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COVIDWATCHIRL Masks

"There is much unfinished business to be dealt with quickly before Ireland can begin to ease coronavirus restrictions."

That is according to Professor Liam Glynn who talks to Kevin O'Sullivan of the Irish Times on how an All-Ireland exit strategy for Covid-19 is best. Read more here  

 

Professor Liam Glynn on 'Face masks for the public'

Will science meet sense? COVID-19 and the Republic of Ireland’s response

Cloth Face Coverings - how to make and use your own

Masks, in our view, should serve as a reminder to everyone that Coronavirus is around & that we need to be vigilant against this threat.

Face masks for the public during COVID-19 crisis

In response to the paper by Trisha Greenhalgh and colleagues arguing if it is time to apply the precautionary principle of face masks for the public during COVID-19 crisis, Professor Liam Glynn writes;

Rapid Response:

Re: Face masks for the public during the covid-19 crisis - Will science meet sense? COVID-19 and the Republic of Ireland’s response

Dear Editor,

In response to your journal's recent analysis [1], we have been watching with interest the debate around use of masks by the general public to reduce transmission of SARS-CoV-2. With the US CDC recommending all citizens wear homemade cloth masks when out in public [2], several countries already using masks with compelling results [3] and recent advice from the UK [1][4], the issue is being hotly debated currently on the island of Ireland. The scientific evidence remains unclear but if the “precautionary principle” [1] is applied, in our view, the benefit does appear to outweigh the risks.

We propose that clear guidance and appropriate instruction to the public will allow us to collectively “own” this issue in Ireland while not risking the supply of medical-grade masks to frontline workers.

Growing evidence about asymptomatic spread [5,6] is a further issue for which use of cloth masks makes intuitive sense. Whether or not this bears out in the research, the homemade cloth mask as a symbol in our fight against SARS-CoV-2 may at the very least serve as a reminder to all to comply with other public health measures, such as maintaining distance and good hand hygiene etc., even if this represents a significant cultural shift for Western social norms.

Our successful national response to “flatten the curve” of SARS-CoV-2 spread [7] and the noticeable return of national flags to many hedges, poles, walls and windows reminds us that unity and community are important aspects of any collective action against a national threat.

We previously raised the question [8], would the Irish trajectory in this pandemic follow that of Bergamo (northern Italy) or Busan (South Korea)? Our progress to date falls somewhere between the two, though with each passing day the results of our strategy seems to be tending toward the South Korean response, as demonstrated by our daily publication of comparative data on Twitter at #COVIDWATCHIRL.

The main area for improvement in our ongoing response is the protection of our vulnerable patients. While concerns regarding our low critical care capacity [9] predominated much of the discussion early on in this crisis, we know that 42% of COVID-19 deaths thus far have happened in the community in the Republic of Ireland [10]. Ireland clearly needs to improve here, our older and infirm patients deserve far better. While not a uniquely Irish problem [11,12], the tragedy of lonely deaths in isolation rooms is deeply saddening and disturbing for a country where saying goodbye via the wake and other funeral traditions are a huge cultural asset for grieving families.

Planned testing of all patients and healthcare workers in nursing homes and residential care settings and increased testing capacity in general aims to decrease COVID-19 infections in such important community-based facilities [13]. This increased testing capacity will also supply key data to inform decisions, particularly as we begin to ease restrictions [14] and go through cycles of “suppress and lift”.

However, ultimately we remain the vectors of SARS-CoV-2 and so continued engagement by the general public with public health advice is the most effective weapon against this virus' spread. We hope encouragement and granting of personal responsibility around the use of homemade masks in public will help keep us all focused on this great national effort and science can ultimately meet sense on this important issue.

