As India enters three weeks of nationwide lockdown to address COVID-19, we must plan an exit strategy from this scenario now. An indefinite period of quarantine is simply infeasible for a country like India, where so many live hand-to-mouth in an informal economy. Instead, mitigation strategies — which dampen the rate of spread of COVID-19, while allowing Indians to continue working — must be the next phase of the strategy. An expansion of mask production on a war footing and a call to action for all Indians to wear them is imperative to making this policy work.

One characteristic that sets COVID apart from other corona and flu viruses is that a large number of infected people remain asymptomatic. Masks are most effective at reducing the spread of disease from asymptomatic carriers, who may be unaware they have the illness, by capturing emitted droplets. But they can also reduce airborne infection rates among healthy individuals. Masks can also help reduce the natural tendency to touch one’s face, reducing contact spread. Mask use does require facial touching to put on properly and remove. For this reason, it is essential to encourage handwashing or hand sanitiser use before mask insertion or removal.

Masks have proven very effective in the past at limiting infection rates from influenza-like diseases. A review of several studies concluded that: “Surgical masks or N95 respirators were the most consistent and comprehensive supportive measures.” A range of other randomised trials have reached similar conclusions. Surgical masks are not as protective as N95 masks (which are less comfortable to wear) in a laboratory setting but are no worse at protecting from influenza in a healthcare setting. Even the United States’ Centers for Disease Control has said surgical masks are an “acceptable alternative” to N95 masks. In addition, if everyone wears a mask even when they are healthy, it will double the protection from masks. Everyone will be protected by two masks: The one the other person is wearing and the one you are wearing.

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