiers if needed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/an-investment-in-clean-indoor-air-would-do-more-than-help-us-fight-covid-it-would-help-us-concentrate-with-lasting-benefits-176547">An investment in clean indoor air would do more than help us fight COVID – it would help us concentrate, with lasting benefits</a>
</strong>
</em>
</p>
<hr>
<p>In the absence of clear guidance on ventilation, people with disability should make sure they have as good an airflow as possible and check their air conditioning and heating are working properly. </p>
<p>If they have the resources, they could purchase a CO2 monitor (or borrow one from someone) to check ventilation and where CO2 levels are high, consider an air purifier. </p>
<h2>Governments need to step up</h2>
<p>Nearly two years into the pandemic, it feels like Australians with disability are being forgotten. </p>
<p>Mandatory respirators, RATs for surveillance and cleaner air are relatively inexpensive strategies critical to protecting people with disability in their home. Governments should provide free of cost for all people with disability who need them, not only NDIS participants. </p>
<p>Governments must be proactive and have guidelines and resources in place as we face Omicron and in future, as new variants emerge.</p><img src="https://counter.theconversation.com/content/176789/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Kavanagh receives funding from the NHMRC, ARC, ANROWS, Suicide Prevention Australia, and the Commonwealth and Victorian governments. Anne Kavanagh is a member OzSAGE. </span></em></p><p class="fine-print"><em><span>Helen Dickinson receives funding from the NHMRC, ARC, Children and Young People with Disability Australia and Commonwealth and ACT governments.</span></em></p>While public health measures in schools and hospitals aim to reduce COVID transmission, people with disability who have support workers in their homes have largely been forgotten.Anne Kavanagh, Professor of Disability and Health, Melbourne School of Population and Global Health, The University of MelbourneHelen Dickinson, Professor, Public Service Research, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1772392022-02-22T22:33:20Z2022-02-22T22:33:20ZMasking in schools: A doctor and COVID-19 researcher explains how it keeps children safe<figure><img src="https://images.theconversation.com/files/447707/original/file-20220222-14-13vf41.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3333%2C2407&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The evidence is clear that masks protect children.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/masking-in-schools--a-doctor-and-covid-19-researcher-explains-how-it-keeps-children-safe" width="100%" height="400"></iframe>
<p>My time as a medical student showed me that one of the most challenging things a parent can face is a sick child, whether the illness is from dehydration, appendicitis or cancer. </p>
<p>The COVID-19 pandemic has also led to childhood hospitalizations. Fortunately, the COVID vaccine offers significant protection. <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7036e2.htm?s_cid=mm7036e2_w">Unvaccinated adolescents were 10 times more likely to be hospitalized than vaccinated</a>. However, of all children infected by the virus throughout the pandemic, vaccinated and unvaccinated, <a href="https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/">roughly one out of 100 children needed to be hospitalized</a>, which indicated disease so severe they require medical intervention to keep them safe and alive. </p>
<p>As the <a href="https://www.cbc.ca/news/health/top-doctor-says-canada-is-past-peak-of-omicron-fuelled-wave-of-covid-19-1.6357173">Omicron wave</a> has started to settle, governments have begun to debate the necessity of continued pandemic measures, including school mask requirements. As a medical doctor and scientist investigating COVID-19, I’ll be discussing what readers need to know to have an informed opinion on possible changes at schools.</p>
<h2>Public health measures work</h2>
<p>Given the recent protests against public health measures, <a href="https://theconversation.com/the-freedom-convoy-protesters-are-a-textbook-case-of-aggrieved-entitlement-176791">such as the anti-vaccine-mandate truck convoy that occupied Ottawa</a>, it is clear that some people question whether such directives provide benefits. </p>
<p>Vaccines offer protection against COVID-19, <a href="https://theconversation.com/omicron-vaccines-remain-the-best-defence-against-this-covid-19-variant-and-others-174195">including the Omicron variant</a>. Vaccine mandates have helped move the pandemic closer to a resolution, <a href="https://www.cbc.ca/news/health/canada-vaccine-mandate-passport-covid-19-omicron-boosters-1.6349038">as observed in Canada</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A blue plastic container filled with individually wrapped children's size cotton face masks, on a blue table" src="https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=437&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=437&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=437&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=549&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=549&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447720/original/file-20220222-27-e84v9p.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=549&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Masks can capture and block particles coming from other people, artificially creating distance between one person’s respiratory secretions and another person’s airway.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Andrew Vaughan</span></span>
</figcaption>
</figure>
<p>Motivating people to get vaccinated leads to more vaccinations, and fewer people getting sick. More people can then live semi-normal lives, meaning economies can recover, and the <a href="https://www.ctvnews.ca/health/coronavirus/supply-chain-disruptions-shift-in-consumer-behaviour-keep-inflation-elevated-in-canada-1.5746164">availability and cost of essential goods improve</a>. </p>
<p><a href="https://doi.org/10.1073/pnas.2014564118">Masks and social distancing offer protection</a> and have had their importance appropriately iterated continuously throughout the pandemic. These measures are essential because they directly address the way the virus is transmitted. </p>
<p>Social distancing puts more distance between you and another individual’s virus particles. This makes it harder to breathe them in, because they are diluted in the air. </p>
<p>Masks can <a href="https://theconversation.com/covid-19-masks-faqs-how-can-cloth-stop-a-tiny-virus-whats-the-best-fabric-do-they-protect-the-wearer-146822">capture and block particles</a> coming from other people, artificially creating distance between one person’s respiratory secretions and another person’s airway. This offers another layer of protection against respiratory particles.</p>
<h2>Polarizing rhetoric</h2>
<p>It is easy to understand how these measures can help bring back normalcy. Unfortunately, certain players have made these measures — which have likely saved thousands if not millions of lives — into <a href="https://www.cbc.ca/player/play/1997821507968">thorny political topics</a>. Confidently expressed and polarizing rhetoric has power and can make intelligent and caring individuals question common-sense measures. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A protesting in winter clothes holds a sign reading 'Unmask our children' outside a school" src="https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447711/original/file-20220222-17-1cdbgnc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public health measures have been turned into thorny political topics. Confidently expressed and polarizing rhetoric has power and can make intelligent and caring individuals question common-sense measures.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nick Iwanyshyn</span></span>
</figcaption>
</figure>
<p>It is reasonable to think that people are less likely to follow inconvenient directives when they question or do not fully understand them. Fortunately, masking by students at schools demonstrates a clear advantage when considering protecting children, and also their families when children exposed to the virus bring it back home.</p>
<p>In October 2021, the Centers for Disease Control and Prevention (CDC) in the United States published a series of peer-reviewed articles on the data behind masking in schools. The first study showed that in U.S. counties with school mask requirements, <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7039e3.htm?s_cid=mm7039e3_w">the number of COVID-19 cases was reduced by at least half</a>. </p>
<p>The data demonstrated a robust statistical relationship between masking and children being protected, meaning that the decreased number of sick children in counties with mask requirements was due to masking. </p>
<p><a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7039e1.htm?s_cid=mm7039e1_w">The second study</a>, which focused on counties in Arizona, showed once again that mask requirements meant safer kids. Schools without mask requirements were over three times as likely to have a COVID-19 outbreak compared to schools with requirements. </p>
<h2>Clear evidence</h2>
<p>Remember that I said kids can get seriously sick from COVID-19? The evidence is clear that masks protect children. When someone claims that they do not or that mask mandates stifle freedom, they are choosing to allow children to get sick with COVID-19, with the knowledge that some of those children will require hospitalization and some will die. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Students entering a classroom wearing face masks, carrying backpacks" src="https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=411&fit=crop&dpr=1 600w, https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=411&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=411&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/447722/original/file-20220222-47535-kjidd4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The evidence is clear that masks protect children.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes</span></span>
</figcaption>
</figure>
<p>Appropriately, the CDC and the American Academy of Pediatrics <a href="https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/cloth-face-coverings/">continue to recommend masking for all children over age two, and for everyone at schools, regardless of vaccination status</a>.</p>
<p>At this point in the pandemic, it is reasonable to assume that many people have an opinion on everything related to COVID-19. I believe in public health measures being sustained until we have evidence that it is safe to gradually lift them, <a href="https://www.canada.ca/en/public-health/news/2022/02/government-of-canada-lightens-border-measures-as-part-of-transition-of-the-pandemic-response.html">which is happening to some extent currently</a>. </p>
<p>While COVID-19 will likely be with us for at least a few more years, we are <a href="https://globalnews.ca/news/8630676/canada-covid-crisis-phase-resurgence/">moving towards living with the virus</a>. Safety measures will likely fluctuate as the number of cases evolves. </p>
<p>We must not forget what we have gone through because we can count on cases rising again in the future. We must remain ready to do our part in serving our neighbours, children and countries by contributing what we can to fight disease. We all have a role in mitigating the pandemic’s effects on peoples’ health, lives and livelihoods, and on our shared economy. Following health-care directives is the most patriotic thing anyone can do. It expresses a commitment to our present and future, and to a more stable world for our children.</p><img src="https://counter.theconversation.com/content/177239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Daniel Sunday Willett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When students wear masks at school, they’re less likely to become infected with COVID-19 and bring it home to their families.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1751432022-01-19T18:59:51Z2022-01-19T18:59:51Z‘Welcome to our world’: families of children with cancer say the pandemic has helped them feel seen, while putting them in peril<figure><img src="https://images.theconversation.com/files/441415/original/file-20220118-3715-10acrhg.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5184%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>For billions of people across the world, life as we knew it stopped in 2020. </p>
<p>Families and friends were separated. Masks mandated. Hand washing essential. Every trip outside became risky.</p>
<p>As news of deaths, variants and long-term effects of COVID trickled in daily, we were forced to adjust to a new normal marked by constant anxiety and fear, which has only worsened with the recent surge in Omicron cases in Australia.</p>
<p>But for a particular group of Australians, this lifestyle is all too familiar.</p>
<p>As both the mother of a childhood cancer survivor and a Curtin University PhD student exploring families’ experiences of childhood cancer, I embarked on a study to understand the pandemic’s effects on kids going through cancer treatment, and their families. </p>
<p>In mid-2020 I interviewed 34 parents of children with cancer across Australia about their experiences during the pandemic. </p>
<p>The answer I received was a resounding: “welcome to our world”. The pandemic lifestyle we are all adjusting to is the life families of children with cancer have already been living.</p>
<p>The parents in our study, <a href="https://academic.oup.com/jpepsy/advance-article/doi/10.1093/jpepsy/jsab125/6448612?login=true">published in December</a> with a team of Curtin University researchers, painted a picture of both benefits and devastating costs. </p>
<h2>Even a cold can lead to hospitalisation</h2>
<p>Every year, almost <a href="https://www.ccia.org.au/about-childhood-cancer">1,000 Australian kids</a> are diagnosed with cancer.</p>
<p>With advances in treatment, survival rates have increased and <a href="https://www.aihw.gov.au/reports/children-youth/australias-children/contents/health/cancer-incidence-and-survival">84% of children</a> now survive to five years after diagnosis. But this comes at the cost of long, gruelling and complex treatments involving a combination of chemotherapy, surgery and radiotherapy. </p>
