Skip to main content

Covid appropriate behaviour? Why masks can't be suitable in hot, humid climate

By Dr Amitav Banerjee*
Appearances can be deceptive. So can be Covid Appropriate Behaviour (CAB). An anecdote illustrates this well known cliché. A man who is very particular about hygiene decides to eat out. After a rather long search, he spots a restaurant which has a spotlessly clean exterior and he walks in.
A waiter in spotlessly clean attire ushers him to a spotlessly clean table. The waiter takes out a pair of spotlessly clean silver tongs from the pocket of his spotlessly clean jacket and with it takes out a spotlessly clean menu card from his other pocket. After going through it the fastidious customer is about to hand it back to the waiter who tells him to throw it away in the nearby waste bin.
The waiter informs that the hotel management is very particular about hygiene and even the menu cards are disposable to prevent cross contamination. The customer is thoroughly impressed now and pats himself on the back on his choice of restaurant. He orders cutlets.
The waiter brings them in a spotlessly clean silver casserole, takes out the spotlessly clean tongs from his pocket, picks up the cutlets and puts them on a spotlessly clean plate. The customer muses on the efforts made to ensure zero transmission of any infection in this spotlessly clean hygienic restaurant.
While munching on his cutlet he noticed a peculiar thing. All the waiters were dressed in spotlessly clean white jackets and black trousers.What intrigued him was that the uniform had a white string hanging over the front flap of the black trousers.
When the waiter brought his bill he enquired about this fascinating aspect of the waiters’ attire. The waiter replied, “Sir, as I told you the management is stickler for hygiene. They want to ensure that even when we go to the washroom we do not use our fingers." 
We use this white string to pull down the zipper!
The customer was impressed by this attention to details. Just as he got up and was leaving, a thought came to him and he asked the waiter, “I get the string to pull down the zipper part, but after that how do you proceed?” “I cannot say about the others, but as for me I use these tongs,” the waiter replied pulling out the spotlessly clean silver tongs from the pocket of his spotlessly clean jacket!
The above anecdote can also be used to explain the principle of “Hazard Analysis and Critical Control Points” or HACCP, a method in food hygiene to make a flow diagram of food from the farm to the plate between which there may be many a slip. After critically examining the process at each step in the flow diagram, “hazard analysis” identifies the hazardous practices, or the “critical control points.” HACCP method has been increasingly applied for critical appraisal of hygienic measures beyond the food industry.
The term “appropriate technology” is one of the principles of health care with a goal to attain Health for All at the Alma-Ata conference in 1978 endorsed by the World Health Organisation (WHO). Appropriate technology has been defined as technology that is scientifically sound, adaptable to local needs and acceptable to the people. It may be worthwhile to examine CAB under the lens of science, HACCP and “Appropriate Technology.”
CAB advocates three practices; use of masks, physical distancing and hand-washing. Wearing of masks has been a bone of contention since the onset of the pandemic. Initially even the great Anthony Fauci, who claims that if you attack him you are attacking science, flip flopped on the need for the common citizen to wear masks, first saying there is no good reason for them to wear masks, then advocating it and subsequently going to the other extreme of recommending double masking.
While few “convenient studies,” mostly observational, including a recent messy meta-analysis published in BMJ, conclude they reduce transmission, two rigorous randomized trials found none to modest reduction in transmission of the virus. 
These modest findings were under study conditions where participants are under observation and a sort of population placebo effect known as the Hawthorne effect comes into play. Being study participants, they would tend to use the masks more properly than practiced by the common citizen under normal conditions.
Viruses are very small particles, many times tinier than the pores of a mask, surgical or cloth. Even a high school student would know that masks would not work as filters for any virus. Therefore the advocacy for masks hinges on spread of droplets carrying the virus. These droplets are thrown out during speaking, coughing or sneezing. Let us do HACCP analysis on use of masks by the common citizen.
It is common tendency to pull down the mask while speaking, and then pull it up. The purpose of mitigating spread of droplets while speaking, when more droplets are expelled, gets defeated. Similarly when a group of people enter a restaurant all masked up, for eating they have to pull down their masks (in some places in the West there are mandates that one should pull up their masks between bites!). Good food increases salivation and speaking while eating with family and friends ejects “lethal” droplets full of virus!
Physical distancing is not appropriate technology for a country with high population density where homes and public transport are crowded
After leaving the restaurant all don their masks as they enter the street outwardly observing Covid Appropriate Behaviour! Transmission, if any, has already occurred indoors. So by the principles of HACCP, masks would have little impact on mitigation of transmission of the virus, until one masters the technique of withholding one’s breath, and observe “maun vrath”! Common sense without fancy trials should also guide policy.
What about mask being “appropriate technology” for hot humid conditions in the country. Surprisingly, no one is studying the harm which masks can cause if used improperly. In hot humid conditions, they get wet with sweat and saliva within hours and the common citizen cannot afford the frequent change which is required to prevent infections with perhaps more lethal pathogens. Fungus including mucor can thrive on moist masks.
Being close to the nose the organisms growing on these soiled masks can easily reach the sinuses and potentially cause life threatening infections. It raises the question whether the high rate of mucormycosis in the country in the second wave occurred due to improper use of soiled masks in addition to underlying diabetes and use of steroids.
Similarly the practice of physical distancing is not “appropriate technology” for a country with high population density where homes, public transport, and even airplanes are crowded. The last practice of frequent hand washing may be the only one which may be feasible by citizens and policy makers alike – the former may keep washing their hands with soap and water, the latter have already “washed their hands off” accountability as they can blame the citizen for not observing CAB in case of any surge!
---
*Professor & Head, Community Medicine, Clinical Epidemiologist; Editor-in-Chief, Medical Journal Dr DY Patil Vidyapeeth, Pune

