Can use of face shields without masks increase cases of COVID-19?By Olugbenga ADANIKIN on July 24, 2020
A STATEMENT attributed to the Ghana Medical Association (GMA) and the West African College of Surgeons (Ghana Chapter) issuing a warning on the danger posed by using face shields alone has gone viral on the internet, blogs, social media.
The statement claimed that using face shields without face masks could lead to further spread of coronavirus disease (COVID-19).
As at the time of this report neither the GMA nor the West African College of Surgeons have debunked the statement. They neither responded to the numerous calls and messages – spanning several days – from The ICIR to confirm if the statement was actually from them.
The statement accused blogs of misinforming the public that using face masks could cause a build-up of carbon dioxide.
The joint press statement dated Wednesday, July 16, 2020 and allegedly signed by Dr. Frank Ankobea, GMA President and Prof. Peter Donkor, the first Vice President and Country Representative of the West African College of Surgeons in Ghana makes two claims:
That “continuous use of face shields without masks by the general public will lead to increase cases of COVID-19”
That “emerging scientific evidence has shown that COVID-19 has the potential to spread through the air.”
The World Health Organisation (WHO) recommends the use of face masks as a preventive measure against COVID-19.
The United States Center for Disease Control and Prevention (CDC) also shared the same position on the importance of using face masks for self-protection and to slow the spread of the disease.
Dr. Robert Redfield, the US, CDC Director in a release issued by the Center, Tuesday, July 14, 2020, emphasised how the use of face masks could protect families and communities from being infected.
“Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting. All Americans have a responsibility to protect themselves, their families, and their communities,” Redfield said.
The ICIR contacted the World Health Organisation (WHO) Nigeria to further verify the claims.
The Infection, Prevention and Control Expert with the WHO, Nigeria, Prof. Adebola Olayinka, said using the mask reduces the virus transmission not face shields.
“That is actually very right. In fact, it is something we have also been discussing because many people now use face shields,” Olayinka said while commenting on the first claim.
She described the issue of community spread as a major concern emphasising that “what will really help to reduce community transmission is the mask and not the shield.”
Olayinka noted that the phrasing of the statement on face shield increasing coronavirus cases could have been better stated.
“Although, the way they put it that the use of it (face shield) will increase, I think it will be better to say the use of face shields would not help us reduce the transmission.
“The use of face shields alone without masks will not help us reduce transmission of the virus,” she noted.
On the second claim, Olayinka concurred with the claim about COVID-19 being potentially airborne, but with a caveat.
She was specific about conditions COVID-19 could become airborne especially in cramped places, crowded locations that are poorly ventilated.
“It is not completely correct because yes, there are emerging piece of evidence that there could be potential airborne transmission in confined places, crowded places and places where there is poor ventilation. We have some conditions attached to it.
“So, there is that potential for it to spread but how easily it spread, we are not really sure but we know that it spread by droplets and also there have been articles based on experiments that have shown it could stay in the air for some time.
“How long it does or not but of course if the ventilation is good, then the chances are much more reduced but if people stay closer together in confined places, then the chances increase.”
Her comment was similar to the position of the WHO International.
The WHO defines airborne transmission as, “the spread of an infectious agent caused by the dissemination of droplet nuclei (aerosols) that remain infectious when suspended in air over long distances and time.”
WHO’s brief on COVID-19 transmission mode
On July 7, the global body published an updated scientific brief on the transmission mode of SARS-CoV-2, the virus causing COVID-19.
The document affirmed the disease could be transmitted through respiratory secretions or droplets expelled on hard surfaces from a confirmed case.
It stated that the airborne transmission of the virus could occur during medical operations that generate aerosols.
Aside that , there are theories that the virus, especially from an infected person could escape through normal breathing and talking via the aerosols. However, this would largely depend on the quantity of the breath out droplets “and the infectious dose of viable COVID-19 virus.”
The WHO brief which was backed up with 99 references, however, called for an in-depth high-quality research to clarify the different mode the virus could be transmitted, the role of airborne transmission and the proportion of COVID-19 virus required for the disease transmission to occur.
Likewise, a study conducted by a group of scientists from China and US to examine if COVID-19 is airborne showed that the virus could spread in enclosed places such as buses and conference rooms.
The study, released in April 2020 was conducted on samples taken from 293 Buddhists and 30 trainees. It, however, concluded on the likelihood of airborne transmission.
In an open letter to the WHO, a group of 239 scientists from 32 countries also agreed on growing evidence that COVID-19 is airborne.
More experts’ opinion
Sunday Omilabu a Professor of Virology, Lagos University Teaching Hospital (LUTH) shared further insights on the need for face masks, and not just the use of face shields alone like obtainable.
The Face shield, Omilabu said is to protect medical officials who take samples from individuals and the idea was to prevent splashes of particles from patients during sample collection.
He said both items serve different purposes, thus face shields should not replace face masks.
“…you can see that it is not only the face shield they (medical personnel) put on. They also have the face mask on,” the Omalibu said while stressing that face mask is to protect the nose and mouth.
On the second claim, the virologist agreed that the virus causing COVID-19 could spread through the air.
He explained that since the virus attacks the respiratory tract and it is lighter compared to bacteria, it could be transmitted by air.
“All along, I have that belief that the virus can be airborne because it is released through saliva. Since all these pathogens are released into the air, the wind has that capacity to transport it, to move it from one place to the other.
“And because the virus attacks the respiratory tract, that gives it the power of being transmitted by air. Most of the respiratory tract infections are airborne. So, it’s not unexpected because it (the virus) is carried by air and air can move it from one place to the other and the virus particles are very light when you compared them to bacteria.”
The ICIR also contacted Dr Emmanuel Balogun, a lecturer in the Biochemistry Department of Ahmadu Bello University, Zaria, he said ‘it is absolutely wrong’, to discard face masks for face shields.
“Taking away the masks and using the face shield alone does not protect you because this is a disease that can be transmitted to you through droplets and this thing can travel far.”
Balogun buttressed his point that individuals could still touch their mouths after touching contaminated surfaces while having the face shield on without masks. But, it is safer when the face mask is on.
On the question, if the virus is airborne, the Varsity teacher shared a similar position with the WHO and the other experts.
He said the possibility of the virus being airborne is high as it could be transmitted through aerosols citing an instance of when an infected person coughs.
The ICIR further attempted to authenticate the statement but every efforts to reach out to the GMA via an email and official phone line failed.
From the evidence above the claim that “continuous use of face shields without masks by the general public will lead to increase cases of COVID-19” is TRUE.
The claim that “emerging scientific evidence has shown that COVID-19 has the potential to spread through the air” is also TRUE.