<p>Chemotherapy leaves children profoundly vulnerable to infection. Even a simple cold can leave a child in hospital struggling for their life.</p>
<p>For the families in this study, wearing masks, washing hands, isolating and missing social events was already a way of life during treatment. Some even placed hand sanitiser outside their front door.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1250257538723000320"}"></div></p>
<h2>COVID silver linings</h2>
<p>For this reason, many of the parents welcomed the increased infection control which came with COVID.</p>
<p>“When COVID happened, [people] started taking care […] social distancing, wiping everything, covering their mouths,” said one father. Another added: “it’s actually positively impacted us […] she wasn’t getting colds and flus she’d normally get”. </p>
<p>Previous research has found parents of children with cancer often struggle trying to care for siblings and <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/pbc.28345">keep up an income</a> while being in hospital with the child with cancer. The shift to online work and school helped reduce some of this burden.</p>
<p>“One of the good things is that COVID allows me to work remotely […] it’s a big weight off my shoulders […] allows for income to keep coming in,” commented one dad, adding “if it had happened in 2019 it would have been a different approach.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-better-treatments-for-childhood-cancer-with-fewer-side-effects-67310">We need better treatments for childhood cancer, with fewer side effects</a>
</strong>
</em>
</p>
<hr>
<p>For both the child with cancer, and their siblings, it’s a lonely road. These kids are forced to miss out on having a normal childhood, missing birthday parties, school and time spent with friends. This is an isolating experience, leaving kids feeling like the “odd one out”, and leaving parents feeling profoundly guilty for the impact on their children. </p>
<p>But parents in our study noticed a silver lining to COVID: their kids no longer felt like the only one missing out. “Either way she didn’t miss out on anything, because everybody missed out,” said one parent.</p>
<h2>A lonely road</h2>
<p>Despite some silver linings of COVID for the families in our study, they also told a story of devastating isolation and fear.</p>
<p>Because of restrictions which allowed only one parent with a child in hospital, several of the parents in our study recalled being alone when they were told of their child’s diagnosis. </p>
<blockquote>
<p>“The very first moment we discovered their diagnosis, I was sitting alone, and my husband was in the ED waiting room. I then stayed with my child and it meant we were left to process this news solo and not together […] the last thing I wanted was to sit with my own thoughts.”</p>
</blockquote>
<p>As treatment progressed, hospital visitor restrictions kept families apart for months: “I couldn’t see my partner for three months […] five minutes at the door of the hospital […] a little kiss and good night, that was horrible.”</p>
<figure class="align-center ">
<img alt="Mother cuddling child with cancer in hospital bed" src="https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441416/original/file-20220118-19-wbxuud.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID restrictions have made for a lonely pandemic for many parents of kids with cancer.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>One mother described the gruelling experience as restrictions kept friends and family from visiting hospital: “For the whole year I was on my own […] it was the loneliest year”. </p>
<p>Travel restrictions also meant overseas parents and relatives couldn’t visit to provide support. One parent said: “we definitely felt like we were in the trenches, just the three of us”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/immunocompromised-people-make-up-nearly-half-of-covid-19-breakthrough-hospitalizations-an-extra-vaccine-dose-may-help-166241">Immunocompromised people make up nearly half of COVID-19 breakthrough hospitalizations – an extra vaccine dose may help</a>
</strong>
</em>
</p>
<hr>
<p>Even though our study was conducted before the recent wave of Omicron cases, it can still teach us some valuable lessons going forward.</p>
<p>Despite the hardships of COVID, the virus has allowed us to develop new ways of connecting online, and increased flexibility for those unable to be there in person.</p>
<p>As we renegotiate what life with COVID looks like, we can use these lessons to protect and support the most vulnerable among us.</p><img src="https://counter.theconversation.com/content/175143/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Davies receives funding from a Commonwealth PhD research scholarship.</span></em></p>The pandemic lifestyle we are all adjusting to is the life families of children with cancer have already been living. But there have been positives, too.Jenny Davies, PhD researcher, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737422021-12-16T20:26:32Z2021-12-16T20:26:32ZFace masks, digital screens and winter weather are a triple threat for dry eyes<figure><img src="https://images.theconversation.com/files/437861/original/file-20211215-17-1nc27z4.jpg?ixlib=rb-1.1.0&rect=41%2C201%2C4877%2C3352&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Eye doctors report that patients are more frequently saying during routine exams that their eyes are irritated, burn and sting.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/face-masks--digital-screens-and-winter-weather-are-a-triple-threat-for-dry-eyes" width="100%" height="400"></iframe>
<p>How do your eyes feel right now? Whether you’re sitting at home or in the office, you’re likely reading this on a digital device, and your eyes may be hot, scratchy, tired and dry. If so, you may be part of a new phenomenon called dry eye triad (DET).</p>
<p>The science of eye dryness has advanced rapidly in recent years, as has general awareness of the condition. Researchers have faced two new variables as the pandemic set in: significant upticks in digital screen use and altered airflow from mask wearing. Colder weather is on the horizon in much of the world, adding a seasonal third punch to a growing problem. </p>
<figure class="align-right ">
<img alt="Close-up of a blue eye" src="https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437847/original/file-20211215-23-1y86kpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Your eyes are subject to the same environmental conditions as the rest of your body.</span>
<span class="attribution"><span class="source">(AP Photo/Patrick Sison)</span></span>
</figcaption>
</figure>
<p>The good news is that people do not need to suffer in silence. Once aware of the causes and steps to counter dryness, everyday comfort is usually within reach.</p>
<h2>What is dry eye disease?</h2>
<p>Eye doctors report seeing more patients with irritated, burning and stinging eyes. These symptoms are very common, and when persistent can be diagnosed as dry eye disease, a condition affecting up to <a href="https://www.tfosdewsreport.org/report-epidemiology_report/71_36/en/">75 per cent of the population</a>. </p>
<p>Severity varies, with most people having minor intermittent symptoms, but for others it can be <a href="https://dx.doi.org/10.1007%2Fs40135-013-0009-1">highly disruptive to work and daily life</a>.</p>
<p>Dry eye disease has many causes, and effectively addressing it requires attention to multiple aspects of ocular health, general health and the environment. </p>
<p>Starting with the eye itself, the role of an eye care practitioner like me has been to ensure the <a href="https://doi.org/10.2147/OPTH.S114674">eyelids and eyelashes are healthy</a>, that the <a href="https://doi.org/10.1016/j.ophtha.2017.05.031">glands in the eyelids are producing oils</a>, that there are <a href="https://doi.org/10.1186/s40662-019-0172-z">sufficient tears to keep eyes feeling moist and ensure that surface inflammation</a> is controlled. It is also important to <a href="https://dx.doi.org/10.1155%2F2012%2F285851">account for health conditions and medications that may contribute to drying the ocular surface</a>. </p>
<p>Then the pandemic arrived, behaviours changed and dry eye triad began to affect millions across the globe.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic detailing the elements of the dry eye triad: Digital device use, fall and winter air and mask wear" src="https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438157/original/file-20211217-21-spenrh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The dry eye triad.</span>
<span class="attribution"><span class="source">(William Ngo)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Factor 1: Impact of fall and winter</h2>
<p>Your eyes are subject to the same environmental conditions as the rest of your body. This is more apparent during the fall and <a href="https://dx.doi.org/10.1016%2Fj.ophtha.2015.02.013">winter</a>. As surrounding air becomes less humid, dry eye symptoms increase. Comfortable levels of humidity typically range between 40 and 70 per cent. During the coldest days of winter, humidity percentages can drop into the single digits. The <a href="https://doi.org/10.1016/j.ajo.2005.10.057">tear film evaporates much more quickly in these conditions</a>, leaving the surface of the eye drier than normal. </p>
<p>Cooler weather comes hand-in-hand with increased use of indoor heating. That commonly dry heat accelerates tear film evaporation even further. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man sitting in front of a laptop, rubbing his eyes with his glasses in his hand" src="https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437862/original/file-20211215-27-1isa0ai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When viewing a digital screen, dryness sensations are driven by a change in blinking patterns.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Several steps can help offset these drying situations. Using <a href="https://doi.org/10.1097/opx.0000000000001136">humidifiers</a> increases moisture in the air and <a href="https://dx.doi.org/10.3390%2Fjcm9113740">air purifiers</a> may also help. </p>
<p>Simple management strategies guard against excessive tear film evaporation by improving the oily (lipid) outer layer of the tear film. Using <a href="https://doi.org/10.1097/01.icl.0000060998.20142.8d">warm compresses</a> on the eyelids helps tear film oils spread more easily, and adding <a href="https://dx.doi.org/10.1089%2Fjop.2017.0052">lipid-based artificial tear drops</a> supplements the oil level. </p>
<p>It also helps to <a href="https://doi.org/10.1167/iovs.12-10175">drink more water</a> to maintain adequate levels of hydration. </p>
<h2>Factor 2: Increased digital device use</h2>
<p>The COVID-19 pandemic has forced many people to work and study remotely from home, spending more time on digital devices. When viewing a screen, dryness sensations are driven by a change in blinking patterns. Blinks are <a href="https://doi.org/10.1097/apo.0000000000000328">less frequent and not as full and complete</a>. </p>
<p>The natural mechanism of blinking is important to distribute a fresh layer of tears over the surface of the eye. With a reduced blink rate, the tear film evaporates and is not replaced quickly enough, leading to <a href="https://dx.doi.org/10.1167%2Fiovs.19-27298">increased irritation and discomfort</a>. </p>
<p>The most straightforward advice is to take more frequent breaks. The “<a href="https://opto.ca/health-library/the-20-20-20-rule">20-20-20 rule</a>” (every 20 minutes, look at something 20 feet away for 20 seconds) helps manage eye strain when working on digital devices. There are even <a href="http://eyedoc2020.blogspot.com/2017/03/best-apps-to-remind-you-to-blink-your.html">programs and apps</a> that remind you to blink more frequently and more fully.</p>
<h2>Factor 3: Mask wear continues</h2>
<figure class="align-center ">
<img alt="Close up of a man's irritated eyes, wearing a protective face mask" src="https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437865/original/file-20211215-15-17rncy2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mask-associated dry eye is caused by exhaled air travelling out the top opening of the mask and over the surface of the eyes, making tears evaporate even faster.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>With indoor mask-wearing still being mandated or recommended to reduce the spread of COVID-19, it has also resulted in some people noticing an <a href="https://theconversation.com/why-face-masks-can-make-eyes-feel-dry-and-what-you-can-do-about-it-143261">increase in dry eye sensations</a>. Termed mask-associated dry eye (MADE), it is caused by exhaled air travelling out the top opening of the mask and over the surface of the eyes, making <a href="https://dx.doi.org/10.1007%2Fs40123-020-00282-6">tears evaporate even faster</a>. </p>
<p><a href="https://dx.doi.org/10.1007%2Fs40123-020-00282-6">The remedy</a> is similar to preventing glasses from fogging with mask wear: use medical tape to “seal off” the top part of the mask to prevent airflow there.</p>
<h2>Managing dry eye triad</h2>
<p>With winter drawing closer, plus increased digital device use and mask wearing, the dry eye triad’s triple-layered threat to the stability of your tear film is real. Thankfully, in most cases, that does not have to be debilitating.</p>
<p>Begin by having a conversation with your eye care provider, who can help you implement the steps I’ve mentioned to make sure your eyes are lubricated, well-rested and not subjected to low humidity and evaporative airflow conditions.</p>
<p>More intense eye dryness may well benefit from tailored treatment. Your optometrist or ophthalmologist may recommend a specific regimen or refer you to a dry eye speciality clinic. Several <a href="https://www.aao.org/eye-health/tips-prevention/new-dry-eye-treatments-ocular-surface-disease">new pharmaceuticals and medical devices</a> are putting relief in reach for even severe cases. </p>
<p>The most important advice of all, though, is not to dismiss dry eye altogether. The condition is real, more prevalent than ever and can be addressed with a combination of education, behaviours and therapies. Understanding your options will put you on a path to comfortable, healthy eyes not only during the cold weather months, but year-round.</p><img src="https://counter.theconversation.com/content/173742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Ngo is a consultant with Alcon and Sun Pharma.
