Main focus for preventing coronavirus spread should be hand hygiene, not face masks

“If I have to make a choice, I will keep my hands clean, I will use hand sanitizer, I will wash my hands with soap and water," a WHO official said.
Image: A woman with a protective face mask in Milan
A passenger with a face mask in Milan on Feb. 27, 2020Marco Di Lauro / Getty Images

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By Rosemary Guerguerian, M.D.

Frequent hand-washing, not wearing a face mask, is the most important step the public can take to prevent the spread of the coronavirus, the World Health Organization said Thursday.

Michael Ryan, the executive director of the WHO Health Emergencies Programme, addressed the use of face masks during a media briefing Thursday. The WHO stance regarding surgical masks being worn by the general public is that only those who are already sick with a respiratory illness should wear them.

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“If I have to make a choice, I will keep my hands clean, I will use hand sanitizer, I will wash my hands with soap and water. I would cough into my sleeve, I will ensure that I, you know, when I touch surfaces, that I wash my hands after,” Ryan said. Other WHO recommendations include not touching your face and keeping a distance from someone coughing or sneezing.

The use of masks by health care workers is different. It’s recommended that health care workers wear a specific type of mask called an N-95 respirator, and not a surgical mask often seen used by the general public.

Health care workers use N-95 masks when dealing with some respiratory illnesses. When the masks are used, they’re worn in addition to other personal protective equipment. Health care workers undergo routine testing to ensure they know how to fit their masks correctly and use precise procedures to remove their equipment to protect themselves after close contact with infected patients. According to the Centers for Disease Control and Prevention, every step and piece of equipment is necessary for that level of protection.

There are indications that there is already a shortage of masks, particularly the N-95s, Ryan said.

“It’s very important, if we have shortages of masks, that we use them for the front line workers, and that we prioritize the use of those masks for the people who really need it in hospital, but also for people who are taking care of people at home,” Maria Van Kerkhove, the technical lead of the WHO's Health Emergencies Programme.

The question of masks for the general public was raised in regard to the stigmatization in China of people choosing to wear them.

“We don’t want to tell people what not to do,” Ryan said. “People take action to protect their health and we are not going to criticize them for trying to protect their health. What we try to do is tell people how to do it properly and then what else you need to do.”

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People across the world wear face masks for a variety of reasons. “Historically, populations and communities in Asia have used masks for pollution purposes in cities … so we have to take that into account,” Ryan said. “That’s why we are very sensitive about saying no to people.”

The WHO recommendation for face mask use by the general public is that people who are sick should wear them — not healthy people.

“We recommend people to wear masks if they themselves are sick,” Van Kerkhove said. “The reason for that is for them to prevent the transmission to someone else, not to protect themselves from getting infected.”

She also highlighted the importance of using masks properly. The WHO guidance on how to put on and remove a face mask is on its website.

The organization's words echo what medical providers practice on a daily basis. A vast volume of research has shown time and again that frequent hand-washing has the greatest effect on preventing the transmission of respiratory illnesses, more so than disinfecting surfaces or using protective equipment such as surgical masks, N-95 respirators, gowns or gloves. Keeping hands clean is the No. 1 thing the public can do.

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