(This article was first published in CC Weekly)
Text/Hongtao Zhang Doctor of Pharmacology in the United States, special expert of Phoenix Network "Tumor Intelligence Agency"
Core Synopsis:
1. On April 12, the National Disease Control and Prevention Administration released the latest version of the Guidelines for the Prevention of Novel Coronavirus Infection by the Public Wearing Masks (April 2023 Edition). The guidelines specify 7 situations in which masks are not allowed and 4 scenarios in which masks are recommended, and also indicate 6 situations or scenarios in which masks should be worn. This version of the guidelines does not completely eliminate masks, but only further reduces the situations or scenarios in which masks should be worn.
2. In the case that the lifting of the mandatory wearing of masks has become a general trend, the public is more concerned about whether the failure to wear masks will trigger a new wave of the epidemic. Data show that after Hong Kong completely lifted the "mask order" on March 1, the virus did not have a large-scale rebound.
3. As the first responsible person for our own health, we should know three common sense about masks: (1) In addition to the new coronavirus, masks can also prevent other respiratory viruses; (2) Physical protection such as masks can only delay the virus, and cannot completely and permanently isolate it; (3) This is a world full of viruses, viruses cannot be avoided, we must develop corresponding protection plans according to our own health conditions.
After wearing a mask for more than three years, is it time to take it off?
Nearly three months after the implementation of "Class B and B tubes" in response to the new crown epidemic, on April 12, the National Disease Control Administration issued the latest version of the Guidelines for the Prevention of Novel Coronavirus Infection by the Public Wearing Masks (April 2023 Edition).
The guidelines clearly stipulate that masks can be worn in 7 situations such as outdoor places such as open-air squares and parks, indoor workplaces and conference rooms where personnel are relatively fixed, and masks are recommended in 4 scenarios such as taking public transportation such as subways and buses.
At the same time, the guidelines also indicate 6 situations or scenarios in which masks should be worn:
During the period of the new coronavirus infection "Class B tube", China has issued five versions of the guidelines for wearing masks, and the background of this version is that the global epidemic is still prevalent, the virus strain is still mutating, and there is still a risk of the epidemic rebounding. This version of the guidelines does not completely eliminate masks, but only further reduces the situations or scenarios in which masks should be worn. Focus on the guidance of the public wearing masks, and put forward categorical suggestions on whether masks should be worn, recommended to wear masks, and may not wear masks for common situations and scenarios closely related to public life, work, and study.
Masks have been synonymous with the "epidemic" in China in the past three years.
Now, this last symbol of epidemic prevention is still not ready to be completely canceled.
Wearing masks is one of the most important and effective prevention and control means to prevent infectious diseases, and it is also an effective way to interrupt the spread of the new coronavirus. Epidemiological studies have shown high use of masks in countries where infection rates have remained low throughout the pandemic. According to a WHO study on masks, mask requirements have also been shown to significantly slow the spread of the virus in countries around the world.
But when masks are removed has become an important indicator of when the epidemic will end and whether it is still prevalent.
▎ Photo/On March 31, at a seminar held in Guangzhou, Academician Zhong Nanshan said, "In the past three years, wearing masks has been a very good and effective means of preventing pathogens, but at this stage of the development of the epidemic, wearing masks can become a non-mandatory measure." People with long-term low exposure to pathogens such as influenza, lack of stimulation of the nasal cavity, is not conducive to the formation of the body's natural immunity, after entering April, conditions permitting, it is recommended to wear masks. ”
Since 2022, countries around the world have lifted the mandatory requirement for masks in public places. On April 18, 2022, a federal judge in Florida, USA, vetoed a U.S. federal government mask mandate for transportation during the pandemic, and since then, all major U.S. airlines have quickly lifted mask requirements for domestic flights. Later, wearing a mask or not even became a "political event" in the United States. The state's judgment on this is also less consistent.
About a month after California lifted the mask ban in public places, it further announced that from April 3, medical workers no longer need to wear masks or get vaccinated to work in medical facilities including hospitals, urgent care centers, dentistry, and physician offices. But visitors and patients are free to choose. On April 10, US President Joe Biden signed a bill to officially end the national coronavirus emergency.
Nearly three months after the announcement of "Class B and B pipe" in China, Macau and Hong Kong announced in March that they would revoke the mask order that had been maintained for more than two years and lasted for more than 950 days. Mainland Taiwan relaxed the mask order on February 20. These three places also stipulate that masks are still mandatory in the two designated places of "medical care and public transportation". In East Asian countries, which are more serious about fighting the epidemic, Singapore lifted the mandatory mask requirements in public transport systems and schools on February 13, Japan on March 13, and South Korea on March 20.