William Ngo is an independent contractor (optometrist) at Market Lane Optical.
William Ngo is a volunteer for the American Academy of Optometry.
William Ngo has received awards and research funding from the American Academy of Optometry Foundation.
As an employee at the Centre for Ocular Research & Education (CORE), we have received research funding from the following companies: Alcon, Allergan, Allied Innovations, Aurinia Pharma, Azura Ophthalmics, Bausch Health Canada, Brien Holden Vision Institute, CooperVision, GL Chemtec, i-MED Pharma, Johnson & Johnson Vision, Lubris, Menicon, Nature’s Way, Novartis, Ophtecs, Ote Pharma, PS Therapy, Santen, SightGlass, SightSage, Visioneering Tech Inc. CORE has also received funding from the following funding agencies: American Academy of Optometry Foundation, Natural Sciences and Engineering Research Council of Canada, Canadian Institutes of Health Research, Mitacs, Canadian Association of Optometrists, European Union Funding for Research & Innovation, Canada Foundation for Innovation, Innovation and Technology Commission.
</span></em></p>Increased digital screen use, face masks and winter weather combine to form a triple threat to eye health: The dry eye triad. Here’s how to combat the resulting eye fatigue, irritation and discomfort.William Ngo, Assistant Professor, School of Optometry & Vision Science, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1715362021-11-25T17:21:35Z2021-11-25T17:21:35ZMask wearing wasn’t disputed in previous crises – so why is it so hotly contested today?<figure><img src="https://images.theconversation.com/files/433754/original/file-20211124-13-1eynnjs.jpg?ixlib=rb-1.1.0&rect=71%2C229%2C2276%2C1589&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Men wearing masks outside a military hospital in New York during the 1918 influenza pandemic.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-men-wore-masks-avoid-flu-248206198">/Shutterstock</a></span></figcaption></figure><p>Across <a href="https://www.liberties.eu/en/stories/europe-mask-war-culture/18901">western countries</a>, people are <a href="https://www.theguardian.com/world/2020/jun/29/face-masks-us-politics-coronavirus">polarised</a> over <a href="https://www.politico.com/news/2020/07/15/masks-britain-culture-war-365370">wearing masks</a>. While some support wearing them as an <a href="https://www.theguardian.com/world/2021/nov/17/wearing-masks-single-most-effective-way-to-tackle-covid-study-finds">effective counter to the virus</a>, others believe having to mask up is a <a href="https://theconversation.com/face-mask-rules-do-they-really-violate-personal-liberty-143634">contravention of their human rights</a>.</p>
<p>Our <a href="https://gtr.ukri.org/projects?ref=AH%2FW003813%2F1">interdisciplinary team</a> is currently exploring the role the media plays in influencing the British public’s thoughts and decisions on mask wearing. We’ve found that these polarised opinions have been reflected and reinforced by the media, where a clear divide has appeared. </p>
<p>Pro-mask messages are more present in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7989238/">mainstream media</a>, including in public health adverts and on TV. Conversely, anti-mask wearing sentiments are more common in personalised sources <a href="https://journals.sagepub.com/doi/full/10.1177/0957926520970385">like social media</a>. </p>
<p>Here, mask wearing is often associated with the historical commands of authoritarian governments. Some have even <a href="https://edition.cnn.com/2021/05/21/politics/marjorie-taylor-greene-mask-mandates-holocaust/index.html">compared mask mandates</a> to the Nazi policy of forcing Jews to wear distinguishing yellow stars.</p>
<p>This split in attitudes is a relatively new development. People were more cooperative when asked to wear masks in response to earlier health epidemics and other dangers in the 20th century.</p>
<p>Indeed, a <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252315">2021 study</a> outlines how approval rates for face coverings during earlier crises were far more collectively positive. During <a href="https://pubmed.ncbi.nlm.nih.gov/33319388/">influenza in 1918</a>, the <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30342-4/fulltext">Blitz in Britain in 1941</a>, and the <a href="https://www.telegraph.co.uk/global-health/science-and-disease/wearing-face-mask-not-new-backlash-against-say-historians/">smog outbreaks</a> that occurred in the UK from the 1930s to the 1960s, masks weren’t contested like today. What explains this change?</p>
<h2>The tangibility of past crises</h2>
<p>The coronavirus is invisible to the human eye, and its worst effects aren’t seen publicly – they occur at home or in hospital wards away from people’s gaze. </p>
<p>Smog, on the other hand, could be seen. Similarly, the threat of a <a href="https://theworld.org/stories/2016-01-08/londons-forgotten-network-massive-underground-air-raid-shelters-being-found-again">Nazi attack in the 1940s</a> was manifested in smoke, debris and dust in the air after German bombing, as well as physical destruction and rubble. Even influenza in 1918, despite its symptoms being very similar to COVID’s, had arguably more publicly visual characteristics (such as vomiting and diarrhoea) that allowed it to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752013/">resist public scepticism</a>.</p>
<p>It may be that the actual visibility of these earlier crises made them seem more threatening, and so wearing a mask seem more necessary. Indeed, in a bid to make the dangers posed by COVID appear more tangible, <a href="https://www.aljazeera.com/news/2021/5/24/un-chief-says-world-at-war-against-covid-19">politicians</a> and the <a href="https://www.cgdev.org/blog/us-losing-global-war-against-covid-19-and-national-security-issue">media</a> have invoked the language of war when discussing COVID, or used <a href="https://www.campaignlive.co.uk/article/will-governments-new-emotive-covid-ad-people-obey-rules/1705634">images of people on ventilators</a> to materialise the threat.</p>
<p>But such tactics have yielded significant debates among health professionals and linguists, as these produce questionable implications, such as potentially identifying infected people as <a href="https://www.tandfonline.com/doi/full/10.1080/10410236.2020.1844989">“enemies” who bear and spread the virus</a>.</p>
<h2>Variety of the media</h2>
<p>A second factor is that formerly, media was restricted to channels controlled or influenced by government, and these all gave positive depictions of masks. Today, however, there are many other channels, which allow for resistance. </p>
<p>During earlier crises, the media promoted mask wearing as a patriotic act. However, the media’s scope in the first half of the 20th century was far more limited than it is today. Promotion of mask wearing was mainly limited to <a href="https://journals.sagepub.com/doi/pdf/10.1177/00333549101250S308">government-approved posters</a> and newsprint in the 1910s. </p>
<p>Mainstream radio didn’t exist until a decade later. And TV was only introduced in the 1930s but wasn’t widespread <a href="https://dspace.library.uu.nl/handle/1874/373997">until much later</a>. Radio, print and newsreels were the main sources of public information during past eras of mask wearing. </p>
<p>By contrast, today’s media landscape – especially <a href="https://www.rollingstone.com/culture/culture-features/mom-influencers-instagram-covid-19-coronavirus-mask-propaganda-misinformation-1033154/">social media</a> – allows for individual and personalised voices to be heard to an extent unthinkable in earlier decades. Media has become a way of <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250817">denigrating</a> as well as endorsing mask wearing. </p>
<p>Even music videos provide an opportunity for people to speak out against masks, providing a stark contrast to the <a href="https://archive.org/details/ATishOo">propaganda films of the 1940s</a>. For example, in the video for <a href="https://www.youtube.com/watch?v=eOkkWIOkWl8">Living the Dream</a> by US rock band Five Finger Death Punch, mask wearing is depicted as a way of enforcing people’s compliance in an authoritarian reimagining of America. Eventually, though, the public rebel, and are shown ripping their masks off as they head into battle against their hypocritical unmasked leader.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/eOkkWIOkWl8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>Pressure to wear a surgical mask</h2>
<p>Although <a href="https://publichealth.jmir.org/2020/2/e18444/?utm_source=TrendMD">public information from the NHS and UK government</a> specifically promotes the use of any “face coverings” (including bandannas, scarves, old clothes and so on), such messages are nearly always <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252315">accompanied by images of surgical masks</a>. Graphics that represent the need to wear a face covering nearly always depict a surgical mask. </p>
<p>And when looking at a <a href="https://www.lexisnexis.co.uk/">database of British newspaper reporting</a> from the COVID pandemic, it’s also clear that journalists refer to “masks” more often than to “face coverings”. Despite <a href="https://www.gov.uk/guidance/regulatory-status-of-equipment-being-used-to-help-prevent-coronavirus-covid-19?utm_source=Gov&utm_medium=Email&utm_campaign=MHRA_COVID-19_updates&utm_content=HCP7#face-masks-and-face-coverings">official guidance</a> only requiring proper masks to be used in medical settings, the way they are spoken about and depicted suggests other forms of face covering aren’t as broadly acceptable.</p>
<figure class="align-center ">
<img alt="An NHS poster telling people to 'wash hands, cover face, make space'" src="https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=330&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=330&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=330&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=415&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=415&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431580/original/file-20211111-27-8614nm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=415&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A typical NHS poster from during the pandemic, with its face covering depicted as a surgical mask.</span>
</figcaption>
</figure>
<p>While there’s good reason for this – surgical masks have been <a href="https://www.caymancompass.com/2021/10/02/study-surgical-masks-more-effective-than-cloth/">shown to be more effective</a> than other forms of face covering – in the mind of the public, this may limit the scope of what is proper to wear. This may then lower people’s willingness to wear a mask, as it’s known that people are <a href="https://books.google.com/books?hl=en&lr=&id=Z6iYwTFY5mIC&oi=fnd&pg=PA1&dq=restricted+choice+leads+to+rebellion+authority&ots=i38bbVGsn_&sig=Iq14oINjC_pTHzWNSu68sk6LxoA">more likely to accept</a> doing something if they <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.134.2.270">perceive that there is choice</a> involved. </p>
<p>Yet in the past, the same pressure didn’t exist. During the influenza and smog outbreaks, attitudes towards <a href="https://www.bbc.co.uk/news/uk-england-london-56085529">alternative face coverings</a> were more permissive, with non-standard masks even being celebrated among the <a href="https://trove.nla.gov.au/newspaper/article/52412108">fashion-conscious cultures</a> of London and Manchester that were impacted by the smog epidemic. Surgical masks of the day would also not have so widely available. The leeway this offered may also have led to a less controversial response to mask mandates compared to today.</p><img src="https://counter.theconversation.com/content/171536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Abrams, Thora Tenbrink, Anaïs Augé and Maciej Nowakowski receive funding from the Arts and Humanities Research Council. </span></em></p><p class="fine-print"><em><span> </span></em></p>How the pandemic is reported by the media can influence people’s behaviour.Nathan Abrams, Professor of Film Studies, Bangor UniversityAnaïs Augé, Assistant Researcher at the School of Arts, Culture and Language, Bangor UniversityMaciej Nowakowski, Research Assistant in Media Communications and Critical Discourse Analysis, Bangor UniversityThora Tenbrink, Professor of Linguistics, Bangor UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699412021-11-24T03:31:44Z2021-11-24T03:31:44ZHow to wear a mask in the heat<figure><img src="https://images.theconversation.com/files/433580/original/file-20211123-20-1cxhigv.jpg?ixlib=rb-1.1.0&rect=2%2C1%2C995%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-attractive-pineapples-wearing-face-mask-1685952682">Shutterstock</a></span></figcaption></figure><p>Summer is on its way and you might be wondering how you’re going to wear a mask as the weather gets warmer.</p>
