Universal Use of Facemasks Against Coronavirus Disease-19 in Nigeria: A Necessity or an Overreaction?

AUTHORS

Roland Nnaemeka Okoro ORCID 1 , *

1 Department of Clinical Pharmacy and Pharmacy Administration, University of Maiduguri, Maiduguri, Nigeria

How to Cite: Okoro R N. Universal Use of Facemasks Against Coronavirus Disease-19 in Nigeria: A Necessity or an Overreaction?, Int J Health Life Sci. Online ahead of Print ; 7(1):e105638. doi: 10.5812/ijhls.105638.

ARTICLE INFORMATION

International Journal of Health and Life Sciences: 7 (1); e105638
Published Online: August 5, 2020
Article Type: Review Article
Received: May 23, 2020
Revised: July 18, 2020
Accepted: July 29, 2020
Crossmark
Crossmark
CHECKING
READ FULL TEXT

Abstract

The upsurge of cases of coronavirus disease-19 (COVID-19) worldwide has compelled many countries including Nigeria to recommend mandatory use of facemask to their citizen in public places to limit the spread of this virus. Although to date, there is no documented evidence that facemask use by the public protected healthy people against COVID-19. Nevertheless, the World Health Organization encourages the general public to wear a non-medical mask in public settings in areas of community transmission. This paper reports on the current mandatory use of facemask by the Nigerian public and highlights the implications of such use.

Copyright © 2020, International Journal of Health and Life Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Context

The coronavirus disease (COVID-19) is primarily a respiratory disease caused by a novel strain of coronavirus that emerged in 2019. The first case of this virus was reported in Wuhan city of China on 31 December 2019 (1). In Nigeria, the first COVID-19 case was reported in Lagos state on 27 February 2020 (2). The index case is an Italian man who works in Nigeria and returned from Milan to Lagos on 25 February 2020 (2).

The infectious nature of this virus compelled the World Health Organization (WHO) to declare COVID-19 a global public health emergency on 30 January 2020 and a pandemic on 11 March 2020 (3, 4). The incubation period of this virus ranges from 2 - 14 days (5). The common signs and symptoms are fever, cough, and tiredness (5). Other symptoms include a loss of taste or smell, shortness of breath or difficulty breathing, muscle aches, chills, sore throat, runny nose, headache, chest pain among others (5). The virus is mainly transmitted through respiratory droplets (that are ejected when speaking, coughing, or sneezing), and contact routes (6, 7).

Since the outbreak of this disease in Wuhan, it has spread to 188 countries/regions as of July 16, 2020, resulting in 13,589,273 confirmed cases, and 584,990 deaths worldwide (8).

2. COVID-19 and Non-Pharmaceutical Intervention (Facemask Use by the General Public)

Facemasks are made of different materials and designs (9) which influences their filtering capability and efficacy. Two types of facemasks are medical masks (surgical mask and N-95 respirator) and non-medical mask (cloth mask). A surgical mask is a disposable barrier device that is loosely worn over the mouth and nose against any potential contaminants in the immediate environment. If appropriately worn, guards against the large-particles droplets, splashes, sprays, or splatter from an individual’s cough or sneeze that may contain COVID-19. It may also help to reduce exposure of the wearer saliva and respiratory secretions to others.

The N-95 respirator is a tightly fitted facial protective device that is capable of filtering airborne particles efficiently. It filters out 95 percent or more of the smallest particles in the air, but they have to fit just right in order to work efficiently. The WHO currently recommends that medical mask should be reserved for healthcare personnel, people with symptoms of COVID-19 infection, caregivers, or those sharing living room with persons suspected of having COVID-19 infection (6).