On March 13, the Ministry of Education, the National Health Commission, and the National Disease Control and Prevention Administration jointly issued a document clarifying that teachers and students are not mandatory to wear masks in colleges and universities, primary and secondary schools; Children in kindergarten institutions are not required to wear masks during kindergarten, and teachers and staff are not required to wear masks during kindergarten. But the mask order did not extend to the public.
This edition of the new mask guidelines shows that the country has not yet reached the time to completely remove masks.
When did the domestic version of the mask order originate? How can local governments adjust mask orders "according to local conditions"?
China's first public release of a special "mask order" was the Notice on Printing and Distributing Guidelines for the Protection of Different Risk Groups of Novel Coronavirus Infection and Guidelines for the Use of Pneumonia Masks for the Prevention of Novel Coronavirus Infection, launched on January 30, 2020.
At that time, the new crown epidemic broke out in Wuhan for less than a month, and people's awareness of the new crown epidemic only stopped at the SARS outbreak in 2003. Masks are considered an important line of defense against respiratory infectious diseases and can reduce the risk of new coronavirus infection. The health commission said that "based on the current understanding of the disease, guidelines have been developed on how to use masks correctly." ”
For the first time, this guideline clarifies that "it is the most important measure to wear masks for the prevention of respiratory infectious diseases, and proposes the principles for wearing, the types of recommended masks and the objects of use, the principles for handling masks after use, and the standards and precautions for children to wear masks..."
Since then, wearing masks has been fixed as an important epidemic prevention mechanism to prevent the new crown epidemic.
In 2021, the Health Commission issued the Guidelines for the Wearing of Masks by the Public and Key Occupational Groups (August 2021 Edition) for the second time.
According to this guideline, the general public is (1) in indoor crowded places such as shopping malls, supermarkets, cinemas, venues, exhibition halls, airports, docks and common areas of hotels; (2) When taking van elevators and public transportation such as planes, trains, ships, long-distance buses, subways, and buses; (3) Masks are required when in crowded outdoor places such as open-air squares, theaters, and parks.
In addition to the above scenes and situations of wearing masks, there are also when visiting and accompanying people in the hospital; When symptoms such as nasopharyngeal discomfort, cough, sneezing, and fever occur; When the restaurant or cafeteria is not eating.
Since December last year, China has successively issued the "Overall Plan on the Implementation of "Class B and B Management" for Novel Coronavirus Infection and the "New Coronavirus Infection Prevention and Control Plan (Tenth Edition)", which still require "insisting on frequent hand washing and wearing masks" in these two documents announcing that the domestic epidemic has entered "Class B and B Management".
That is, formally, there is not a single document announcing the end of the mask order.
At present, there is only one clear official lifting of the mask order, which is the notice issued by the three ministries on March 13 this year, requiring teachers and students to no longer mandate the wearing of masks.
The notice gives a national "scientific wearing of masks" landing plan, that is, to distinguish scenes, crowds and epidemic situations, and then decide whether masks should be worn. Specifically, for kindergarten institutions, children do not wear masks during kindergarten, teachers and staff are not mandatory to wear masks during kindergarten, and they can choose whether to wear masks according to their personal health conditions and wishes; For colleges and universities, primary and secondary schools, teachers and students are not required to wear masks during school, and they can choose whether to wear masks according to their personal health conditions and wishes.
However, for the masking order for the public, all localities are still continuing to implement the 10th and 21st edition of the mask guidelines.
On March 20, according to the "Chengdu Release" WeChat public account, Chengdu Metro strictly implemented the requirements of the "Novel Coronavirus Infection Prevention and Control Plan (10th Edition)" issued by the Comprehensive Group of the Joint Prevention and Control Mechanism of the State Council: "Advocate the public to abide by the basic code of conduct for epidemic prevention, insist on washing hands frequently and wearing masks." ”
At present, subways in various places no longer strictly regulate passengers to wear masks, and wearing masks is still a local random behavior, not a rule that can be followed.
However, to cancel the mask order, amendments to the Guidelines on the Wearing of Masks by the Public and Key Occupational Groups (August 2021 Edition) are required. Wang Weiping, director of the Department of Epidemiology at the School of Public Health of Fudan University, believes that the mainland can refer to Hong Kong's operation, that is, relax the regulations on wearing masks, but in nursing homes, hospitals and other institutions, it is still required to continue to wear, especially in some areas with poor medical access, it is recommended to assess according to the specific local conditions, maintain flexibility, and dynamically adjust the "mask order" in a timely manner according to the development of the epidemic prevention and control situation.