<p>Which mask is best? Is there anything you can do to prevent “<a href="https://www.dailycardinal.com/article/2021/02/how-to-handle-macne?ct=content_open&cv=cbox_latest">macne</a>”? How can you stop the ear loops from chafing? How do you prevent your sunglasses fogging up? </p>
<p>Here are some practical tips to keep you comfortable while helping you stay safe.</p>
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Read more:
<a href="https://theconversation.com/which-mask-works-best-we-filmed-people-coughing-and-sneezing-to-find-out-143173">Which mask works best? We filmed people coughing and sneezing to find out</a>
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<hr>
<h2>Which mask is best in the heat?</h2>
<p><a href="https://www.bmj.com/content/372/bmj.n432">Disposable surgical masks</a> are more effective at filtering out viruses than cloth masks but to remain effective they should only be used once. Cloth masks are not quite as effective but can be washed and reused. </p>
<p>According to the World Health Organization, cloth masks <a href="https://www.bmj.com/content/372/bmj.n432">should have three layers</a>. The inner layer should be soft cotton as this is <a href="https://theconversation.com/how-do-i-know-if-my-mask-actually-works-what-about-the-candle-test-144124">more comfortable on the face</a>. This is also more absorbent, and less irritating, than synthetic materials. <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html">Cloth masks</a> with synthetic material in the inner layer will also increase sweating, so avoid these.</p>
<p>All masks become less effective when damp – from the damp air you exhale and from your sweat. The best mask to wear in the heat is the one you are most likely to wear.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cloth masks laid out on a yellow background" src="https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433595/original/file-20211124-21-10ufex3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you choose a cloth mask, make sure the inner layer is made from soft cotton.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/flat-lay-design-colorful-fashion-face-1683124312">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Sweating, wearing masks and macne</h2>
<p>Wearing a mask can affect your skin in a number of ways. It <a href="https://pubmed.ncbi.nlm.nih.gov/32605056/">increases skin temperature</a> and sweating, which can worsen acne or other skin conditions. That’s where the term “macne” or “<a href="https://www.wired.com/story/mascne-causes-and-treatments/">mascne</a>” comes from.</p>
<p>Mask wearing also <a href="https://pubmed.ncbi.nlm.nih.gov/33217053/">increases production of sebum</a> (skin oil), which can clog pores. </p>
<p>Masks can cause friction if they don’t fit well. They can also cause sensitivity reactions if the innermost layer is made from synthetic fibres, and depending on how you wash them.</p>
<p>While it might seem odd, your skin also <a href="https://pubmed.ncbi.nlm.nih.gov/33813749/">gets drier</a> under a mask. That’s possibly because the humidity under the mask disrupts the normal skin barrier. </p>
<p><strong>What to do</strong></p>
<p>If you want to wear a cloth mask, a soft cotton-lined one is recommended to reduce the risk of skin irritation. <a href="https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems">Dermatologists also recommend</a> avoiding makeup, such as some foundation and face powder, when wearing a mask, to avoid clogging the pores.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1300116312371408898"}"></div></p>
<p>Dermatologists <a href="https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems">also recommend</a> washing your mask regularly, preferably after each use. If you are prone to skin conditions use a laundry detergent for sensitive skin to wash your mask, as normal laundry detergents contain perfumes and chemicals that can cause skin reactions. Avoid using fabric softeners for the same reason. </p>
<p>Dermatologists also <a href="https://www.aad.org/public/everyday-care/skin-care-basics/care/face-washing-101">suggest</a> washing your face morning and night with lukewarm water and a mild cleanser and avoiding irritating solutions such as retinoids or aftershave. A <a href="https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems">moisturiser</a> before and after mask wearing can help rehydrate the skin; ensuring your mask fits snugly will reduce friction.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/13-insider-tips-on-how-to-wear-a-mask-without-your-glasses-fogging-up-getting-short-of-breath-or-your-ears-hurting-143001">13 insider tips on how to wear a mask without your glasses fogging up, getting short of breath or your ears hurting</a>
</strong>
</em>
</p>
<hr>
<h2>Avoid sore ears</h2>
<p>When you wear a mask for extended periods, the elastic loops can cause painful pressure on the backs of your ears.</p>
<p>To prevent this, use <a href="https://www.usatoday.com/videos/tech/problemsolved/2021/01/05/use-paper-clips-save-your-ears-face-mask-loop-pressure/4130220001/">paper clips</a> to join the loops together at the back of your head, taking the pressure off your ears.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1251910401219940352"}"></div></p>
<p>Another nifty solution is to use a <a href="https://www.businessinsider.com.au/headband-that-holds-up-face-mask-healthcare-workers-2020-4">headband with buttons</a> or paper clips attached. You attach the ear loops to the buttons/paper clips rather than putting the loops over your ears.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1247989374194720769"}"></div></p>
<h2>How do you stop your sunnies fogging up?</h2>
<p>People who wear prescription glasses will be used to avoiding fogging while wearing a mask. The same advice applies to people wearing sunglasses.</p>
<p>Sunnies fog up when you wear a mask because the warm water vapour in your breath comes out the top of your mask <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3293317/">and condenses</a> on your lenses.</p>
<p>Prevent the moist air from reaching your sunnies by:</p>
<ul>
<li><p>resting them on the mask rather than above the mask. The pressure of the sunnies reduces the chance of vapour exiting the top of the mask</p></li>
<li><p>pinching the top of the surgical mask to improve the fit around the top of your nose. If using a cloth mask, insert a pipe cleaner in the top to shape the mask over the nose</p></li>
<li><p>using soft tape suitable for skin to tape down the top of the mask. If you do this, test the tape somewhere else on your body first to make sure you don’t have a reaction to it.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1461730641125548033"}"></div></p>
<p>Other anti-fogging strategies include:</p>
<ul>
<li><p>using anti-fogging wipes or spray on the lenses, which you can buy over the counter from your local pharmacy or at an optometrist</p></li>
<li><p>making your own anti-fogging effect by rubbing a thin layer of liquid soap or shaving cream across the inside of each lens.</p></li>
</ul>
<p>Use anti-fogging solutions with care, though, as some may damage any anti-glare or anti-UV films on the lens. Check with your optometrist if unsure.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-get-your-kid-to-wear-a-mask-here-are-5-things-you-can-try-166648">Can't get your kid to wear a mask? Here are 5 things you can try</a>
</strong>
</em>
</p>
<hr>
<h2>In a nutshell</h2>
<p>Whether you choose to wear a cloth or surgical mask this summer, these simple tips will help this become more comfortable as the temperatures rise, you sweat more and your skin may become more irritated.</p>
<p>But make sure you wear your mask correctly. Wearing it <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html">under your nose</a> makes it completely ineffective. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-easy-to-judge-but-some-people-really-cant-wear-a-mask-143258">It's easy to judge. But some people really can't wear a mask</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/169941/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the Griffith University postgraduate Infection Prevention and Control program. </span></em></p>Here are some practical tips to keep you comfortable while helping you stay safe.Thea van de Mortel, Professor, Nursing and Deputy Head (Learning & Teaching), School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1700882021-10-19T12:22:23Z2021-10-19T12:22:23ZSimple safety tips for trick-or-treating after Fauci greenlighted Halloween 2021<figure><img src="https://images.theconversation.com/files/426809/original/file-20211017-17-lqcsev.jpg?ixlib=rb-1.1.0&rect=77%2C0%2C8660%2C5730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Experts give trick-or-treating the green light this year.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/little-kids-at-a-halloween-party-royalty-free-image/1270677135">Anchiy/E+ Collection via Getty Images</a></span></figcaption></figure><p>The air is getting chillier, pumpkins are perched on porches and kids across the country are planning their spooky costumes. As a <a href="https://www.purdue.edu/hhs/nur/directory/faculty/sorg_meg.html">professor of pediatric nursing</a> and a mom to four young children, I know the excitement and anxiety that pandemic holidays bring to children and parents alike. </p>
<p>Halloween 2020 brought creative ways to trick or treat while minimizing the spread of infection (<a href="https://www.usatoday.com/story/news/nation/2020/10/29/halloween-2020-trick-treat-chutes-catapults-socially-distance/6057569002/">candy catapult</a>, anyone?). But scientists have since determined that the <a href="https://health.ucsd.edu/news/releases/Pages/2020-10-30-infection-by-confection-covid-19-risk-trick-or-treating.aspx">risk of transmission of COVID-19 via candy wrappers</a> is low. </p>
<p>Still, the extremely contagious delta variant of the coronavirus continues to show moderate-to-high rates of infection in many areas of the country, and it continues to sicken children and teens at a <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html">higher rate</a> than the dominant strain that devastated the world in 2020. Parents may be wondering if participating in Halloween fun and games is safe, or if they would be better off staying home this year. </p>
<p>Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said that <a href="https://www.npr.org/2021/10/12/1045202813/trick-or-treating-halloween-is-safe-fauci-says">kids can indeed still enjoy</a> a safe, fun Halloween. But here are a few simple precautions that trick-or-treaters can take.</p>
<figure class="align-center ">
<img alt="A woman wearing a face mask sends candies down a chute to a boy trick or treating" src="https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426807/original/file-20211017-27-p848sw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Candy chutes were a popular way to trick or treat while maintaining social distance in 2020.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-wearing-a-face-mask-sends-candies-down-a-chute-to-a-news-photo/1229391943">Aimee Dilger/SOPA Images/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<h2>1. Mask up</h2>
<p>Children under 12 are not yet eligible to receive a COVID-19 vaccination, which means the majority of kids going door to door are still at an increased risk for contracting the virus. </p>
<p>Because COVID-19 spreads through respiratory transmission, masking remains an effective way to reduce the spread of infection for kids age 2 and older. Unfortunately, Halloween costume masks are not a substitute for masks designed to limit the spread of viral particles. Parents can get creative about making a <a href="https://www.usatoday.com/story/tech/reviewedcom/2021/09/21/halloween-costumes-ideas-kids-can-wear-masks/42632645/">face mask part of a child’s costume</a>. Or, kids can wear a face mask under their costume mask. Parents should make sure their child is able to breathe comfortably if choosing this option. </p>