Cloth mask is made of other materials which may be tightly woven cotton fabric, such as quilting fabric, cotton sheets, or T-shirt fabric with or without sewing, including using a bandana and coffee filter to create a face covering (10). In areas of community transmission WHO encourages the general public to wear non-medical masks in public settings (grocery stores, at work, social gatherings, closed settings, including schools, churches, mosques, etc) (6). Similarly, the United States’ Center for Disease Control (CDC) recommends wearing a cloth facemask in public places (grocery stores and pharmacies) where physical distancing is difficult to achieve (10). Consistent with these guidelines, the Nigerian Centre for Disease Control recommends the use of cloth facemask to the general public, especially when going to crowded places such as markets, shops, and pharmacies among other places in addition to compulsory preventive measures such as social and physical distancing, hand hygiene, and other non-pharmaceutical measures (11).

From the foregoing, one may ask, is facemask use by the public capable of preventing healthy people from contracting COVID-19? To date, there is no documented evidence that universal facemask use in the community protected healthy people against COVID-19 (6, 12, 13). Though, the absence of evidence is not evidence of absence.

3. COVID-19 and Non-Pharmaceutical Intervention (Facemasks Use by the General Public) Across the Globe

From global perspectives, most countries have mandated their citizens to use a facemask in public places in an effort to contain the spread of COVID-19. Austria, Bosnia and Herzegovina, China, Czech Republic, Hong Kong, South Korea, Japan, Thailand, Taiwan, Slovakia, the United States of America (USA), Germany, Indonesia, Israel, Morocco, Vietnam, Mongolia, and Canada are among the countries that have ordered/implemented mask use by the general population (14-29). Others are Argentina, Bahamas, Bahrain, Benin Republic, Bulgaria, Cameroun, Chile, Democratic Republic of Congo, Rwanda, Ecuador, Guinea, Honduras, India, Italy, Kenya, Liberia, Lithuania, Luxembourg, Mozambique, North Macedonia, Pakistan, Philippines, Poland, Turkey, Jamaica, Russia, Spain, Slovenia, Ukraine, Uzbekistan, and Zambia (30-57).

In line with the global trend, On 27 April 2020, the Nigerian government made the use of facemasks in public places mandatory for its citizens as one of the mitigation measures against the spread of COVID-19 in the country (58).

4. COVID-19 and Non-Pharmaceutical Intervention (Facemask Use by the General Public) in Nigeria

The transmission characteristics of COVID-19 made surgical facemask to become a hot and scarce commodity in Nigeria a few days after the index case was confirmed. As of 28 February, 2020 the cost of surgical facemask (a box of 50 masks) in the open market rose from about 700 Nigerian Naira (1.94 USD) to 25,000 Nigerian Naira (69.44 USD). Nigerians struggled to acquire surgical masks to protect themselves. The mismatch between demand and supply for this critical item due to panic buying and disruption in the supply chain worldwide during lockdown caused many pharmacies to run out of stock.

Prior to the mandatory facemask use in Nigeria, citizens voluntarily wear surgical masks outside their homes. However, overreaction by the population and the order that the general public should wear facemask caused acute shortages of surgical masks and hike in the price we are currently witnessing in our country. The scarcity of this item spurred some ingenious Nigerian tailors to start local manufacturing of cloth masks as an alternative in order to meet the rising demand.

5. The Implications of the Mandatory Facemask Use by the Nigerian General Public

The belief of most Nigerians that surgical mask is more effective than cloth mask also contributed to shortages and high cost of surgical masks. This has made them unavailable or out of the reach for those who genuinely need them such as frontline health workers, people with respiratory tract infections or those who have been confirmed to have the COVID-19 and their caregivers.

Apart from shortages of surgical masks and cost issues, a major concern of facemask use by the public is that it could create a false sense of security that may end up putting people at a greater risk of COVID-19 due to the tendency to abandon other preventive measures such as hand hygiene, social and physical distancing (6). Again, it may also lead to touching of the face under the masks and under the eyes with unwashed hands thereby increasing the chance of an individual contracting the virus (6). This highlights the need to enlighten the general public of which a majority is not educated on what mask to wear, when and how, and on the importance of continuing to strictly follow all other layers of preventive measures such as hand hygiene, physical and social distancing, and other non-pharmaceutical measures.

