Misuse and Abuse of Face Masks for COVID-19 Prevention in Nigeria
The science of the prevention and control of COVID-19 pandemic is rapidly evolving, and many countries are adopting preventive measures based on emerging evidence and local applicability. One of such measures is the use of face mask to either protect uninfected persons from acquiring the infection or prevent infected persons from spreading it to others (otherwise called source control).
The Nigerian Centre of Disease Control (NCDC) recently released an advisory on the use of masks by members of the public without respiratory symptoms. It recommended wearing of face masks, (or equivalent) as an optional additional layer of protection to be used in addition to other measures such as physical distancing, hand and respiratory hygiene measures. Unfortunately, despite strong advice by the NCDC about the dangers of inappropriate use and disposal of face mask, it is observed that many Nigerians are misusing and abusing face masks in a bid to protect against COVID-19.
The Nigerian Infectious Diseases Society (NIDS) is a multidisciplinary society of practitioners in the field of infectious diseases (ID), with a vision to advance the prevention and control of ID in Nigeria. The society is concerned that inappropriate use of face masks (both medical or homemade) without consideration given to hand hygiene, prevention of self-contamination and contamination of the environment, and how inappropriate use could facilitate further spread of COVID-19 in Nigeria.
Specifically, the NIDS has observed the following inappropriate habits and practices regarding use of face masks for COVID-19 prevention in Nigeria:
- Medical masks such as surgical masks and N95 respirators are being routinely used for non-medical purposes by members of the general public and government officials, even as these medical masks are not available in sufficient quantities in our hospitals.
- N95 respirators with exhalation valves are being used indiscriminately by top government officials and wealthy personalities. It should be noted that this type of respirator is not appropriate for use as a means of source control since they do not prevent the release of exhaled respiratory particles from the wearer into the environment. Unfortunately, many unsuspecting Nigerians may be exposed to infected droplets from those who wear these respirators and do not know that they are infected.
- The Nigeria media is awash with images of members of the general public, including top ranking government officials, wearing face masks on their jaws and neck without covering their mouth or nose, or covering only their mouth while the nose is left opened. This practice could lead to exposures of the uncovered areas to infected droplets especially when the wearer is in close proximity with an infected person that has respiratory symptoms.
- Many people who use face masks are commonly observed to pull down their face masks to their jaws to talk and then pull it back over their mouth and nose after talking. This practice could result in self-contamination of the users face and may spread the virus to others if the user is unknowingly infected and disperses infected droplets while talking.
- People are also observed to repeatedly touch the front of their face mask in a bid to adjust the face masks, to remove it or touch their face masks during reflex touching of their face. This practice could lead to contamination of the hands of the wearers especially as the front and inside of the masks are the most potentially contaminated parts of the masks.
- Some remove their face masks inappropriately without practicing hand hygiene and then hold these masks with their bare hands or keep them inside their pockets or with personal belongings. This practice could lead to contamination of hands, clothing and surroundings of the wearer if the face masks were already contaminated before removal.
- It is also observed that some people wear one single face masks for prolonged periods during the day without replacing when they are wet or damp or when they are required to be washed and reused. When face masks are used for prolonged periods without replacement, they no longer protect the wearer and may serve as a medium for the growth of micro-organisms including viruses.
- Face masks used for prevention of COVID-19 by the general public are being disposed inappropriately on the streets, on walkways and everywhere in the environment. This practice could lead to widespread contamination of the environment if the face masks were already contaminated by droplets from an infected person.
To mitigate the negative and unintended consequences of misuse and abuse of face masks in the prevention and control of COVID-19 in Nigeria, the NIDS makes the following recommendations.
- The Federal and state governments, the NCDC and other relevant agencies of governments, and their partners, should heighten awareness creation on when to use, how to use and how to dispose of face masks appropriately.
- To preserve medical masks for use by healthcare workers in the face of global scarcity, surgical masks and respirators such as N95 masks should be reserved for healthcare workers and those caring for suspected or confirmed COVID-19 patients. The Federal and State governments are advised to adopt a policy banning use of medical masks by the general public except during care of a patient with respiratory symptoms.
- Where face masks use by the public has been made mandatory by a state government, sufficient quantities of homemade masks must be made available for use by the populace and strategies should be instituted to enable appropriate use and disposal.
- Relevant Federal and State government agencies should ensure all locally produced face masks are safe, they do not significantly affect breathing when worn, and are wide enough to completely cover the nose and mouth.
- When using face masks, the general public should learn to always cover their nose and mouth, not to touch the front or inside of the masks, adjust and remove the masks using the straps when necessary and dispose used masks in a closed waste bin where available or store used face masks safely inside a polythene bag for later disposal. Preferably, hand hygiene should be practiced every time the masks is touched.
- The ministries of environment in the various states and the Federal Capital Territory should devise strategies to mitigate indiscriminate disposal of face masks by making provisions for covered waste bins in public spaces, proactively and safely removing used face masks from the environment, decontaminating areas contaminated by used face masks and applying appropriate sanctions on defaulters where necessary.
- The NIDS recognizes that prolonged wearing of face masks is not comfortable and appropriate use may not always be feasible outside healthcare settings. The general public is advised to comply with guidelines provided by the NCDC and to adopt strict social distancing measures such as staying at least 1metre from other persons, avoiding crowds and staying at home when use of homemade masks may not be feasible.
Public mask wearing is most effective at stopping spread of the novel coronavirus when compliance is high, when masks are used appropriately and when they are used in combination with hand hygiene. The NIDS commits to supporting the NCDC and other relevant government agencies to engage in continuous advocacy and public sensitization to promote rational use of face masks in Nigeria.