Experts say strict mask regulations not needed for now

Setting at rest fears over Covid restrictions being relaxed, several experts say the two-year stringent mask mandate has led to fatigue and can be removed from public spaces for now just as many countries have done. While the message around the benefits of masking should continue, it would be wise to lift the mandate and reintroduce it if there is another Covid wave for better compliance, experts said, pointing to the futility of ill-fitting masks and lack of community consensus on the matter.

“The issue is of compliance fatigue,” Ramanan Laxminarayan, director of Washington's Center for Disease Dynamics, Economics & Policy, told PTI while noting that many countries around the world have removed mask restrictions. “I would urge messaging around the usefulness of masking in closed spaces, but would not suggest that it needs to be enforced punitively,” added Gautam Menon, professor, Departments of Physics and Biology, Ashoka University in Haryana.

The assurance comes as India reports a low number of cases  “on Thursday 1,033 new coronavirus infections were recorded” and also one case of a new Covid strain in Mumbai. On Wednesday the Brihanmumbai Municipal Corporation (BMC) reported India's first case of the Omicron recombinant strain XE. However. INSACOG, which monitors genomic variations in the SARS-CoV-2 in India, has decided to take up another round of genomic sequencing at a national lab for confirmation. ‘Recombinant’ means the genome of XE is a combination of the genomes of the BA.1 and the BA.2 sub-variants of Omicron.

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With India seeing the lowest number of COVID-19 cases in two years, several states, including Delhi, Maharashtra, Punjab and Haryana, have done away with the mandatory use of masks. Epidemiologist Laxminarayan said it may be necessary for the public to start using masks again in the future if there is another variant and wave. “But keeping these requirements in place indefinitely causes the public to not take them seriously. It is therefore better to remove them and then reintroduce them when necessary,” Laxminarayan explained. Scientist and modeller Menon agreed.

Given that the BA.2 sub-variant of the Omicron coronavirus variant drove the surge in India during the third wave, it should be possible to relax masking restrictions in public spaces, he said. “Getting compliance with Covid boosters is probably more important than enforcing masks”. “We will have to think about how to return to normal life and this time appears to be as good as any, given what we know. Hopefully the lessons of the pandemic will stick and dealing with any future uptick in cases from a new variant will be easier, since people are now habituated to restrictions,” he added.

Immunologist Satyajit Rath said it was a ‘mistake’ to pretend the pandemic is no longer the responsibility of the state but simply of individual people. “Persistently using 'law-and-order'-style policies, such as all the restrictions is a mistake, especially when used widely and long,” Rath, from Delhi's National Institute of Immunology (NII), told PTI. He also cautioned that removing mask restrictions may lull people into thinking that the pandemic is over and lead to lowering of overall guard against the disease.

“It certainly will, but neither has it helped very much to 'mandate' masking without providing people with accessible, cheap, reusable, effective masks in the first place, and without building a community consensus about masking,” he added. As numbers fall and mandates lift, people are wondering if it is possible to avoid trade-offs between returning to pre-pandemic lifestyles and an uptick in Covid related deaths.

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A recent modelling study in the US found that relaxing masking mandates and other restrictions resulted in some "rebound" in COVID-19-related deaths in most states. The analysis, published in the journal JAMA Health Forum, assumed the current pace of vaccination in the US is maintained into the future, and modelled different dates of lifting mandates.

"The inevitable rebound in mortality was directly attributable to the Omicron variant -- when we repeated the analysis, assuming the infectivity of the previous Alpha and Delta variants, the model did not project such rising mortality after relaxing mask mandates," said study co-first author Benjamin P. Linas, a professor of medicine at Boston University School of Medicine.

In March, the World Health Organization warned that a combination of factors, including misinformation that the pandemic is over, the lifting of mask mandates, ending physical distancing - and a more transmissible Omicron BA.2 variant - are causing an increase of COVID-19 cases globally. Many countries, including China, are still witnessing an uptick in new Covid cases.

Addressing concerns, Menon said that given the current level of vaccination and population exposure in India, it is unlikely that a future wave will cause as much damage as the second wave of the Delta variant last year. The cumulative doses administered in the country so far under the nationwide COVID-19 vaccination drive has exceeded 185.20 crore.

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In Rath's view, while the 'seriousness' of the disease is waning with widespread prior immunisations or infections, it remains true that the more rapidly the virus spreads, the more problems will arise for the healthcare system. “Also, the more widely the virus circulates, the more the chances of a variant with new characteristics emerging,” he added.

Menon added that since cases are at an all-time low at the moment and test positivity is very small, masking won't have a significant effect. He suggested that the time is right to consider opening up, but also to ramp up surveillance for any unusual rise in cases as well as genomic analysis for new variants. “Such surveillance could also incorporate testing for the presence of the virus in waste-water, since this has proved to be a good advance indicator of the disease trajectory.”

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