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Rapid response to:


Covid-19: control measures must be equitable and inclusive

BMJ 2020; 368 doi: (Published 20 March 2020) Cite this as: BMJ 2020;368:m1141

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Rapid Response:

COVID-19: New Equitable & Inclusive Containment Strategy

Dear Editor,

With regards to this article, I would like to propose a promising new containment strategy for the virus that can be realistically implemented across all levels of society. The strategy aims to counter COVID-19’s most useful tool – the unknown infected individual.

Consider this – if everyone wears a mask in public, the unknown infected individuals will also be masked, limiting their ability to spread the virus widely. We have been so obsessed with protecting the individual that we have overlooked another option: protecting others from the individual.

The beauty of this solution is that these masks can just be simple cloth masks – with the focus shifted from exclusion to containment, any mask with a hydrophilic inner layer will be able to capture the majority of the infectious aerosol from a cough, sneeze or breath. This will result in less contaminants in the air and on public surfaces. Any particles that escape will also not be able to travel far as most of their momentum would have been robbed by the mask.

Cloth masks are washable, reusable and best of all, can be made at home, allowing this solution to be quickly deployed if everyone chips in. Another tip for those making these masks: include a pocket in the mask for tissue paper; the added absorbency will make a cloth mask even more effective at trapping contaminants.

This strategy of ‘community protection’ has a powerful brute-force element to it – similar to the concept of lockdown – which enables it to catch all unknown infected individuals if everyone participates. Moreover, it does not have much of an element of ‘fatigue’ to it – communities can only be locked down for so long, but everyone wearing a washable, reusable mask is a viable strategy that can be employed indefinitely.

Therein lies the hope for communities where the virus is already freely-spreading: this is a solution that can be deployed tomorrow. Make a cloth mask for yourself, your family, your friends and your colleagues and start wearing them. The more masks you put on other people, the more protected everybody is. Together with other properly executed containment strategies such as social distancing, contact tracing, self-quarantine and good hygiene, we might even be able to halt the free spreading of COVID-19 and reverse the situation in affected communities.

If you think this strategy has potential, please share it and push it up the chain of command for evaluation and execution. We need to update our official narrative & overall containment strategy to include both cloth masks and the concept of ‘community protection’.

God bless, good luck and best wishes to everyone.

PS: Please do NOT put masks on individuals who cannot remove them without assistance. This includes infants and the frail elderly; it is a suffocation hazard to them. In addition, please refrain from using masks if you experience breathing difficulties with it. Also, do not sleep with a mask on, this is very dangerous.

If you are looking for mask design plans, there are many available online. You can also use items such as a bandana or a balaclava as a temporary substitute. Also, do not apply ‘waterproof spray’ on your cloth mask, it has been linked to respiratory damage and may do you more harm than good.

When you wash a mask, take care not to dislodge any potential contaminants from it. Remove it carefully and place it in a container of soapy water and lather additional soap in gently. Let it sit for a few minutes and continue washing gently.

Competing interests: No competing interests

21 March 2020
Brian Ong
Member of the Public