Comments

TRENDING

North Gujarat gram panchayat bars villagers from dealing with Muslim hawkers, traders

By Our Representative  A gram panchayat in North Gujarat has barred its residents not to buy anything from Muslim traders and hawkers. An order of the Waghasan group gram panchayat of Tharad taluka of Banaskantha district dated June 30 states that the decision has been taken in the wake of beheading of a Hindu tailor after he posted a derogatory writeup on Prophet Mohammad in Udaipur. The gram panchayat resolution says, anyone seen buying or selling any commodity from a Muslim hawker or trader would be fined Rs 5,100. Bringing this to light, Mujahid Nafees, convener, Minority Coordination Committee, in a letter to Gujarat chief minister Bhupendra Patel, says, the state government should take legal action against the panchayat chief who has signed the “unjust” order. The letter says, the act of the sarpanch and other signatories is a violation of rule of law of the state and threat to peace, pointing out, the move is in violation of Article 15 of the Constitution, which says that none

Unlike Soviet Union, Russia is no friend to India: Ukrainian scholar tells 'Indian friends'

Counterview Desk In an open letter to "dear Indian friends", Anastasia Piliavsky, born in Odessa, Ukraine, studied at Boston and Oxford Universities (on a Rhodes Scholarship), and now teaches at King’s College, London, has said that she faces "deep moral dilemma", personally and professionally, over the "astonishingly unified Indian response to the war in Ukraine." Based on her interaction with a "number of thoughtful and caring Indian friends", in this letter, she says, she is "reeling at the ubiquitous silence at, justifications of or outright support for Putin’s terror, which now prevails in India, at the ubiquitous #IStandWithPutin and #istandwithrussia hashtags." She insists, India must understand, "Unlike the Soviet Union, Russia is no friend to India. Soviet leaders, beginning with (the Ukrainian) Nikita Khrushchev – who declared hindi rusi bhai bhai – built up deep political and cultural exchange with India." Text : I

PLFS data: Is rising employment good news? Deeper analysis suggests contrary results

By Ishwar Chandra Awasthi, Puneet Kumar Shrivastav*  Results of the Periodic Labour Force Survey (PLFS), 2020-21 , released by the Ministry of Statistics and Programme Implementation, Government of India (GoI) on June 14, 2022, show improvement in work force participation rate (WPR) and labour force participation rate (LFPR) and declining unemployment rate. Four rounds of data have been released from 2017-18 to 2020-21 based on PLFS. The general trend in the last four rounds clearly shows consistent increase in WPR and LFPR and falling unemployment rates by usual status (PS+SS). Though increase in WPR and LFPR is reported highest in 2019-20 over 2018-19, yet rising trend in these two key indicators continues throughout, and similarly fall in unemployment is registered highest in 2019-20 over 2018-19. Clearly, the recent results give some solace and relief after unprecedented Covid-19 pandemic that has entailed enormous loss of human lives and livelihoods and crippled economic activit

Technocratic globalism, tyranny? Health Ministry warned: bill to 'enslave' Indians

Sandeep Pandey, Tushar Gandhi By Rosamma Thomas*  Union of Concerned Citizens, a group comprising Magsaysay Award winner Prof Sandeep Pandey, human rights activist Tushar Gandhi, former judge of the Bombay High Court BG Kolse Patil, pediatrician Dr Jacob Puliyel and several renowned Indian citizens have written to the Union Health Minister cautioning him against tabling the draft Public Health Bill in the Monsoon Session of Parliament. “The Public Health (Prevention, Control And Management Of Epidemics, Bio-Terrorism And Disasters) Bill, 2017 and a Prospective Bill of 2022 as discussed in news articles, is straightforwardly violative of Fundamental Rights of the citizens of India and therefore, Ultra Vires of the Indian Constitution. It contravenes several International Treaties and Conventions including the Nuremberg Treaty of 1947 which was enacted to ensure that no country would repeat such inhuman medical atrocities on fellow human beings”, the 12-page letter reads. “Strangely, t

'Drop all falsed charges': 150 citizens demand early release of AltNews co-founder

