When news of the novel coronavirus outbreak in Wuhan, China emerged in December 2019, no one could have imagined how quick it would spread its wings and cast a shadow over the world. Today, the pandemic has caused over 9.63 million deaths worldwide.

Since there is no vaccine yet, the only solutions available are precautions like social distancing, washing and sanitising hands, and wearing masks. While other safety measures are easy to follow, convincing people to wear masks has been a battle, especially in Pakistan where many think the disease is a rumour concocted to deceive the public.

The lack of scientific knowledge in the masses is evident from the violence that took place in the Karachi Civil Hospital on 30 May. After the hospital refused to hand over the body of a patient who died of Covid-19, a mob of 70 people carrying rods and knives barged into the hospital chanting “Koi corona nahin hai, yeh sab doctors ka drama hai” (there is no coronavirus, this myth has been created by the doctors).

This reluctance to accept the existence of the virus and refusing to wear masks is not uncommon. For instance, in China, people were arrested for not wearing masks. Singapore on the other hand, imposed a fine of approximately $300 on those spotted without masks.

However, with Pakistan almost reaching 200,000 cases of infection, and the lockdown slowly easing all over the country, it is more important than ever to wear masks and adapt to other precautionary measures that aid in reducing the spread of infection - even if it requires the government to impose strict laws.

Believe it or not, things won’t change until and unless the usage of masks in normalised through advertising, laws, awareness.

The discourse around masks

One of the reasons people around the globe are rejecting the idea of wearing masks is due to the confusing debate and conflicting statements regarding mask usage by health organisations and world leaders.

The World Health Organization (WHO) initially recommended mask usage only to the sick or those taking care of a person with COVID-19. These guidelines were released after there was a global shortage of N-95 masks and the healthcare professionals who required them the most to treat infected patients were left with a lack of supplies. Recently, in the light of new studies, the WHO released guidelines for the usage of fabric masks by the public.

The Center for Disease Control and Prevention (CDC) of the United States, on the other hand, recommended everyone to wear a face mask in public to reduce the chances of asymptomatic individuals spreading infection. Crucially, CDC also suggested wearing cloth face masks instead of N-95s. Supporting this sentiment, President Dr. Arif Alvi also recommended that the public leave N-95 masks for health professionals working in COVID-19 isolation wards.

While the discourse around types of masks proceeded, Pakistan divided itself into two groups: those who wear masks and those who don’t. In an attempt to stop the rapid spread of the virus, the Sindh government declared wearing face masks in public compulsory on 18 April. The government of Khyber Pakhtunkhwa followed suit on 25 April.

However, bringing a seismic shift in how masks are viewed is an arduous task that requires constant campaigning.

Besides believing that the coronavirus does not exist, there are sectors of the population who do not understand why and how masks can protect them. However, to counter myths, conspiracy theories and unintentional ignorance, several organisations in Pakistan have taken up the cause of helping the masses understand the purpose of wearing face masks as a precaution against COVID-19.

Movements that created a change

Doctors are our heroes during this stressful pandemic, but so are organisations, individuals, and NGO’s who are doing their part in increasing awareness regarding standard operating procedures (SOPs), as well as providing masks and sanitisers to those who can’t afford them.

Days after the first coronavirus case was announced in Pakistan, a campaign to distribute free surgical face masks started in Chakwal. Similarly, on 23 March 2020, ‘Deliver it’, an online delivery service provider joined the cause and announced the distribution of more than 10,000 face masks and hand sanitiser bottles with the help of the Islamabad Capital Territory Administration (ICTA) Volunteers Task Force in rural areas of Islamabad.

By the end of March, the Chinese government also extended help to Pakistan in the form of 500,000 face masks, including 50,000 N-95 masks, whereas a non-profit organisation, The All-Pakistan Chinese Enterprises’ Association (APCEA), donated 16,000 face masks to the Pakistan Institute of Medical Sciences (PIMS).

To further influence the masses and provide masks to those who were unable to purchase them, Pakistani fashion brands also donated masks.

This begs the question: why is promoting masks so important?

According to Syed Hani Abidi, Assistant Professor Department of Biological and Biomedical Sciences at the Agha Khan University (AKU), masks are essential because they can protect one from getting exposed to aerosols generated by those infected during sneezing and coughing.

“Their effectiveness, though, can vary with the type of mask used,” explains Abidi. “N-95 is

around 95% effective but they are short in supply and can cause altered blood oxygen level if

worn for long.”

He suggests surgical and fabric masks (including homemade ones) to be worn instead.

Dr Abbis Jaffri, a healthcare scientist with a PhD from University of Virginia, is of a similar view. “There is evidence that masks can slow down the infection rates if not completely prevent it,” says Jaffri, who has a special interest in evidence based on medicine.

Quoting a laser light scattering experiment performed and reported in the New England Journal of Medicine, he elucidates, “The experiment reveals how far spit droplets can travel when talking. This is enough evidence to make wearing masks mandatory.”

Keeping in mind the results of scientific researches, a global movement called Masks4All took off in March 2020. It reached Pakistan in May after it was launched by Sab Saath and the Chainstore Association of Pakistan (CAP). Apart from awareness, the campaign led to the distribution of five million masks around the country.

Furthermore, to change the perception of cloth masks, a student-led movement Mask Banao also took off in April in Pakistan. Mask Banao launched its website on 18 April 2020 and subsequently launched a social media campaign, debunking myths about COVID-19 and providing information about masks. Artists like Zoe Viccaji, Hadiqa Kiyani, and Ayesha Omer joined the campaign over time.

The initiative is also raising funds to distribute a million masks across Pakistan, and has collaborated with the District Municipal Corporation (DMC) and a few non-governmental organisations to disinfect markets, mosques and other crowded places around Karachi.

Last but not the least, the Combating Corona Volunteers Programme (CCVP) by the Sustainable Social Development Organisation (SSDO) is another campaign that changed the public’s perception on masks by educating the masses about how the novel coronavirus can spread using posters and social media posts.

After months of efforts through advertising campaigns, mask distribution, and meetings with relevant authorities, on 31 May, Director of Health System Development, Dr Zafar Mirza declared it mandatory for everyone across Pakistan to wear a mask in public.

The decision by Mirza is enough to prove the positive effects of campaigning for the right cause. Unfortunately, there are still many rural areas in Pakistan where the population brushes off the existence of COVID-19. Will the government and NGO’s be able to help them before it’s too late?

The future

Though there are numerous organisations and movements asking Pakistanis to view face masks as a necessity in the ‘new normal’, there are still millions of people who need to be convinced. Only a collective effort from the government along with numerous organisations and influencers can make a difference.

According to Dr. Muhammad Usman Zaheer, who holds a PhD in Epidemiology from the

Colorado State University, the government of Pakistan should recommend the use of masks

while providing scientific evidence to the public.

“Once the government establishes clear, coherent and consistent guidelines for wearing masks, they can join hands with the media and focus on spreading a single message across different platforms,” explains Zaheer.