<p>Children and parents, regardless of vaccination status, should wear a mask when attending indoor parties or when going door to door due to the close interactions with other people. Those giving out candy should also wear a face mask.</p>
<h2>2. Keep hands clean</h2>
<p>Washing hands and using hand sanitizer remains a priority. Even though the likelihood of spreading COVID-19 via candy wrappers is <a href="https://health.ucsd.edu/news/releases/Pages/2020-10-30-infection-by-confection-covid-19-risk-trick-or-treating.aspx">relatively low</a>, that risk decreases even further when proper hand hygiene is practiced prior to passing out candy.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-important">Get The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p>
<p>Kids should wash their hands before they eat their candy in case they picked up any germs while out and about. The candy wrappers themselves are not considered contagious, so there’s no need to quarantine the candy before eating it.</p>
<h2>3. Celebrate outside</h2>
<p>Other ways families can celebrate while maintaining a low risk status are to keep gatherings and activities outside, where people are <a href="https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/safe-activities-during-covid19/art-20489385">less likely to contract the virus</a>, and to keep groups small.</p>
<p>Kids who are demonstrating signs of illness should be kept home to rest and avoid exposing others to their germs. Those 12 years old and older should get the COVID-19 vaccination to protect against serious infection.</p>
<p>It feels nice to be staring at the beginning of the 2021 holiday season with some semblance of normalcy. While the risk of COVID-19 isn’t entirely in the past, families should enjoy trick-or-treating while taking reasonable precautions.</p><img src="https://counter.theconversation.com/content/170088/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meg Sorg does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s no need to pull out the candy catapult this year, but a few reasonable precautions can keep COVID-19 transmissions in check.Meg Sorg, Clinical Assistant Professor of Nursing, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1676672021-09-10T22:01:43Z2021-09-10T22:01:43ZBiden’s pandemic plan overlooks mask mandates and vulnerable populations<figure><img src="https://images.theconversation.com/files/420366/original/file-20210909-25-qm8y20.jpg?ixlib=rb-1.1.0&rect=0%2C446%2C7427%2C4628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">President Joe Biden addresses the nation on latest coronavirus plan.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-joe-biden-speaks-about-combatting-the-coronavirus-news-photo/1339350253?adppopup=true">Kevin Dietsch/Getty Images</a></span></figcaption></figure><p>President Joseph Biden on Sept. 9, 2021, unveiled his <a href="https://www.whitehouse.gov/covidplan/#testing-masking">revamped strategy</a> to confront the pandemic, outlining an approach that focuses heavily on attempting to reduce the number of unvaccinated Americans.</p>
<p>The new plan comes at a crucial time. The delta variant continues to spread in states across America. The virus is currently taking <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">more than 1,500 lives</a> each day, and new <a href="https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions">hospital admissions</a> <a href="https://www.cnn.com/2021/09/08/health/delta-variant-in-kids/index.html">of children</a> are higher now than at any other point during the pandemic. Concern is especially high in states with low vaccination rates. High transmission is also harming economic recovery as people <a href="https://www.wsj.com/articles/u-s-airlines-warn-of-dimming-outlook-amid-delta-variant-11631188178">stay home</a> to avoid the virus.</p>
<p><iframe id="1G3GE" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/1G3GE/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>As such, policies aimed at getting people vaccinated make sense – vaccination is a proven way to <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e1.htm">protect populations from hospitalizations</a> <a href="https://www.nih.gov/news-events/nih-research-matters/vaccines-prevented-140000-covid-19-deaths-us">and death</a> from coronavirus infection.</p>
<p>To encourage vaccination, <a href="https://www.cbsnews.com/live-updates/biden-covid-19-vaccine-mandates-announcement/">the president is mandating</a> that employees at companies with more than 100 workers are either vaccinated or test for the virus every week. His new plan also includes <a href="https://www.politico.com/video/2021/09/09/biden-invokes-the-defense-production-act-to-supply-mainstream-retailers-with-rapid-covid-tests-324182">enhanced production of rapid tests</a> and <a href="https://theconversation.com/over-the-counter-rapid-antigen-tests-for-covid-19-can-help-slow-the-spread-of-the-delta-variant-heres-when-to-use-them-166869">making them available</a> either free to Medicaid recipients or at cost via retailers such as Walmart and Amazon.</p>
<p>As <a href="https://www.bu.edu/sph/profile/julia-raifman/">leaders of a team</a> of <a href="https://statepolicies.com/about/team-members/">health policy researchers</a> that track policy responses to COVID-19, we know there is no perfect approach to preventing the virus. It is certainly encouraging that the administration has acknowledged that more needed to be done – and the measures outlined by the president are likely to encourage vaccinations. But we believe they would work better if supplemented by further actions – be it at a federal or state level – that would protect vulnerable people through stronger mask mandates and improved vaccine delivery. </p>
<p>We are also concerned that the headline policy – mandating workplace vaccinations – may have only a limited impact in low-income communities where many workers are <a href="https://home.treasury.gov/system/files/131/WP-114.pdf">independent contractors</a> like gig workers and agricultural workers. <a href="https://www.statnews.com/2021/07/01/essential-workers-getting-vaccinated-something-to-celebrate/">Analyses show</a> unvaccinated rates tend to be higher in such communities.</p>
<h2>No federal mask policies</h2>
<p>Biden’s plan would continue to require the use of masks on interstate transit and federal property and <a href="https://www.businessinsider.com/biden-covid-plan-doubles-tsa-fines-refusing-mask-mandate-airplanes-2021-9">doubles the fine</a> for failure to comply. But it fell short of calling for universal mask policies.</p>
<p>This is despite internal documents from the Centers for Disease Control and Prevention <a href="https://context-cdn.washingtonpost.com/notes/prod/default/documents/54f57708-a529-4a33-9a44-b66d719070d9/note/753667d6-8c61-495f-b669-5308f2827155.#page=1">in which scientists made clear</a> that “universal masking is essential to reduce transmission.”</p>
<p>Stronger mask policies would be especially helpful for <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818">immediately reducing</a> the transmission of the delta variant, especially in <a href="https://www.pnas.org/content/118/17/e2018995118">higher-risk indoor spaces</a> and among children who are not eligible for vaccines. Hospitalizations in the U.S. of children went from record lows to record highs – and climbing – in a span of <a href="https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions">just four weeks</a>.</p>
<p>Mask mandates can reduce community transmission, allowing more time to intensify vaccine delivery efforts and messaging.</p>
<p>A data-driven approach to mask mandates would supplement the measures Biden has laid out in his path out of the pandemic. Such a policy has been put to good use in <a href="https://theconversation.com/state-policies-can-provide-clear-guidance-on-when-to-put-on-and-take-off-masks-with-benefits-to-health-education-and-the-economy-165521">Nevada</a>, where mask mandates come into effect in counties with high numbers of infections and are then removed when cases fall below a certain level.</p>
<h2>Vaccine mandates may still miss population groups</h2>
<p>The administration’s plan includes a <a href="https://federalnewsnetwork.com/workforce/2021/09/biden-will-now-require-vaccines-for-all-federal-employees-via-new-executive-order/">vaccine mandate for federal employees</a> and health care workers at Medicaid and Medicare serving hospitals. The administration also asked the Occupational Safety and Health Administration to <a href="https://www.nytimes.com/2021/09/09/business/osha-vaccine-biden-mandate.html">develop a rule</a> that would require these employers to provide paid time off for vaccination and recovery. </p>
<p>While many federal employees, health care workers and higher-income workers are already vaccinated, even modest increases could make a difference, especially in regions with low vaccination rates.</p>
<p>The new vaccine mandates are less likely to reach low-income workers, many of whom are considered <a href="https://home.treasury.gov/system/files/131/WP-114.pdf">independent contractors</a> or who work in small restaurants or other businesses and as such will not be covered.</p>
<p>Research has shown that <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7022e1.htm">vaccination rates tend to be lower in lower-income communities</a>. This may be because lower-paid workers are focused on meeting other needs like <a href="https://www.nytimes.com/2021/08/06/opinion/covid-delta-vaccines-unvaccinated.html">food, housing and child care for their families</a>, have less time because they are working more than one job or cannot afford <a href="https://www.washingtonpost.com/us-policy/2021/08/16/paid-leave-covid-vaccine/">unpaid time off work</a> to get a shot.</p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>The delta variant continues to spread rapidly through the U.S. State leaders can play an important role in speeding up vaccine delivery efforts at schools, <a href="https://www.washingtonpost.com/outlook/2021/08/05/vaccine-block-party-lowell-massachusetts/">neighborhoods</a> and <a href="https://www.statnews.com/2021/07/01/essential-workers-getting-vaccinated-something-to-celebrate/">workplaces</a>. Efforts that are directed toward low-income communities and workers where vaccination rates remain lowest are more likely to yield greater results. And mask policies could slow the spread of COVID-19 until more adults and children can be vaccinated.</p><img src="https://counter.theconversation.com/content/167667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Raifman receives funding from the NIH and Robert Wood Johnson Foundation</span></em></p><p class="fine-print"><em><span>Alexandra Skinner does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Biden outlined a six-point strategy to confront the pandemic. But two public health scholars believe it would work better with help from states.Julia Raifman, Assistant Professor of Health Law, Policy and Management, Boston UniversityAlexandra Skinner, Research Fellow of Health Law, Policy and Management, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670262021-09-01T12:09:50Z2021-09-01T12:09:50ZState efforts to ban mask mandates in schools mirror resistance to integration<figure><img src="https://images.theconversation.com/files/418730/original/file-20210831-23-368k3d.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5637%2C3487&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Southern states' bans on mask mandates in schools may violate the rights of disabled students. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-attend-a-special-board-of-education-meeting-on-mask-news-photo/1234838553?adppopup=true">Matthew Hatcher/Getty Images</a></span></figcaption></figure><p>When the U.S. Supreme Court issued its 1954 <a href="https://www.oyez.org/cases/1940-1955/347us483">Brown vs. Board of Education decision</a> that struck down segregated public schooling, white Southern politicians responded to the decision with ferocity.</p>
<p>Although preservation of states’ rights was at the heart of their resistance claims, it was the racist practice of segregation that they sought to uphold.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man speaks on stage next to two Black children and a group of other men." src="https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418741/original/file-20210831-15-1t18rwo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Former Sen. Harry Byrd (D. Va.) was deeply opposed to school integration.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sen-harry-f-byrd-d-va-at-telethon-1952-n-news-photo/644004948?adppopup=true">CQ Roll Call via Getty Image</a></span>