Counterview Desk  About 150 concerned citizens have demanded the release of Mohammed Zubair, co-founder of the fact-checkng newsportal AltNews, arrested over a 2018 tweet which allegedly hurt religious sentiments, even as booking for criminal conspiracy and having received foreign funds in violation of the Foreign Contribution Regulation Act (FCRA). Denied bail last weekend and sent to 14-day judicial custody, the concerned citizens, in a statement, regretted that while the Delhi High Court issued notice to the Delhi police on a petition filed on behalf of Zubair challenging the legality and propriety of his police remand and the seizure of his electronic devices, the “frivolous case” continues. Excerpts: The illegal arrest of Mr. Mohammed Zubair happened on June 27, 2022, by the Delhi Police for allegedly hurting religious sentiments and promoting enmity over a tweet from 2018. The IPC Sections included 153(a) (Promoting enmity between different groups on grounds of religion, race,

Chennai residents 'suffering': Faulty design, implementation of storm water project

By NS Venkataraman*  The Greater Chennai Corporation is now implementing storm water drainage project in 559 roads, covering a distance of 1033 kilometres, which cost around Rs 4,070 crore. For this massive project, which is targeted to be completed between April and September this year, huge loan has been availed from World Bank, Asian Development Bank and others. Several technocrats have pointed out that the project has been designed with outdated technology and quality of the implementation is so poor that the residents have been put to great hardships. As part of the project, digging of the road has been done to around 5 to 6 feet deep and width of around 4 to 5 feet. The drains are being constructed using steel reinforced cement concrete with two walls on either side with provisions for manhole, chute etc. This has been done in front of several houses leaving little space between the gate of the house and that of the drainage structure. As the work has been going on for mor

Prime Minister's 'affordable' housing policy fails to help Gujarat slum dwellers: Study

By Rajiv Shah  A new study on the implementation of one of the major policy initiatives for the urban poor by the Narendra Modi government after it came to power, Pradhan Mantri Awas Yojana (PMAY), has said that in Gujarat, which happens to be the Prime Minister’s home state, has quoted state officials as “confirming” that no progress towards tenure regularization, a key requirement for providing housing to the state’s slum dwellers. Stating that this particularly true of smaller town, the study, carried out by the non-profit Homes in the City (HIC), which is based in Bhuj, district headquarter of Kutch that saw a devastating earthquake in 2001, says, the failure to provide affordable housing is there despite the fact that there has been “significant demand” in all the 83 out of 153 Gujarat municipalities studied by experts involved in the study. According to the study, out f a total of 1.41 lakh demands for housing under the Beneficiary Led Construction (BLC) category, 94,232 (66.7%)

'Contractor-official nexus led to RTI activist's murder': Fact-finding team seeks probe

Courtyard inside of PWD office where Ranjeet Soni was killed Counterview Desk  A fact-finding team* visited Vidisha, Madhya Pradesh (MP) on June 19, 2022 to meet with the family of Ranjeet Soni, who was shot dead on June 2, 2022 inside the premises of the PWD office in Vidisha. The objective was to gather information about the circumstances surrounding the death of Ranjeet Soni and his work on exposing corruption through the use of the Right to Information (RTI) Act. A report prepared by the team members says that Ranjeet had been extensively using the RTI Act to access information from the government, and upon receiving documents showing misuse of public funds or corruption, he was filing complaints to various authorities including the Lokyukta, Publi Works Department (PWD) and the Chief Minister’s Office. It notes, Ranjeet used to work as a contractor and often undertook government works in collaboration with other contractors, including those being investigated for his murder. A f

Buddhist shrines were 'massively destroyed' by Brahmanical rulers: Historian DN Jha

Nalanda mahavihara By Our Representative Prominent historian DN Jha, an expert in India's ancient and medieval past, in his new book , "Against the Grain: Notes on Identity, Intolerance and History", in a sharp critique of "Hindutva ideologues", who look at the ancient period of Indian history as "a golden age marked by social harmony, devoid of any religious violence", has said, "Demolition and desecration of rival religious establishments, and the appropriation of their idols, was not uncommon in India before the advent of Islam".

Electricity Bill: Centre's reform measures contain 'carrot and stick package' for states

Counterview Desk  The Peoples’ Commission on Public Sector and Public Services (PCPSPS), claiming to be a network of eminent academics, jurists, erstwhile administrators, trade unionists and social activists, seeking consultations with stakeholders with those who are against the government’s decision to monetise, disinvest and privatise public assets/enterprises, has said that the proposed Electricity (Amendment) Bill-2022 will have far-reaching impacts on the finances of states. Insisting that the proposed Bill would lead to “assault on India’s federal structure”, in a statement, it says, it would weaken the finances of states’ power distribution companies, have adverse impact on utility employees, cripple the states' finances, impose a heavy cost burden on the smaller subsidized consumers (especially farmers), and benefit only corporate business houses. “States cannot afford to ignore the far-reaching implications of the Bill on their economy, finances, agricultural and industria