6. Conclusion

Despite the lack of evidence of reduced community transmission of COVID-19 with the use of facemask by apparently healthy people in the community, it is associated with uncertainties and unimaginable consequences. It may take away the surgical masks from those that genuinely need them such as frontline health workers, people with respiratory tract infections, or who have been confirmed to have the COVID-19 and their caregivers. Again, it could create a false sense of security that may end up putting people at a greater risk of COVID-19. Therefore, decision-makers should enlighten the public on the appropriate use of masks and the importance of continuing to strictly follow all other layers of preventive measures.

Footnotes

References

  • 1.

    WHO. Coronavirus disease (COVID-19) in China. 2020, [cited 15 July 2020]. Available from: https://www.who.int/china/emergencies/coronavirus-(covid-19).

  • 2.

    Nigerian Centre for Disease Control (NCDC). First case of coronavirus disease confirmed in Nigeria. 2020, [cited 15 July 2020]. Available from: https://ncdc.gov.ng/news/227/first-case-of-corona-virus-disease-confirmed-in-nigeria.

  • 3.

    WHO. Statement on the second meeting of the International Health Regulation (2005). Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Geneva, Switzerland; 2020, [cited 15 July 2020]. Available from: https://who.int/news-room/detail/30.01.2020-statement-on-the-second-meeting-of-the-international-health-regulation-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-nCoV).

  • 4.

    WHO. WHO Director General's opening remarks at the media briefing on COVID-19. 2020, [cited 15 July 2020]. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19-11-march-2020.

  • 5.

    Mayo Clinic. Coronavirus disease 2019 (COVID-19). 2020, [cited 15 July 2020]. Available from: https://www.mayoclinic.org/diseases-conditions/coronavirus/symptoms-causes/syn-20479963.

  • 6.

    World Health Organization (WHO). Advice on the use of masks in the context of COVID-19. 2020, [cited 15 July 2020]. Available from: https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novelcoronavirus-(2019-ncov)-outbreak.

  • 7.

    Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen H, et al. Facemasks against COVID-19: An evidence review. PNAS. 2020. doi: 10.20944/preprints202004.0203.v2.

  • 8.

    Johns Hopkins University. COVID-19 Dashboard by the Center for System Sciences and Engineering (CSSE) at Johns Hopkins. 2020, [cited 15 July 2020]. Available from: https://coronavirus.jhu.edu/map.html.

  • 9.

    Brosseau L. N95 Respirators and Surgical Masks. 2009, [cited 16 July 2020]. Available from: https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/.

  • 10.

    Centers for Disease Control and Prevention (CDC). Coronavirus Disease 2019 (COVID-19). 2020, [cited 18 April 2020]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html.

  • 11.

    Nigeria centre for Disease Control (NCDC). Advisory on the use of masks by members of the public without respiratory symptoms. 2020, [cited 18 April 2020]. Available from: https://www.covid19.ncdc.gov.ng/resources/guideline/UseOfmasks.pdf.

  • 12.

    National Health Service (NHS). Are face masks useful for preventing coronavirus?. 2020, [cited 18 April 2020]. Available from: https://www.nhs.uk/conditions/coronavirus-covid-19/commonquestions/.

  • 13.

    Federal Ministry of Health (FMH). Daily updates on the coronavirus: is wearing a surgical mask, as protection against acute respiratory infections, useful for members of the general public?. Germany; 2020, [cited 18 April 2020]. Available from: https://www.bundesgesundheitsministerium.de/en/press/2020/coronavirus.html.

  • 14.

    Bell B. Coronavirus: Why you now have to wear a mask in Austrian shops. BBC News; 2020, [cited 23 April 2020]. Available from: https://www.bbc.com/news/world-europe-52143873.

  • 15.