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<p>U.S. Senator <a href="https://encyclopediavirginia.org/entries/byrd-harry-f-1887-1966/">Harry Byrd</a> of Virginia declared the ruling “<a href="http://www2.vcdh.virginia.edu/civilrightstv/documents/byrd_001.html">the most serious blow that has yet been struck against the rights of the states</a>.” Thomas P. Brady, Mississippi circuit judge and future state supreme court justice, called the day of the ruling “<a href="https://egrove.olemiss.edu/citizens_pamph/3/">Black Monday</a>.” Brady also claimed that racial integration was a communist plot to unify the country around one common culture. </p>
<p>Over 100 Southern House and Senate members signed a <a href="https://history.house.gov/Historical-Highlights/1951-2000/The-Southern-Manifesto-of-1956/">Southern Manifesto</a>, vowing to stop school integration in what Byrd called a “massive resistance.” The governor of Virginia, Thomas Manley, appointed a commission to explore legal options in the wake of the Brown vs. Board of Education decision. <a href="http://www2.vcdh.virginia.edu/civilrightstv/glossary/topic-009.html#:%7E:text=The%20Gray%20Commission's%20emphasis%20on,position%20to%20accomplish%20most%20effectively">The Gray Commission</a>, as it was known, recommended that no child in Virginia “be required to attend a school wherein both white and colored children are taught.”</p>
<p>I don’t bring up this Southern resistance to federal mandates that affect U.S. schools merely to recount history. As a researcher who <a href="https://scholar.google.com/citations?user=vK7qfnkAAAAJ&hl=en&oi=ao">focuses on the role of federalism in U.S. education</a>, I believe this resistance helps shine light on why several Southern states today are <a href="https://www.flgov.com/2021/07/30/governor-desantis-issues-an-executive-order-ensuring-parents-freedom-to-choose/">pushing back</a> against federal guidance for teachers and students to wear masks in schools to lessen the risks of contracting the <a href="https://asm.org/Articles/2021/July/How-Dangerous-is-the-Delta-Variant-B-1-617-2">more dangerous</a> delta variant of COVID-19.</p>
<h2>Defiance in spite of risks</h2>
<p>In late July 2021, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html">Centers for Disease Control and Prevention</a> and <a href="https://www.reuters.com/world/us/biden-says-cdc-will-advise-unvaccinated-kids-mask-up-school-this-fall-2021-07-22/">President Joe Biden</a> recommended students wear masks in schools to protect themselves and others from COVID-19. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in a suit speaks at a podium." src="https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418737/original/file-20210831-15-axux32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Florida Gov. Ron DeSantis has refused to impose statewide mask mandates.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/florida-governor-ron-desantis-speaks-during-a-press-news-photo/1227675767?adppopup=true">Paul Hennessy/SOPA Images/LightRocket via Getty Images</a></span>
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<p>Subsequently, Florida Gov. Ron DeSantis issued an <a href="https://www.flgov.com/2021/07/30/governor-desantis-issues-an-executive-order-ensuring-parents-freedom-to-choose/">executive order</a> that banned schools in the state from requiring masks, claiming that the masks are unproven to be effective and might cause harm to children. The governors of <a href="https://gov.texas.gov/uploads/files/press/EO-GA-38_continued_response_to_the_COVID-19_disaster_IMAGE_07-29-2021.pdf">Texas</a> and <a href="https://apnews.com/article/health-arizona-coronavirus-pandemic-f4c807150376d4a1dc1ea88b3aecce7c">Arizona</a> took similar measures, leaving schools, concerned parents, teachers and vulnerable students few options and with little time before the school year began to decide how to respond. The Texas legislature is <a href="https://www.houstonchronicle.com/politics/texas/article/Texas-Democrats-say-GOP-bill-blocking-future-mask-16398646.php">considering legislation</a> that would make public mask requirements illegal.</p>
<h2>A history of resistance</h2>
<p>Southern states ignoring federal educational guidance is not new. </p>
<p>For instance, rather than integrate schools, Virginia <a href="https://www.odu.edu/library/special-collections/dove/timeline">elected to close many school districts</a> and instead offer white students vouchers to attend private schools. The state legislature enabled this in 1956, when it <a href="https://www.vqronline.org/essay/massive-resistance-virginia%E2%80%99s-great-leap-backward">passed laws that stripped local school boards</a> of their power and put it in the hands of committees appointed by the governor. </p>
<p>When Lindsey Almond took over as governor of Virginia in 1957, he warned that integrated schools would lead to the “<a href="https://www.commentary.org/articles/erwin-knoll/desegregations-tortuous-course-washington-showcase-of-integration/">livid stench of sadism, sex, immorality, and juvenile pregnancy</a>” that he claimed existed in nearby Washington’s integrated school system.</p>
<h2>Other acts of resistance</h2>
<p>In Mississippi, things were little different than in Virginia. <a href="https://www.jstor.org/stable/40578897">Gov. Hugh White</a> thought that he might avoid integration by convincing Black residents to voluntarily agree to continue segregation. He promised more money for schools. He met with 90 Black leaders and asked for voluntary segregation. The plan failed when only one person at the meeting agreed to the proposal. As a result, the governor called a special session of the state legislature.</p>
<p>The legislature <a href="https://www.jacksonfreepress.com/news/2004/may/12/black-monday/">passed a bill that led to the closure of public schools in the state</a>. Public schools would be mostly private and segregated. It took 16 years for Mississippi schools to comply with the Brown decision and fully integrate.</p>
<p>Other states <a href="https://www.jstor.org/stable/40578897">resisted integration in similar ways</a>, with various policies that privatized public schools, <a href="https://www.naacpldf.org/case-issue/landmark-brown-v-board-education/#:%7E:text=The%20legal%20victory%20in%20Brown,and%20institutions%20of%20higher%20education.">leading to the modern civil rights movement</a>. The civil rights movement opened the door for a <a href="https://www.justice.gov/crt/types-educational-opportunities-discrimination#:%7E:text=The%20Civil%20Rights%20Division%2C%20Educational,and%20institutions%20of%20higher%20education.">larger federal government role</a> in educational policy. The Justice Department has the authority to investigate and prosecute schools under the <a href="https://www2.ed.gov/about/offices/list/ocr/docs/tix_dis.html#:%7E:text=Title%20IX%20states%3A,activity%20receiving%20Federal%20financial%20assistance.">Title IX provision</a> of the Civil Rights Act of 1964 that mandates civil rights protection for students.</p>
<h2>Fight against federal government continues</h2>
<p>Fast forward to 2021 and governors and lawmakers in states such as <a href="https://apnews.com/article/joe-biden-business-health-education-coronavirus-pandemic-1aba40b697a210a65356269c916780d4">Florida, Texas and Arizona are clamoring</a> with a similar states’ rights argument as their predecessors. </p>
<p>Like Virginia and Mississippi in the 1950s, these states are attempting to undermine federal intervention in schools. The U.S. Constitution creates a federal system where the national government shares power with states. Any power not explicitly listed in the Constitution is left to the states, <a href="https://www.law.cornell.edu/constitution/tenth_amendment">per the 10th Amendment</a>. As a result, educational policy is largely left to the states, so long as civil rights are protected. </p>
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Read more:
<a href="https://theconversation.com/federal-role-in-education-has-a-long-history-74807">Federal role in education has a long history</a>
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<p>Within states, power is shared with local governments in whatever way state constitutions and law decide. Florida Gov. DeSantis has <a href="https://www.tallahassee.com/story/news/local/state/2021/08/09/florida-gov-desantis-threatens-salaries-school-superintendents-school-board-members-mask-mandates/5544903001/">threatened retaliation against schools who defy his order</a> by cutting superintendent salaries. Yet, a <a href="https://apnews.com/article/lifestyle-health-education-florida-coronavirus-pandemic-1908088a0b5c5b02d89fd7e007822408">state judge stopped</a> his order. DeSantis <a href="https://www.clickorlando.com/news/local/2021/08/30/well-end-up-getting-it-back-desantis-confident-in-appeal-of-mask-mandate-ruling/">claims that he will win on appeal</a>.</p>
<p>Texas and Arizona officials have <a href="https://www.edweek.org/policy-politics/can-governors-really-take-money-from-schools-over-masks/2021/08">threatened consequences</a>, such as loss of funding and lawsuits, to school districts that mandate masks. Threatening localities with retaliation did not prevent the eventual integration of schools in the South. Considering that local school districts are following federal health guidance, threats from governors to browbeat localities into submission have stirred <a href="https://www.nationalgeographic.com/science/article/as-kids-head-back-to-school-battles-over-masks-are-pitting-parents-against-governors">community outrage</a> from parents and lawsuits from concerned citizens. </p>
<p>Nevertheless, federalism makes power-sharing between the states and federal government complicated. The Constitution gives states the power to create their own educational and health policies, but the federal government can enforce civil rights laws in schools, making educational policy political whether people like it or not.</p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>This is why, on Aug. 30, 2021, the U.S. Department of Education announced <a href="https://www.ed.gov/news/press-releases/department-educations-office-civil-rights-opens-investigations-five-states-regarding-prohibitions-universal-indoor-masking">that it would investigate</a> whether statewide mask bans deny civil rights to students with disabilities.</p>
<p>Like school integration in the past, policies that require or encourage masks have become the new arena for the ongoing American argument about Southern states’ rights.</p><img src="https://counter.theconversation.com/content/167026/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dustin Hornbeck does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fighting against federal authority is a political tradition in the South – and resisting federal guidance to wear masks in schools is just the latest example, an education policy expert writes.Dustin Hornbeck, Postdoctoral Research Fellow of Educational Leadership and Policy, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1655942021-08-16T17:48:00Z2021-08-16T17:48:00ZSchools can reopen safely – an epidemiologist describes what works and what’s not worth the effort<figure><img src="https://images.theconversation.com/files/415907/original/file-20210812-14-1g3pwg4.jpg?ixlib=rb-1.1.0&rect=36%2C21%2C4853%2C3401&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Masks are an important tool for slowing the spread of COVID-19 in schools.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/school-children-in-face-masks-raising-hands-royalty-free-illustration/1326411776">Malte Mueller via Getty Images</a></span></figcaption></figure><p>Just when schools were getting ready to reopen for the new school year, <a href="https://coronavirus.jhu.edu/map.html">cases of COVID-19 started surging</a> in the United States, driven in large part by the more contagious <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html">delta variant</a>. School administrators around the country are working to bring students back into the classroom safely, while still providing kids an enriching learning environment. </p>
<p>As an <a href="https://globalhealth.washington.edu/faculty/brandon-guthrie">infectious disease epidemiologist</a> at the University of Washington, I have spent the past year and a half working with a group of epidemiologists and health professionals to collect, review and evaluate the <a href="https://depts.washington.edu/pandemicalliance/covid-19-literature-report">scientific evidence</a> about COVID-19 for state and local public health agencies.</p>
