To wear or not to wear a face mask? That has been one of the biggest puzzles for Kenyans amid the coronavirus pandemic.
Advice on the matter has been inconsistent, with health experts and the World Health Organisation earlier advising that people leave the masks to medics and others on the Covid-19 frontline.
That position has, however, been questioned by various researchers, and it is now clear that wearing a mask is crucial in protecting oneself from a virus that has infected more than one million people worldwide and killed more than 50,000.
On Thursday, Health Cabinet Secretary Mutahi Kagwe announced measures to make the wearing of masks mandatory for all travellers, signalling a major policy shift.
In the US, the Trump administration was expected this week to announce that all Americans should wear cloth masks or other face coverings if they go out in public, based on a forthcoming recommendation from the Centers for Disease Control and Prevention that would also mark a shift in federal guidelines amid new concerns that the coronavirus is being spread by infected people who have no symptoms.
The CDC, like WHO, had advised that ordinary people don’t need to wear masks unless they are sick or coughing.
Part of the reason was to preserve medical-grade masks, including N95 respirators, for healthcare workers who desperately need them at a time when they are in continuous short supply.
But according to a US federal official, the CDC will now recommend that everyone wear face coverings in public settings, like pharmacies and supermarkets, to avoid unwittingly spreading the virus.
Public health officials have stressed that N95 masks should be saved for frontline doctors and nurses, who have been in dire need of protective gear.
Earlier this week, Dr Robert Redfield, director of the CDC, confirmed in a radio interview that the agency was reviewing its guidelines on who should wear masks.
Citing new data that shows high rates of transmission from people who are infected but show no symptoms, he said the guidance on mask-wearing was “being critically re-reviewed to see if there’s potential additional value for individuals that are infected or individuals that may be asymptomatically infected”.
Kenya’s guidelines are limited to passenger service vehicles, boda-bodas and tuktuks, but it still brings to the public domain a major tool in the war against the coronavirus that has been previously ignored, and which could prove a game changer in the coming days.
In preparation for a surge in demand, the Ministry of Health approved the Kitui County Textile Centre to produce the masks, while Eldoret-based Rivatex East Africa Ltd has also begun mass production.
Rivatex managing director Thomas Kurgat said the company has the capacity to produce 1,200 masks per day.
On Friday, Industrialisation and Trade Cabinet Secretary Betty Maina announced that the government had made a million masks, which she said would be distributed starting on Monday
Ms Maina said these include masks and overalls, which would be used by healthcare workers.
She did not provide details but Health Chief Administrative Secretary Mercy Mwangangi said the ministry had taken the protective equipment through quality assurance to ensure they can protect healthcare workers.
Dr Jeremiah Chakaya, a pulmonary infections expert and an official at the Respiratory Society of Kenya, told the Saturday Nation that everyone should consider wearing masks when going to public places, while Dr Patrick Oyaro, an epidemiologist with vast experience in public health, said masks are “a physical barrier” that keeps away tiny organisms or microbes that a sick person might expel to the environment.
They also protect healthy people from inhaling those microbes, he said.
The use of masks has been credited for slowing down the spread of the virus in China, Japan, South Korea, and Taiwan, much better in the United States and Europe.
Dr Chakaya said “any time someone has a disease that has affected the lungs, there is a possibility that when they speak, sneeze or cough, they will release droplets in the air”.
The WHO states that larger droplets travel only a few metres before falling to the ground or onto another surface, such as desktops, doors or clothes. Those who touch those surfaces become infected.
The biggest danger, however, is in the tiny droplets, called aerosols in physics, that float in the air for hours, as when healthy people walk into the pathogenic cloud that these microdroplets create, they breathe them in and become infected.
This is what the masks are aimed at preventing. Dr Benjamin Wachira, an emergency medicine specialist and associate professor at The Aga Khan University Hospital, has worn the masks for more than a decade in his line of work.
He has used the N95, which comes in two forms, the N95 respirators and surgical masks.
Both are typically round with a protrusion around the nose area and the mouth. When they are worn, they are able to cover the nose and mouth, and when properly fitted from a tight seal around the nose and mouth.
The N95s can filter out nearly all bacteria, viruses, fungi and other microbes, even in their tiniest form.
Literature around the masks indicates that they got the name from their ability to filter out 95 per cent of particles that are as tiny as 0.3 microns wide. These, unlike dust, are invisible to the eye.
The N95 is made up of a thick mesh of plastic fibres that trap disease-causing germs either on the inside (for the person who is sick and does not want to release this to the environment) or on the outside.
Dr Wachira says the masks should be disposed of whenever they become wet or dirty, or in the unlikely event they are damaged.
“Because people are not used to wearing them, they are likely to touch the masks on the body, and if there are any germs trapped there, they will move them to their face or mouth and contaminate themselves,” he says.
This new interest in masks is coming at a time when the Strategic and Technical Advisory Group for Infectious Hazards, a panel of advisers to the WHO, is studying whether the virus can be projected farther than previously thought after a study in the US suggested that coughs can reach six metres and sneezes up to eight metres.
Speaking at a Chatham House briefing in the United Kingdom on Wednesday, Prof David Heymann, an infectious-disease expert with WHO, said the decision to review the policy of the role of face masks was driven by new evidence from Hong Kong shared confidentially with the WHO.
Already some health experts are advising vulnerable people to wear masks while in public.
For instance, Dr Phindile Erika, an assistant professor of emergency medicine at Emory University in Atlanta, Georgia, told journalists in a web interview this week that pregnant women have been advised to wear masks while in public.
The Kenya Bureau of Standards had given manufacturers until Friday to take their samples for inspection and clearance.
The call came after specialists raised concerns about the quality of locally produced masks.
At best, clothe face masks made my small-scale businesses will be used by the public and the N95s left to healthcare workers.
Affordability will also be a major issue as tailored masks cost between Sh50 and Sh300, while five pieces of the N95 cost no less than Sh2,500.
Ms Main on Friday said that the price could fall to below Sh10 once local manufacturing gathers pace.
Additional reporting by Dennis Lubanga