REFERENCES
1. Face masks for the public during the covid-19 crisis
Greenhalgh Trisha, Schmid Manuel B, Czypionka Thomas, Bassler Dirk, Gruer Laurence.
BMJ 2020; 369 :m1435
Available at- https://www.bmj.com/content/369/bmj.m1442 (accessed 19-4-20)

2. Use of Cloth Face Coverings to Help Slow the Spread of COVID-19
Centres for Disease Control and Prevention, United States.
Available at: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth... (accessed 19-4-20)

3. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity
Kar Keung Cheng, Tai Hing Lam, Chi Chiu Leung
The Lancet. April 16, 2020
Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30918-1/fulltext#articleInformation (accessed 20-4-20)

4. Covid-19: should the public wear face masks?
Javid Babak, Weekes Michael P, Matheson Nicholas J.
BMJ 2020; 369 :m1442
Available at: https://www.bmj.com/content/369/bmj.m1442 (accessed 19-4-20)

5. Covid-19: four fifths of cases are asymptomatic, China figures indicate.
Day Michael.
British Medical Journal 2020; 369 :m1375
Available at- https://www.bmj.com/content/369/bmj.m1375 (accessed 19-4-20)

6. Suppression of COVID-19 outbreak in the municipality of Vo, Italy
Enrico Lavezzo, Elisa Franchin, Constanze Ciavarella, Gina Cuomo-Dannenburg, Luisa Barzon, Claudia Del Vecchio, Lucia Rossi, Riccardo Manganelli, Arianna Loregian, Nicolò Navarin, Davide Abate, Manuela Sciro, Stefano Merigliano, Ettore Decanale, Maria Cristina Vanuzzo, Francesca Saluzzo, Francesco Onelia, Monia Pacenti, Saverio Parisi, Giovanni Carretta, Daniele Donato, Luciano Flor, Silvia Cocchio, Giulia Masi, Alessandro Sperduti, Lorenzo Cattarino, Renato Salvador, Katy A.M. Gaythorpe, Imperial College London COVID-19 Response Team, Alessandra R Brazzale, Stefano Toppo, Marta Trevisan, Vincenzo Baldo, Christl A. Donnelly, Neil M. Ferguson, Ilaria Dorigatti, Andrea Crisanti
medRxiv 2020.04.17.20053157.
Available at- https://doi.org/10.1101/2020.04.17.20053157 (accessed 19-4-20)

7. Statement from the National Public Health Emergency Team - Thursday 16 April
Department of Health (DOH) website.
Available at: https://www.gov.ie/en/press-release/0906df-statement-from-the-national-p... (accessed 20-4-20)

8. Bergamo or Busan: What will be the outcome of Ireland’s response to the COVID-19 pandemic?
Liam G Glynn, Michael E O’Callaghan, Khalifa Elmusharaf.
Available at- https://www.bmj.com/content/368/bmj.m810/rr-18 (accessed 19-4-20)

9. National adult critical care capacity and activity census report 2019.
Acute Operations Division, HSE and Critical Care Programme, National Clinical Programmes, Clinical Design and Innovation, HSE.
Available at- https://www.hse.ie/eng/about/who/cspd/ncps/critical-care/critical-care-c... (accessed 19/4/20)

10. The latest news as of 6pm on Saturday April 18
Department of Health (DOH) website.
Available at: https://www.gov.ie/en/news/7e0924-latest-updates-on-covid-19-coronavirus/ (accessed 19/4/20)

11. Mortality associated with COVID-19 outbreaks in care homes: early international evidence
International Long-Term Care Policy Network.
Adelina Comas-Herrera, Joseba Zalakain, Charles Litwin, Amy T Hsu and Jose-Luis Fernandez-Plotka.
Available at: https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbr... (accessed 19/4/20)

12. Coronavirus: Care home deaths 'far higher' than official figures.
BBC News website. 19/4/20.
Available at: https://www.bbc.com/news/uk-52341403 (accessed 19/4/20)

13. Statement from the National Public Health Emergency Team - Monday 20 April
Department of Health (DOH) website.
Available at: https://www.gov.ie/en/press-release/b02c86-statement-from-the-national-p... (accessed 20-4-20)

14. Daily briefing on the government's response to COVID-19 - Monday 20 April 2020.
Department of Health (DOH) website.
Available at: https://www.gov.ie/en/publication/a96939-daily-briefing-on-the-governmen... (accessed 20-4-20)

Competing interests: No competing interests