<p>Our group concluded that vaccines and masking work well for preventing COVID-19 outbreaks in schools, but other strategies like plexiglass barriers and temperature checks are probably not worth the effort.</p>
<h2>What works</h2>
<p>A COVID-19 vaccine is the single most important tool for <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html">preventing COVID-19</a> in schools, as well as nearly everywhere else. All the vaccines currently authorized for use in the U.S. have been shown to help <a href="https://doi.org/10.15585/mmwr.mm7013e3">prevent infections</a> and protect against moderate and <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow.html">severe disease</a>. Some variants, such as delta, may be more likely to cause <a href="https://doi.org/10.15585/mmwr.mm7031e2">breakthrough infections</a>, but vaccinations have <a href="https://doi.org/10.1056/NEJMoa2108891">shown protection</a> against symptomatic disease caused by delta.</p>
<figure class="align-center ">
<img alt="Teen girl wearing a mask and showing a bandaid on her forearm" src="https://images.theconversation.com/files/415944/original/file-20210812-25118-1g92ln6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415944/original/file-20210812-25118-1g92ln6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415944/original/file-20210812-25118-1g92ln6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415944/original/file-20210812-25118-1g92ln6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415944/original/file-20210812-25118-1g92ln6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415944/original/file-20210812-25118-1g92ln6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415944/original/file-20210812-25118-1g92ln6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Students who are at least 12 years old can get a COVID-19 vaccine.</span>
<span class="attribution"><a class="source" href="https://www.https://gettyimages.com/detail/photo/teen-girl-after-her-vaccination-royalty-free-image/1311564458">Capuski/E+ via Getty Images</a></span>
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<p>The more people in a school who are vaccinated, the lower the risk of an outbreak in the school and the lower the likelihood that someone will develop severe disease if infections occur. COVID-19 vaccines are currently available to anyone <a href="https://www.cdc.gov/vaccines/covid-19/index.html">age 12 or older</a>, and it is possible that at least one of the vaccines <a href="https://www.theatlantic.com/health/archive/2021/08/covid-vaccination-timeline-children/619729/">will be authorized</a> for younger school-age children in the later months of 2021 or early in 2022. </p>
<p>Masks are important, too. Not everyone in a school can be or will choose to be vaccinated, and there is also a risk of breakthrough infections, especially from the delta variant. Masks reduce the risk of an infected person <a href="https://doi.org/10.1063/5.0035072">spreading the virus</a> and provide some protection for the wearer against <a href="https://doi.org/10.3201/eid2612.203764">becoming infected</a>. During the past academic year, mask-wearing was shown to reduce the spread of <a href="https://doi.org/10.1542/peds.2020-048090">COVID-19 in schools</a>. Masks also don’t disrupt the school day in the way that other measures might, such as keeping students in fixed cohorts or shortening the school day for split shifts.</p>
<h2>What probably isn’t worth the effort</h2>
<p>Other prevention measures have had limited effectiveness in some settings but likely are not worth the cost and effort to implement in most schools. </p>
<p>Plexiglass barriers, common in businesses and other venues, can be expensive <a href="https://doi.org/10.15585/mmwr.mm7021e1">and do little</a> to prevent airborne transmission in school environments. In some situations, barriers like desk shields may actually <a href="https://doi.org/10.1126/science.abh2939">increase the risk</a> of transmission by reducing air circulation. </p>
<p>Daily temperature checks and symptom screening have also <a href="https://doi.org/10.15585/mmwr.mm6945a4">not proved to be an efficient way</a> to prevent COVID-19 in public settings. This approach misses asymptomatic cases, which are <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html">especially common</a> among children and younger adults. Still, students, teachers and staff should stay home until they have a negative test if they are experiencing symptoms of COVID-19 or have been exposed to someone with COVID-19. </p>
<p>Other policies can reduce transmission but can be disruptive to students, like physical distancing of at least 6 feet or separating students into cohorts that are not permitted to mix. If students are wearing masks, and especially if most are vaccinated, these measures are unlikely to add <a href="https://www.idmod.org/covidreports?year_reports%5B1%5D=1&report_topic%5B%5D=102&author=18&search=&sort_by=field_report_date_value_1">much more protection</a>. The CDC currently recommends <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html">3-foot spacing in schools when possible</a> and multilayered prevention measures when not possible.</p>
<p>It’s also probably not worth testing everyone on a regular basis. Frequent <a href="https://doi.org/10.1016/S2468-2667(21)00002-5">testing is expensive</a>, and <a href="https://doi.org/10.1101/2021.03.20.21253976">real-world examples</a> and <a href="https://www.idmod.org/covidreports?report_topic%5B%5D=102&author=18&search=testing+the+waters&sort_by=field_report_date_value_1">mathematical models</a> indicate that routine asymptomatic testing for COVID-19 in schools provides little additional benefit beyond widespread vaccination and masking. However, the CDC does include some asymptomatic testing in schools as one of the potential components of a <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html">layered prevention strategy</a>. </p>
<h2>What to do about lunch</h2>
<p>When I talk to school administrators about reopening safely, one of the most common questions they ask me is how to run lunchtime, when students are gathered together and cannot always wear masks. Many schools included lunch during the past year <a href="https://doi.org/10.15585/mmwr.mm7012e2">without causing COVID-19 outbreaks</a>, which suggests that lunch can be done safely.</p>
<figure class="align-center ">
<img alt="Rear view of a young girl with a backpack walking into a school cafeteria" src="https://images.theconversation.com/files/415938/original/file-20210812-20530-1tcet83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415938/original/file-20210812-20530-1tcet83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415938/original/file-20210812-20530-1tcet83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415938/original/file-20210812-20530-1tcet83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415938/original/file-20210812-20530-1tcet83.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415938/original/file-20210812-20530-1tcet83.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415938/original/file-20210812-20530-1tcet83.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">To avoid spreading the virus, it helps to be extra careful in the cafeteria.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rear-view-of-young-schoolgirl-entering-cafeteria-royalty-free-image/1191725369">SDI Productions/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>There is little direct evidence on the risk of transmission when comparing different approaches to the lunch problem, but there are some basic guiding principles. </p>
<p>Students should wear masks whenever they are not actively eating. As challenging as it is to manage a rambunctious lunchroom, shouting, <a href="https://doi.org/10.15585/mmwr.mm6919e6">singing</a> and loud talking <a href="https://doi.org/10.1093/cid/ciaa1241">spread more virus</a> and should be discouraged, especially without masks. And <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/ventilation.html">good ventilation</a>, particularly in <a href="https://doi.org/10.3201/eid2607.200764">spaces where people are eating</a>, is important.</p>
<p>Students also need to keep their distance from one another while they eat. Schools may consider having more lunch periods, having children eat in their classrooms, or using other spaces in the school to reduce crowding.</p>
<h2>Risks outside of school</h2>
<p>The <a href="https://doi.org/10.1016/S1473-3099(20)30882-3">strongest driver of COVID-19</a> in children, teachers and families is <a href="https://doi.org/10.1542/peds.2020-048090">not school</a> – it’s the level of <a href="https://doi.org/10.15585/mmwr.mm7012e2">community transmission</a>. </p>
<p>Given what we currently know, schools can continue to operate in person <a href="https://doi.org/10.15585/mmwr.mm7012e3">without widespread transmission linked to schools</a>. When community transmission is high, schools should take extra care to stick to their prevention strategies. But the main way to protect students is to stop the spread of COVID-19 outside of school.</p>
<h2>What we still don’t know</h2>
<p>It’s not clear how the rise of the delta variant will affect the return to school. People infected with delta tend to <a href="https://doi.org/10.1101/2021.07.07.21260122">spread the virus more</a> than those infected with other strains, and breakthrough infections from this variant can cause <a href="https://doi.org/10.15585/mmwr.mm7031e2">large outbreaks</a> when other prevention measures are not in place. Relying on vaccinations alone to control COVID-19 does not seem to be a winning strategy.</p>
<p><a href="https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report">More children are becoming infected</a> during the delta variant surge. There have been sharp increases in July and August 2021 in the total number of children identified with infections and <a href="https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions">hospitalized for COVID-19</a>. But the number of cases in the general population has increased, too. There has only been a modest increase in the proportion of COVID-19 cases in children relative to other age groups, and that could be due to the fact that children are an increasing share of the unvaccinated. </p>
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<p>COVID-19 never fails to provide new surprises. Many aspects of the next school year remain unknown, but by learning from what worked and didn’t work over the past school year, we have evidence that in most situations students can safely return to school in person as long as these <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/k-12-guidance.html">layered prevention measures</a> are put in place and adhered to.</p><img src="https://counter.theconversation.com/content/165594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brandon Guthrie receives funding from the Washington State Department of Health. </span></em></p>Vaccinations, masks and some distancing – along with low community transmission – can help protect students in classrooms and cafeterias.Brandon Guthrie, Associate Professor of Global Health and Epidemiology, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1636972021-08-10T12:29:00Z2021-08-10T12:29:00ZWhat are COVID-19 variants and how can you stay safe as they spread? A doctor answers 5 questions<figure><img src="https://images.theconversation.com/files/415277/original/file-20210809-19-1b0adqz.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccination, masking and social distancing are tried and true ways to protect against COVID-19 infection.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mother-and-daughter-at-the-pediatric-office-royalty-free-image/1266645987">Marko Geber/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>With the delta variant making up <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">over 98% of COVID-19 cases in the U.S. by mid- August 2021</a>, questions arise about how to stay protected against evolving forms of the t virus. Here, pediatrician and infectious disease specialist <a href="https://scholar.google.com/citations?user=vrcymjkAAAAJ&hl=en&oi=sra">Dr. Lilly Cheng Immergluck</a> of Morehouse School of Medicine answers some common questions about variants and what you can do to best protect yourself.</em></p>
<h2>1. What are variants and how do they emerge?</h2>
