A mandatory mask

Pakistan is courting a public health disaster of epic proportions. Having officially infected more than 205,462 individuals and taken 4,167 lives as of June 29, the coronavirus pandemic is spreading at an exponential rate.

With even official sources predicting 1-1.2 million infections by end-July, we are merely weeks from entering a catastrophic phase which will result in the loss of tens of thousands of precious lives – an unimaginable horror.

We should not be here. Pakistan has had months to prepare. Yet, in what has become a disappointingly predictable pattern, the national discourse yet again descended into contradictory policy statements, political point-scoring, and at times outright obfuscation. Amidst the babble, we lost sight of measures which could offer both high containment effect and would be reasonably viable. Months have been lost in a divisive debate which has pitted citizen health against the economy, posing a false dichotomy which is stalling other policy actions with the potential to halt the spread of the virus.

While debates about lockdowns, smart or otherwise, have their place, the single paramount measure which can be adopted without delay is universal mask-wearing. Masks can drastically reduce spread, are inexpensive, can be easily produced, distributed, and even made at home. They will cut down transmission in crowded urban areas, particularly if combined with thoughtful distancing measures.

“Masks are effective in decreasing viral loads even when they are imperfect,” states Dr Siddharta Mukherjee, Pulitzer prize-winning author and NYC-based researcher who is emphasizing mask-wearing, particularly in crowds, closed spaces, and close-contact settings. Dr Mukherjee is part of 100 prominent academics calling on governors across the United States to make mask-wearing mandatory via the #masks4all campaign.

Lest further time be lost to debate, there are two critical questions to answer. First, does mask wearing reduce Covid-19 spread in high population-density countries? An emphatic yes. Mask-wearing is a key part of virus combat tactics in East Asian countries such as South Korea, and Japan, which have high population densities yet some of the lowest infection and mortality rates. In Japan, despite no lockdown, as of May 8, there had been less than 600 fatalities.

Berkeley computer scientist De Kai’s maksim simulation model calculates that with 80 percent of a population using masks, Covid-19 infections drop by a game-changing one-twelfth the number of infections.

Any residual doubts can be dispelled by a read of the ‘The Masks Masquerade’ by world-renown mathematical statistician, Nassim Nicholas Taleb. In this scathing opinion, he points out six errors in reasoning about face covering. First amongst these is underestimating the significant compound effect which accrues when a majority masks up. Unfortunately, ill-informed international debate made even this simple measure controversial. It shouldn’t be.

With the premise accepted, the question becomes one of how best to ensure near-universal adoption. Present adoption in Pakistan is sub-optimal, to put it mildly. One can get into statistical inferences, but you need only drive out to a major bazaar in any large city – it is not a comforting sight. Under De Kai ‘s model, high uptake will be required to attain optimal infection reduction – at 30-40 percent, the benefits won’t be substantive.

In Pakistan, this can be achieved through a multi-pronged approach – educate, equip, and enforce. First, mask wearing must be driven single-mindedly through a coherent national campaign in coordination with provincial governments, civil society, and media. The public sector can magnify its resources through collaboration with Pakistani civil society, leveraging its deep experience in community outreach and ensuring that the message can reach every household, village, and urban dwelling.

For mask wearing to become instinctive, they need to be affordable and readily available to all social classes. The National Command and Operations Centre already has the mandate for PPE provision. It needs to double down on ensuring supply, and that an effective delivery-chain is put in place. An easily identifiable quality standard would also help. This can be done through public-private cooperation, using financial incentives to stimulate industrial production where necessary. Delivery prioritization must start from highest-risk/lowest utilization, and then work outwards. If private corporations can deliver fizzy drinks to the remotest mountain villages, surely this is not beyond our collective capability.

These steps alone won’t get us there; a large proportion of the population will continue to disregard the advice to mask without enforcement. Here, the state’s administrative and security apparatus must adopt a tough position and mandate compulsory mask-wearing in public. High, deterrence-inducing fines must be imposed on anyone found to be deliberately non-compliant.

There is much room to discuss various other effective measures, but universal mask wearing offers an edifice upon which these can be layered. It must be moved from recommended to the compulsory category. The lack of proactive action will only ensure that many thousands of precious Pakistanis lives will be lost, a catastrophe which must not be allowed to pass. Universal mask wearing can turn the tide by quite literally muzzling the virus. The hour of decisive action is now.

The writer is an economic competitiveness specialist.

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Arsalan Ali Faheem

Arsalan Ali Faheem is an economic competitiveness specialist. He tweets at @arsalanalif, and his essays and opinions can be found at arsalanalifaheem.com