Around mid-May this year, the Centers for Disease Control and Prevention in the United States eased its mask-wearing guidelines. Those who were fully vaccinated didn’t have to wear masks anymore when in company of other fully-vaccinated people. Most Nepalis, living in Nepal, took off their masks after receiving the second dose of vaccine because “America said you could”.

But medical and public health experts ApEx spoke to unanimously insist that Nepalis must wear masks and wear them properly—not under the chin, below the nose, or dangling by their ear—at least until 70 percent of the population is vaccinated. Currently, the rate stands at less than four and nine percent for double and single dose vaccination respectively. Wearing a mask, thus, isn’t an option. It’s mandatory.

What we also need to understand is that America, where masks aren’t compulsory in outdoor settings, has high vaccination rates and their vaccines have higher efficacy—Pfizer (95 percent) and Moderna (94.1 percent)—than the ones we have received in Nepal (Covishield at 70 percent, VeroCell at 50 to 79 percent and Johnson & Johnson at 66.3 percent).

Dr Binjwala Shrestha of the Department of Community Medicine and Public Health, Tribhuvan University Teaching Hospital (TUTH), says we can’t be careless because Covid-19 cases are on the rise. The figures of daily new infections we hear of are a result of undertesting and underreporting. The data also doesn’t include the results of rapid antigen tests, many of which are positive. The actual figure is much higher, says Dr Shrestha, and you never know who is infected. Masks, she adds, remain the first-line of defense against this deadly virus.

The coronavirus, according to dental surgeon Dr Neil Pande, is 600 times smaller than the width of a hair strand, which makes it highly transmissible. Dr Pande, from the start of the pandemic, has been trying to raise awareness on the importance of proper masking and ventilation to control the spread. Unfortunately, no one is listening and people, he says, are appallingly careless, more so now that the lockdown has been eased and gatherings and celebrations seem to be in full swing.

“The most basic thing we can do is wear a mask, even if and especially if you are vaccinated because you could still be transmitting the virus,” says Dr Pande. Many people seem to have the very concept of vaccine wrong. They think being vaccinated means you are shielded against the virus. But the virus can enter your system and you can infect other people. What it won’t be able to do is replicate and lead to disease and its potential complications. 

Vaccination no excuse

But that doesn’t mean vaccinated people are safe. Not yet, say experts. Dr Bidesh Bista, pulmonologist, Civil Service Hospital of Nepal, says there have been cases of vaccinated individuals getting infected and developing pneumonia. The common perception that if you have been vaccinated, you won’t have severe complications even if you are infected isn’t necessarily true. There have been many cases, worldwide, of people dying of covid complications even after receiving both the vaccine doses.

Dr Samir Kumar Adhikari, joint spokesperson, Ministry of Health and Population, says we can break the chain of infection and be safe only if everybody takes the required precautions. Nepalis, he says, seem to be in a hurry to take off their masks when in fact, now, more than ever, is when everyone needs to be vigilant.

“People look at what’s happening in America, they saw packed Euro Cup stadiums and think they are safe here as well, that the coronavirus threat has been mitigated. That’s not true,” says Dr Adhikari. Our circumstances, he says, are different. We have our own conditions and limitations and our actions should reflect that.

Dr Navindra Raj Bista, assistant professor, Anesthesia and Critical Care, TUTH agrees with Dr Adhikari and adds that our social culture puts us at grave risk. As horrifying as it may sound, our society has never been keen on hygiene. Regular hand washing isn’t an ingrained habit and consciously doing so takes effort—that not a lot of people are inclined to make. Spitting on the sidewalk from steps of stores and while walking and on the road out of buses and cars is also common. The condition of our public transport too ensures close contact among people, making virus transmission easy and likely.

With so much stacked against us, it would be a sin not to do the least we can to keep ourselves safe. Dr Shrestha believes we are committing a social crime of sorts every time we choose to go out without a mask or lower it because “our ears hurt”. Various studies have shown that masks can reduce the risk of infection by 95 percent (when everyone is masked and practicing social distancing measures). 

‘Vaccines are here’

On the streets of Pulchowk and Sanepa in Lalitpur, ApEx questioned several people who weren’t wearing a mask. With mocking smiles and often rolling their eyes, they asked why they should wear one when “the vaccines are already here”. Other responses were “Are masks of any use?”, “You are wearing one, why should I?”, and “We don’t think we have to anymore.”

Some, like Dr Shrestha said, claimed their ears hurt and that masks were suffocating. Others said they simply didn’t feel like wearing one. The people questioned had either not received the second dose of the vaccine or hadn’t been vaccinated at all. When requested for a quick photo, accompanied by the whipping out of a cell phone, every one of them pulled up their masks or fished one out of their pockets.

It basically boils down to people’s attitude, says Dr Shrestha. The ones who are vaccinated think they are safe and are reckless. The fact that they could still transmit the virus and endanger the lives of those around them isn’t of much concern to them. Lack of awareness isn’t the problem here. Rather, it’s the absence of integrity and accountability. Educated people and those belonging to the upper echelons of the society too have a couldn’t-care-less mindset.

Even those who are wearing masks are doing it all wrong. From loosely fitted masks and just covering the mouth to using disposable masks for days and stuffing them in our pockets, we simply aren’t taking it as seriously as we ought to.

Dr Pande stresses the need to wear a properly fitted mask—one that feels snug around the chin and nose, to ensure it is clean, and not to pull it down to the chin and then back up again. Dr Adhikari says a lot of people are wearing the same surgical mask for days on end when a disposable mask should only be worn for four to five hours and then replaced. Dr Bista adds the focus should be on wearing a mask the right way.

Imminent third wave

Experts agree that the best option is a tightly fitted surgical mask but a three-layered cloth mask works as well. N95 masks, they say, are good but not necessary and neither is doubling up if your mask fits well.

“The whole idea of wearing a cloth mask over a surgical mask is so that air doesn’t leak out and you aren’t taking in unfiltered air,” says Dr Bista. A properly worn mask, he adds, won’t fog your glasses either. If that’s been happening then you aren’t putting the mask on correctly. Dr Pande, on the other hand, shares a trick to check if your mask is protective as it should be: Simply hold it up to sunlight. If light filters through, the mask isn’t good enough.

Experts believe the pre-pandemic lifestyle we seem to be following now makes a third wave imminent in Nepal. We have all witnessed the medical catastrophe Covid-19 can bring about—the second wave had us running from hospital to hospital in search of an ICU bed and buying oxygen cylinders in the black market—and the scenario is likely to repeat unless we change our ways. A good place to start would be wearing a mask and doing so properly, irrespective of our vaccination status.