<p>Viruses <a href="https://dx.doi.org/10.1007%2Fs00018-016-2299-6">mutate over time</a> to adapt to their environment and improve their survival. Over the course of the pandemic, <a href="https://doi.org/10.1038/s41579-020-00459-7">SARS-CoV-2</a>, the novel coronavirus that causes COVID-19, has mutated enough to change both its ability to spread through the population and its ability to infect people.</p>
<p>These new strains are called <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html">variants</a>. The U.S. Centers for Disease Control and Prevention currently classifies variants into <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html">three categories</a>, listed in order of least to most concerning:</p>
<ul>
<li><p>Variant of Interest (VOI): Have features that may reduce your immune system’s ability to prevent infection. For example, you might have heard of VOI eta, iota or kappa.</p></li>
<li><p>Variant of Concern (VOC): Are less responsive to treatments or vaccines and more likely to evade diagnostic detection. They tend to be more transmissible, or contagious, and result in more severe infections. Alpha and delta are VOCs, for instance.</p></li>
<li><p>Variant of High Consequence (VOHC): Are significantly less responsive to existing diagnostic, prevention and treatment options. They also result in more severe infections and hospitalizations. There have not been any VOHCs identified so far.</p></li>
</ul>
<p>The World Health Organization uses <a href="https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/">similar classifications</a>, but their definitions may differ from the CDC’s U.S.-based ones, as variant features and effects may differ by geographic location.</p>
<h2>2. Are variants always more harmful?</h2>
<p>A variant may be more or less dangerous than other strains depending on the mutations in its genetic code. <a href="https://hub.jhu.edu/2021/07/19/andrew-pekosz-delta-variants/">Mutations can affect attributes</a> like how contagious a viral variant is, how it interacts with the immune system or the severity of the symptoms it triggers.</p>
<p>For example, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html">alpha variant</a> is more transmissible than the original form of SARS-CoV-2. Studies show it’s somewhere between <a href="https://doi.org/10.1126/science.abg3055">43% to 90% more contagious</a> than the virus that was most common at the start of the pandemic. Alpha also is more likely to cause severe disease, as indicated by <a href="https://www.cidrap.umn.edu/news-perspective/2021/06/alpha-sars-cov-2-variant-tied-more-severe-outcomes">increased rates of hospitalization and death</a> after infection.</p>
<p>Even more extreme, the delta variant is reported to be <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html">more than twice as contagious</a> as previous strains and may cause even more severe disease among those who are unvaccinated. The <a href="https://www.statnews.com/2020/04/14/how-much-of-the-coronavirus-does-it-take-to-make-you-sick/">viral load</a> of those infected with delta – meaning the amount of virus detected from the nasal passages of an infected person – is also reported to be <a href="https://doi.org/10.1038/d41586-021-01986-w">over 1,000 times higher</a> than in those infected with the original form of SARS-CoV-2. Recent evidence also suggests that both <a href="https://www.cdc.gov/media/releases/2021/s0730-mmwr-covid-19.html">unvaccinated and vaccinated people carry similar viral loads</a>, further contributing to the especially contagious nature of this variant.</p>
<h2>3. Which variants are most common in the US?</h2>
<p>Over the course of a few months, the delta variant has become the predominant strain in the U.S., accounting for <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">the vast majority of COVID-19 cases at the end of July 2021</a>.</p>
<p><iframe id="T19uC" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/T19uC/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>But there are regional variations across the country. As of July 31, the CDC estimated that the alpha variant represented over 3% of cases identified in a region of eight states that includes Georgia, Florida and Tennessee, compared with less than 1% in the region that includes Iowa, Kansas, Missouri and Nebraska. Since then, the delta variant has dominated alpha and other variants in these regions. The <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">CDC tracks variants</a> in cooperation with state health departments and other public health agencies. <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/cdc-role-surveillance.html">COVID-19 infection samples</a> from across the country are genetically sequenced each week to identify existing and new variants.</p>
<p>And new variants will likely continue to <a href="https://www.vox.com/science-and-health/22586816/next-coronavirus-variant-delta-covid-19">appear as the virus evolves</a>. <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/what-is-delta-variant-coronavirus-with-k417n-mutation-2021-06-23/">Delta plus</a>, for instance, is a sub-lineage of delta. The effects of this subvariant are yet to be determined.</p>
<h2>4. How are vaccines holding up against variants?</h2>
<p>Researchers are working to figure out how effective the <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow.html">three COVID-19 vaccines currently authorized for emergency use</a> in the U.S. are at preventing infection from variants in “real-world” conditions where variant distribution and frequency constantly change. Several preliminary studies that have not yet been peer-reviewed suggest that these vaccines are <a href="https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---20-july-2021">still effective in preventing COVID-19-related serious infections and death</a>. </p>
<p>No vaccine is perfect, however, and <a href="https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html">breakthrough COVID-19 infections</a> are possible in those who are vaccinated. <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html">Older adults and those with immunocompromising conditions</a> may be at increased risk to have these breakthrough infections.</p>
<figure class="align-center ">
<img alt="People getting vaccinated at a clinic." src="https://images.theconversation.com/files/415063/original/file-20210806-21-1abdroh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4000%2C2449&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415063/original/file-20210806-21-1abdroh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415063/original/file-20210806-21-1abdroh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415063/original/file-20210806-21-1abdroh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415063/original/file-20210806-21-1abdroh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=462&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415063/original/file-20210806-21-1abdroh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=462&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415063/original/file-20210806-21-1abdroh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=462&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccines are not foolproof, but they significantly reduce the risk of severe infection.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-get-vaccinated-at-a-vaccination-clinic-at-save-max-news-photo/1233919858">Xinhua News Agency/Getty Images</a></span>
</figcaption>
</figure>
<p>Thankfully, fully vaccinated individuals generally experience <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness/why-measure-effectiveness/breakthrough-cases.html">milder COVID-19 infections</a>. For example, a <a href="https://doi.org/10.1056/NEJMoa2108891">study analyzing COVID-19 cases in England</a> estimated that two doses of the Pfizer BioNTech vaccine are 93.7% effective in preventing symptomatic disease from the alpha variant and 88% effective from delta. A different <a href="https://doi.org/10.1101/2021.06.28.21259420">study in Ontario, Canada, that is not yet peer-reviewed</a> reported that the Moderna vaccine is 92% effective in preventing symptomatic disease from alpha. </p>
<h2>5. How can I stay safe?</h2>
<p>How cautious you should be <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html">depends on a number of individual and external factors</a>. </p>
<p>One factor is whether you’re <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html">fully vaccinated</a>. <a href="https://theconversation.com/us-is-split-between-the-vaccinated-and-unvaccinated-and-deaths-and-hospitalizations-reflect-this-divide-164460">Nearly all - 99.5% - of COVID-19 deaths</a> in the U.S. over the past few months were among unvaccinated people.</p>
<p>The <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html">most recent CDC guidelines</a> recommend that everyone wear a mask in areas of <a href="https://covid.cdc.gov/covid-data-tracker/#county-view">substantial or high transmission</a>, regardless of whether or not <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html">they’re vaccinated</a>. More caution should especially be taken if you <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html">aren’t fully vaccinated</a> or have a <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html">weakened immune system</a>. </p>
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<p>Another factor to consider is the level of community transmission and the proportion of unvaccinated people in your local community. For example, someone who lives in an area that is below the <a href="https://covid.cdc.gov/covid-data-tracker/#county-view">national average for COVID-19 vaccinations</a> may have a higher chance of encountering someone who is unvaccinated – and so more likely to spread the coronavirus – than someone in an area with higher vaccination rates.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/9Tv2BVN_WTk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Properly wearing a mask can help protect you and others from COVID-19 infection.</span></figcaption>
</figure>
<p>Finally, there are still a significant number of people who are at high risk of COVID-19, including children. As of Aug. 18, 2021, <a href="https://data.cdc.gov/Vaccinations/COVID-19-Vaccination-and-Case-Trends-by-Age-Group-/gxj9-t96f">only 32.6% of children ages 12 to 15</a>, and 43% of those ages 16 and 17, had been fully vaccinated. The American Academy of Pediatrics and the Children’s Hospital Association note that <a href="https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-state-level-data-report/">4,413,547 total child COVID-19 cases</a> had been reported as of Aug. 12. Children make up 14.4% of reported COVID-19 cases. If your child is unvaccinated, the best way you can protect them and other unvaccinated members of your household is to <a href="https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19/caring-for-children/families.html">get yourself vaccinated and have everyone wear a mask in indoor public spaces</a>.</p>
<p>Guidelines provided by public health agencies are simply that – general guidelines. They are not tailored to be prescriptive for each individual and their personal risk assessments. </p>
<p>Vaccines remain the best protection against every strain of the novel coronavirus. But <a href="https://doi.org/10.1016/S0140-6736(20)31142-9">masking, social distancing and avoiding crowds and poorly ventilated indoor spaces</a> add extra layers of protection against <a href="https://theconversation.com/what-is-a-breakthrough-infection-6-questions-answered-about-catching-covid-19-after-vaccination-164909">breakthrough infections</a> and lower your risk of <a href="https://theconversation.com/can-people-vaccinated-against-covid-19-still-spread-the-coronavirus-161166">inadvertently spreading the virus</a>.</p>
<p><em>Article updated to reflect data current as of Aug. 19, 2021.</em></p><img src="https://counter.theconversation.com/content/163697/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lilly Cheng Immergluck receives funding from the National Institutes of Health (NIH) and Pediatric Emergency Medicine Associates, LLC. </span></em></p>New variants of the COVID-19 virus may be more contagious and cause more severe disease than the original. A pediatrician and infectious disease specialist explains why.Lilly Cheng Immergluck, Professor of Microbiology, Biochemistry and Immunology, Morehouse School of MedicineLicensed as Creative Commons – attribution, no derivatives.