    Andelane L. Coronavirus: Countries where face masks are mandatory in COVID-19 fight. Newshub; 2020, [cited 18 April 2020]. Available from: https://www.newshub.co.nz/home/world/2020/04/coronavirus-countries-where-face-masks-are-mandatory-in-covid-19-fight.html.

  • 16.

    National Health Commission of the People's Republic of China. Guidelines on different mask for different groups of people. 2020, [cited 18 April 2020]. Available from: https://web.archive.org/web/20200405123936/http://en.nhc.gov.cn/att/20200207/1581067840474054531.jpg.

  • 17.

    Tait R. Czechs get to work making masks after government decree (Republic and Slovakia are only countries in Europe to make coronavirus mask-wearing mandatory). The Guardian; 2020, [cited 18 April 2020]. Available from: https://www.theguardian.com/world/2020/mar/30/czechs-get-to-work-making-masks-after-government-decree-coronavirus.

  • 18.

    Chambers M. German city introduces face masks for shoppers as coronavirus spreads. Reuters; 2020, [cited 18 April 2020]. Available from: https://www.reuters.com/article/us-health-coronavirus-germany-masks/german-city-introduces-face-masks-for-shoppers-as-coronavirus-spreads-idUSKBN21I10K.

  • 19.

    Centre for Health Protection. Prevention of Coronavirus Disease 2019 (COVID-19). 2020, [cited 18 April 2020]. Available from: https://www.chp.gov.hk/files/pdf/prevention_of_covid_19_en.pdf.

  • 20.

    Ngui Y. Malaysia to Give Out Masks to Households as Guidance Shifts. Bloomberg; 2020, [cited 18 April 2020]. Available from: https://www.bloomberg.com/news/articles/2020-04-08/malaysia-to-give-out-masks-to-households-as-guidance-shifts.

  • 21.

    Staff T. Netanyahu urges wearing masks outside; announces stipends for kids, elderly. The Times of Israel; 2020, [cited 18 April 2020]. Available from: https://www.timesofisrael.com/netanyahu-tells-israelis-to-wear-masks-outside-gives-stipends-for-kids-elderly/.

  • 22.

    Eljechtimi A. Morocco makes face masks compulsory due to coronavirus. Reuters; 2020, [cited 18 April 2020]. Available from: https://www.reuters.com/article/us-health-coronavirus-morocco/morocco-makes-face-masks-compulsory-due-to-coronavirus-idUSKBN21O31E.

  • 23.

    Chia-nan L. Virus Outbreak: Fines authorized for unmasked riders Taipei Times. 2020, [cited 18 April 2020]. Available from: https://taipeitimes.com/News/front/archives/2020/04/04/2003733965.

  • 24.

    Everington K. Masks mandatory on Taiwan trains, inter-city buses starting today. Taiwan News; 2020, [cited 18 April 2020]. Available from: https://www.taiwannews.com.tw/en/news/3908366.

  • 25.

    Po-wei W, Wan-lin L, Lin K. Taiwan mask output to hit 10 million per day by next week: minister. Focus Taiwan; 2020, [cited 18 April 2020]. Available from: https://focustaiwan.tw/business/202003090013.

  • 26.

    The Star. All in Vietnam must wear face mask in public places for coronavirus prevention. 2020, [cited 18 April 2020]. Available from: https://www.thestar.com.my/news/regional/2020/03/16/all-in-vietnam-must-wear-face-mask-in-public-places-for-coronavirus-prevention.

  • 27.

    Mahase E. Covid-19: What is the evidence for cloth masks? BMJ. 2020;369:m1422. doi: 10.1136/bmj.m1422. [PubMed: 32265341].

  • 28.

    Government of Canada. Consideration in the use of homemade masks to protect against COVID-19. Notice to general public and healthcare professional. 2020, [cited 19 April 2020]. Available from: https://www.canada.ca/en/health-products/medical-devices/activities/announcements/covid19-notice-home-made-masks.html.

  • 29.

    Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). 2020, [cited 18 April 2020]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html.

  • 30.