But at present, the large-scale spread of influenza A in the spring, there are still about 1,000 new crown positive infections every day, and considering the concerns about the second wave of the epidemic, this may be the main reason why masks have not been completely eliminated in this version of the mask guidelines.
▎Photo/On January 28, various towns and streets in Dongguan carried out a publicity campaign of "all people wear masks", distributing masks to citizens for free, reminding citizens not to forget to "cover" and take care of themselves during the Spring Festival.
Will taking the subway and flying without wearing masks trigger a new wave of epidemics? One month after Hong Kong relaxed mask order, has new crown infections increased or decreased?
Everyone wants the epidemic to pass quickly, and they all want to forget the unpleasant memories of the epidemic as soon as possible. Intentionally or unintentionally, we may have forgotten the rules we had set in place to deal with the pandemic, and we need to adapt them to keep pace with the times.
For example, everyone now feels that checking nucleic acid is a very distant thing, and they do not know that they now come to China from many countries and regions, and they also need to submit a negative nucleic acid report within 48 hours.
Regarding masks, let's just say that even if all experts do not feel the need to wear masks, if the subway still has a mask rule, then if you don't wear a mask, you may still not be able to take the subway; And for a person who is coughing, as long as there is a mask on his face, even if the mask cannot block the coughed droplets, he has not violated any rules
Masks, it seems, are only one form left.
From the trend point of view, the lifting of the mandatory requirements for masks is sooner or later implemented by subway and bus systems everywhere. People may be more concerned about whether they should wear masks, but whether they will trigger a new wave of epidemics after not wearing masks?
There is no standard answer to this question, but the situation in Hong Kong can be used as a reference. Hong Kong has completely lifted the "mask order" from March 1, and people are not required to wear masks when riding public transport. According to data released by the Hong Kong government department, a total of 8,719 positive cases of new crown nucleic acid have been detected since January 31, 2023; On 31 March, only 87 new positives were detected. However, it has been observed that after the lifting of the "mask order", about half of Hong Kong citizens still choose to wear masks when riding the MTR.
It wasn't the virus that completely disappeared that the mask order was lifted; But there was no large-scale rebound of the virus because the mask order was canceled.
▎Photo/On March 25, Zhang Wenhong, director of the Department of Infectious Diseases at Huashan Hospital affiliated to Fudan University, said when invited to attend the 2023 Asian Young Leaders Forum in Guangzhou: "Human beings have fully established an immune barrier against the new crown epidemic, and we should not be far from the time to get out of the public health emergency. At this stage of the pandemic, wearing masks can become a non-mandatory measure. WHO has also signaled ending the coronavirus as a public health emergency. ”
Everyone should be the first responsible person for their own health; After 3 years of the epidemic, what common sense should we have about masks?
After 3 years of the epidemic, if we have not formed these common sense about masks, then our suffering is in vain.
Common sense one: There are not only new crowns in the world, but also other respiratory viruses.
Whether it is the new crown or the influenza (influenza A) virus, it can cause a large-scale epidemic, not because there is no new crown epidemic, masks are completely unnecessary to exist.
In addition to viruses, masks can also reduce pollen inhalation and reduce symptoms of seasonal pollen allergies.
Common sense two: physical protection can only delay the virus, reduce the invading virus particles, and cannot completely and long-term keep the virus out.
When an outbreak is large, especially when there is no vaccine or antiviral drugs, physical protection such as masks can delay the epidemic, but it is impossible to completely isolate the virus for a long time.
Physical protection not only reduces the new crown, but also greatly reduces the incidence of influenza in the new crown epidemic in countries around the world; However, because the immune system has lost the stimulation and training of various viruses, there has been a rebound of influenza epidemics in various countries after the new crown epidemic.
Common sense three: This is a world full of viruses, and the fittest can survive.
Fear cannot defeat the virus, defeating the virus is not our goal, survival is our goal. The development of anti-epidemic plans must take into account the cost of survival.
We can't rely on the state to keep the virus out of the "one size fits all," and we can't expect everyone else in a subway car to be virus-free.
We can only develop a corresponding plan according to the health status of the individual and according to the possibility of infection. If the infection is more prevalent and your health is not good, you need to avoid crowd gathering occasions, and if you cannot avoid it, you should wear a mask.
If there is no large-scale epidemic and there is no problem with your body, there is no need to live in fear, and you can't go out without clothes because you are not wearing a mask.