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Is it really necessary to wear face shield on top of masks outdoors?

By JUSTINE PUNZALAN Published Dec 15, 2020 8:22 am Updated Dec 15, 2020 10:09 am

Everyone stepping outdoors is now required to wear both a face mask and a full face shield.

Presidential Spokesperson Harry Roque, who also speaks for the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF), announced the new rule in a virtual presser today, Dec. 15.

Roque said that while wearing the face shield with a mask is already mandated in commercial establishments, the new protocol would lessen the risk of COVID-19 infections as more Filipinos go out during the holiday season. The wearing of a face shield was only required previously in commercial establishments and public transportation.

“It’s an additional protection para maiwasan ang surge. Lahat naman po ‘to hindi ire-require kung hindi po makakabuti sa ating kalusugan,” Roque said. “Whether it be for the holiday or for a longer period of time, meron na tayong face shield, gamitin na lang for added protection.”

Some netizens, however, weren’t too happy with the new protocol. Several of them said that wearing the face shield for a long period of time makes it hard to breathe and see clearly. Others stressed that it’s bothersome for those who travel by bike.

Screenshot from Philippine Star on Facebook

PhilSTAR L!fe talked to preventive health education and health reform advocate Dr. Anthony Leachon and UP Manila Institute of Molecular Biology and Biotechnology director Dr. Edsel Salvaña, who is also a member of the IATF technical advisory group, to weigh in on the matter.

More than 90 percent risk reduction

Salvaña said wearing a face shield together with the face mask will help prevent the spread of COVID-19 further.

“Face shields are a good idea on top of masks because masks aren’t perfect and neither are they perfectly worn,” Salvaña said. “Multiple layers of defense are not effective, in line with the ‘Swiss cheese’ concept.” 

The ‘Swiss cheese’ is a risk analysis model developed by Dante Orlandella and James T. Reason of the University of Manchester. It states that the more layers of protection or “cheese” a person has, the harder it will be for the virus to penetrate them.

Face shields are a good idea on top of masks because masks aren’t perfect and neither are they perfectly worn.

Leachon, a former IATF adviser, likewise supports the new protocol, as it lessens the chance for people to contract the virus in crowded places.

“Actually I go out talaga with face mask and face shield kasi there’s a study in Lancet [research journal] na when you wear face mask the reduction in coronavirus transmission is only 67 percent than the ordinary surgical mask. But when you use the N95, it’s 96 percent,” Leachon said.

“Now when you use, as a single measure, ang face shield, it could only keep you [protected] 76 percent. When you combine that with social distancing, it will give you 99 percent reduction,” he added.

“Therefore, the reason why they are doing this combination—‘yung face mask and face shield—it will give you more than 90 percent risk reduction since they could not prevent people from coming or going out during the holiday reason.”

Meron tayong potential 'tridemic', which is a triple epidemic.

Another reason Leachon supports the government’s mandate is that the country has already exceeded the normal coronavirus production rate of 1.1.

“Ang reproduction number natin, as reported by OCTA [Research Institute], exceeded 1.1 already,” the physician said. 

“Ibig sabihin noon, madali tayo magkaroon ng spread of the virus,” he added. “Since meron tayong holiday rush, dinodoble nila ‘yung pag-iingat right now sa face mask and face shield.”

Leachon also raised the possibility of a “potential tridemic” that usually occurs during the holiday season.

“Meron tayong potential tridemic, which is a triple epidemic. In the US, basta nag-November na, nagi-increase ang pneumonia and flu. Tayo rin naman, because of the colder temperature, nagkakaroon tayo ng flu and pneumonia," he said.

“Because of the holiday season, lumalamig ang panahon, nagkakaroon tayo ng increase in cases of heart attack and stroke. Remember that prior to the COVID crisis, because of the increase in parties, overindulgence of people, a lot of people get heart attack and stroke. And do you know who’s the most vulnerable to COVID transmission? Those elderly prone to develop heart attack and stroke. So [flu and pneumonia] plus the COVID surge, ito iyong tinatawag natin triple epidemic. " Leachon added.

“We should be careful during the holiday season because of these three epidemic: influenza-slash-pneumonia, cardiovascular disorder (stroke and heart attack), and the potential COVID surge because of the holiday rush.”

The previous IATF protocol only mandated wearing of face masks inside public transporation and commercial establishments (The Philippine Star/Andy Zapata, Jr)

Half a million projected infections by end of 2020

The Philippines has reported 451,839 COVID-19 cases as of press time. But that number could jump to half a million by the end of December, according to the University of the Philippines OCTA Research Group.

But Leachon said the use of the face shield with the masks would spare many Filipinos from the disease.

“For the last few months naman, there’s a downward trajectory of the cases as we can see. I must commend the IATF and the NTF, but more so, I think it’s because of the compliance of the Filipino,” he said.

“As we reopen the economy, and prior to the arrival of the four typhoons, nagkaroon tayo ng breach of protocols in evacuation centers and the holiday rush, that contributed actually to the reproduction number of 1.1,” he added. 

“Since we could not naman prevent people from going out because it’s the holiday and there are festivities, I think that the mandate of the government to wear face masks and face shields is justifiable,” Leachon concluded.

At this time, we do not know how much protection a face shield provides to people around you.

The US Centers for Disease Control and Prevention does not have a take on wearing a face mask and face shield in conjunction, but it said that it does not recommend “using face shields or goggles as a substitute for masks.

“Do not use a plastic face shield (or a mask) on newborns or infants,” the CDC said.

The CDC further noted that face shields have large gaps below and alongside the face, where droplets may escape and reach others.

“At this time, we do not know how much protection a face shield provides to people around you,” CDC said.