    Bickel JA. Casa Rosada, provincial governments recommend using homemade face masks. Buenos Aires Times; 2020, [cited 23 April 2020]. Available from: https://www.batimes.com.ar/news/argentina/casa-rosada-and-local-governments-now-recommend-using-face-masks.phtml.

  • 31.

    Bahamas Local. Mandatory use of Face Mask Requirement. 2020, [cited 23 April 2020]. Available from: https://www.bahamaslocal.com/newsitem/241148/mandatory_use_of_face_mask_requirement.html.

  • 32.

    Arab News. Bahrain makes face masks compulsory in public, allows shops to re-open. 2020, [cited 23 April 2020]. Available from: https://www.arabnews.com/node/1656026/middle-east.

  • 33.

    Kaledzi I. Benin enforces compulsory face mask wearing over covid-19. Africa Feeds; 2020, [cited 23 April 2020]. Available from: https://africafeeds.com/2020/04/09/benin-enforces-compulsory-face-mask-wearing-over-covid-19/.

  • 34.

    Sofia News Agency. As of Today, Wearing Masks in Public Places in Bulgaria is Mandatory. 2020, [cited 23 April 2020]. Available from: https://www.novinite.com/articles/204102/As+of+Today%2C+Wearing+Masks+in+Public+Places+in+Bulgaria+is+Mandatory.

  • 35.

    VOA News. Cameroon City makes wearing mask mandatory in fight against coronavirus. 2020, [cited 23 April 2020]. Available from: https://www.voanews.com/science-health/coronavirus-outbreak/cameroon-city-makes-wearing-mask-mandatory-fight-against.

  • 36.

    Chile reports. The use of masks in enclosed public spaces becomes mandatory. 2020, [cited 23 April 2020]. Available from: https://chilereports.cl/en/news/2020/04/20/the-use-of-masks-in-enclosed-public-spaces-becomes-mandatory.

  • 37.

    Tasamba J. COVID-19: Rwanda, DR Congo makes mask wearing mandatory. AA News; 2020, [cited 23 April 2020]. Available from: https://www.aa.com.tr/en/africa/covid-19-rwanda-dr-congo-make-mask-wearing-mandatory/1810165.

  • 38.

    XINHUANET. LatAm countries turn to face masks to contain pandemic. 2020, [cited 23 April 2020]. Available from: http://www.xinhuanet.com/english/2020-04/08/c_138956755.htm.

  • 39.

    Africa News. Guinea orders the compulsory wearing of face masks in public. 2020, [cited 23 April 2020]. Available from: https://annafrica.news/2020/04/guinea-orders-the-compulsory-wearing-of-face-masks-in-public/.

  • 40.

    Gonzalez J, Castillo J, Humayun H. Honduras makes it mandatory to wear face masks in public. CNN; 2020, [cited 23 April 2020]. Available from: https://edition.cnn.com/world/live-news/coronavirus-pandemic-04-07-20/h_cc68da29376ef362f108cac9fc190be6.

  • 41.

    Withnall A. Coronavirus: India makes face masks mandatory for more than 300m people, punishable by up to six months in prison. Independent; 2020, [cited 23 April 2020]. Available from: https://www.independent.co.uk/news/world/asia/coronavirus-india-face-masks-prison-police-who-delhi-mumbai-a9458516.html.

  • 42.

    The Guardian. Lombardy insists on face masks outside homes to stop Covid-19. 2020, [cited 23 April 2020]. Available from: https://www.theguardian.com/world/2020/apr/05/lombardy-insists-on-face-masks-outside-homes-to-stop-covid-19.

  • 43.

    Muraya J. Masks now mandatory in public places, Kenya declares. Capital News; 2020, [cited 23 April 2020]. Available from: https://www.capitalfm.co.ke/news/2020/04/masks-now-mandatory-in-public-places-kenya-declares/.

  • 44.

