Last week in Kuala Lumpur, I was at the Plaza Rakyat LRT station when a family lugging wheelie suitcases asked me whether they were at the right platform to get to KL Sentral. Being from out of town myself, I said I did not know, but continued to watch them because the two teenage daughters were wearing surgical masks. I have had a rather ghoulish fascination with infectious diseases since childhood, and when the pandemic started back in April, my lab-mates and I followed it like Malaysians watching the English Premier League.
The family eventually got affirmation from someone else that we were indeed on the correct platform. As we waited for the train, one of the girls’ shoulders shuddered, and she pulled down her mask to cough vigorously without covering her mouth. Relieved, she replaced the mask and continued staring into space.
Despite advisories from the Ministry of Health and other experts, most people still have the wrong end of the stick regarding surgical masks: their primary purpose is to protect other people from your germs, not the converse. The Centers for Disease Control and Prevention’s advice on facemask use is that sick persons, not well, should wear them. They do protect the wearer from large splatters, but they do not filter out aerosol-sized droplets and have big gaps around the nose and sides, unlike a real respirator. When I had to wear an N95 respirator for working with viruses in graduate school, the fitting involved trying on several different models and jumping up and down while being sprayed in the face with a saccharine solution to check if any droplets got through.
(On the other hand, the use of facemasks in healthcare settings such as clinics and hospitals can help to slow the spread of flu, since many people may be infected and shedding virus in those locations. This still does not mean that an uninfected individual wearer is protected, and neither WHO nor the CDC recommend mask use in community settings.)
If facemasks do not work, why are people so enthusiastic about them?
First, it gives people a sense of control over the situation. We can watch out for robbers, but an invisible virus is a terrifying, insidious idea for most (especially those who cannot do math and think the world is ending). Unlike the advice to stay healthy, wash your hands, and go home if sick — which a sensible person should practice all the time anyway — buying a mask gives the consumer a sense of having done something concrete. The same goes for heading to the doctor to demand Tamiflu, which to me is really terrifying because antiviral abuse inevitably leads to viruses becoming drug-proof.
Secondly, I think Malaysians are exceptionally susceptible to silly claims about health because we are muddled between our Asian cultures with their various traditional remedies, modern biomedical science, and Western pop-culture pseudoscience. All you have to do is look at the number of ads in the newspapers and on banners selling health products (Tongkat Ali vs. Quantum Pendants). The exorbitant prices that masks were going for, before the introduction of price controls last week, further encouraged the perception that masks were a valuable prophylaxis against the dreaded flu. The terrible quality of science and math education does not help either, since it creates the mentality that those are things you memorize for exams, not tools for real-world application.
The final irony is that influenza virions (virus particles) are notoriously fragile and break down quickly at room temperature — this is in comparison to viruses like polio, which can hang around in water supplies for quite a long time. In particular, the stability of the virus in aerosols at tropical heat and humidity is significantly less than in the cold, dry winter in so-called ”temperate” countries, which is why we usually have low levels of flu year-round rather than seasonal outbreaks like Europe, Australia, and North America.
Some researchers think that flu is more likely to spread by contact or fomites (contaminated objects) in tropical regions. That means that your best friend is not a facemask, but a soap bottle. As an enveloped virus, flu is particularly susceptible to detergents. Why this has not been more strongly emphasized by the MOH, and why you can see toilet attendants wearing facemasks while guarding public toilets with no soap, boggles the mind.
HWA SHI-HSIA recently finished her MS in comparative biomedical sciences at the University of Wisconsin. She maintains http://xenobiologista.com/blog/.