    Brooks C. As Coronavirus On The Increase, Liberia's Health Minister declares forceful use of face masks nationwide. CNN Liberia; 2020, [cited 23 April 2020]. Available from: http://gnnliberia.com/2020/04/21/as-coronavirus-on-the-increase-liberias-health-minister-declares-forceful-use-of-face-masks-nationwide/.

  • 45.

    Jačauskas I. Lithuanian government extends quarantine, makes facemasks mandatory. 2020. Available from: https://www.lrt.lt/en/news-in-english/19/1161456/lithuanian-government-extends-quarantine-makes-facemasks-mandatory.

  • 46.

    Ville de Luxembourg. Mandatory use of masks. 2020, [cited 23 April 2020]. Available from: https://www.vdl.lu/en/news/mandatory-use-masks.

  • 47.

    All Africa. Mozambique: Government orders wearing of masks. 2020, [cited 23 April 2020]. Available from: https://allafrica.com/stories/202004091000.html.

  • 48.

    Garda World. North Macedonia: Face masks required in public spaces. 2020, [cited 23 April 2020]. Available from: https://www.garda.com/crisis24/news-alerts/335411/north-macedonia-face-masks-required-in-public-spaces-april-23-update-7.

  • 49.

    Pakistan Today. Balochistan govt makes face masks mandatory. 2020, [cited 23 April 2020]. Available from: https://www.pakistantoday.com.pk/2020/04/18/balochistan-govt-makes-face-masks-mandatory/.

  • 50.

    The Star. Philippines require people to wear masks in public. 2020, [cited 23 April 2020]. Available from: https://www.thestar.com.my/news/regional/2020/04/02/philippines-requires-people-to-wear-masks-in-public.

  • 51.

    ALJAZEERA. Which countries have made wearing face masks compulsory?. 2020, [cited 23 April 2020]. Available from: https://www.aljazeera.com/news/2020/04/countries-wearing-face-masks-compulsory-200423094510867.html.

  • 52.

    Bobylev S. Face masks made mandatory in Russia's Khabarovsk to prevent coronavirus spread. Russian News Agency; 2020, [cited 23 April 2020]. Available from: https://tass.com/society/1117559.

  • 53.

    Hodgson C. Obligatory use of face masks in Spain to combat coronavirus is delayed. The Olive Press; 2020, [cited 23 April 2020]. Available from: https://www.theolivepress.es/spain-news/2020/04/07/obligatory-use-of-face-masks-in-spain-to-aid-combat-coronavirus-is-delayedd/.

  • 54.

    Total Slovenia News. COVID-19 and Slovenia, Night 29 March: Movement restrictions, mandatory masks, more aid for individuals. 2020, [cited 23 April 2020]. Available from: https://www.total-slovenia-news.com/politics/5951-covid-19-slovenia.

  • 55.

    gov-ua. New restriction measures for the period of quarantine explained. 2020, [cited 23 April 2020]. Available from: https://www.kmu.gov.ua/en/news/rozyasnennya-shchodo-novih-obmezhuvalnih-zahodiv-na-period-karantinu.

  • 56.

    timesca. Afghanistan reports first coronavirus fatality, Uzbekistan makes protective masks mandatory. 2020, [cited 23 April 2020]. Available from: https://www.timesca.com/index.php/news/22276-afghanistan-reports-first-coronavirus-fatality-uzbekistan-makes-protective-masks-mandatory.

  • 57.

    Zambian Watchdog. Lungu orders mandatory wearing of masks. 2020, [cited 23 April 2020]. Available from: https://www.zambiawatchdog.com/lungu-orders-mandatory-wearing-of-masks/.

  • 58.

    Ajasa F. Covid-19: Face masks now compulsory for Nigerians, total lockdown in kano-Buhari. The News Guru; 2020, [cited 23 April 2020]. Available from: https://www.thenewsguru.com/news/nigeria-news/article/covid-19-face-masks-now-compulsory-for-nigerians-total-lockdown-in-kano-buhari.

  • COMMENTS

    LEAVE A COMMENT HERE: