Just recommending a mask confuses and use should be mandatory, say doctors

The decision of the Covid-19 Contingency Committee of the São Paulo government to recommend the use of masks in closed places was a correct measure, according to infectologists. However, for them, the authorities should not only suggest, but compel the use of the item in order to prevent the spread of Sars-Cov-2.

In recent weeks, a trend of increasing cases has been observed. Data from the SP Covid-19 Info Tracker platform, created by researchers from USP and Unesp with support from Fapesp to monitor the evolution of the pandemic, show that the moving average of new hospitalizations (ICU and ward) increased by 74% in the state of São Paulo in three weeks. The 6th and 27th of May were compared, when the averages reached 176 and 306, respectively.

​The end of the mandatory use of masks in closed places was announced by former governor João Doria (PSDB) on March 17. The item, however, is still mandatory on public transport and in health facilities.

The announcement of the return of the recommendation took place this Tuesday (31). In a note, the government said that the decision comes after “there was an increase in the number of cases and hospitalizations, without a proportional increase in deaths thanks to the wide vaccination coverage of the state of São Paulo, a reference and world leader in vaccination”.

This Wednesday (1st), the City of São Paulo followed the government’s guidelines and also announced only the recommendation to use the equipment.

Director of SBIm (Brazilian Society of Immunizations), Monica Levi says that the new recommendation confuses people. “Unfortunately, we have a country divided on how to understand and face a pandemic. However, the collective interest has to prevail over individual opinions”, she says.

For her, it is impossible to carry out the control of infectious diseases based on common sense. “We need to have guidelines according to the moments of the pandemic. It is possible to flexible according to the low rates in open places, but in closed places it has to be mandatory”, said Levi, who evaluates that new variants have increased the number of cases and it is necessary that “tighten measures until Covid-19 becomes endemic”.

The doctor also mentions that, in addition to Covid, at this time of year when low temperatures and dry weather are recorded, it is common for an increase in respiratory syndromes to be recorded. Thus, the mask would have the ability to prevent not only the spread of Covid, but also the flu and other seasonal diseases.

Doctor and consultant to SBI (Brazilian Society of Infectious Diseases), Renato Grinbaum says that the decision to remove masks in closed places was premature and “with precarious scientific basis”. “We returned because the pandemic is not over,” he says.

Grinbaum supports the mandatory use of masks indoors. “The authorities no longer want to be incisive in the pandemic and are transferring public health decisions to individuals.”

He analyzes that, despite the increase in the number of cases, the epidemiological situation is not as serious as last year. However, care is needed. “There’s also a lack of discussion of what to do when the pandemic is over, what rules to follow and what the new normal will be. We need a non-radical transition.”

André Ricardo Ribas Freitas, professor of epidemiology at the São Leopoldo Mandic School of Medicine, agrees that the use of protective equipment indoors should never have ceased to be mandatory.

“Even if these measures are taken now, it does not seem to me that they will have an impact because it is not mandatory. People were encouraged to believe that the pandemic is over, due to the posture of the state, the federal government and the lack of coordination of these measures. actions,” he says.

For Freitas, there should be an increase in cases of influenza. “We will face in the coming weeks an increase in cases of influenza and syncytial virus, which can cause a bottleneck in the system.”

“Although they are not very serious cases, we still have an above average number of deaths. We are used to talking about hundreds of deaths from Covid, but this is not normal”, he says, citing that there is a clear lack of unified coordination of states.

The professor also analyzes that the current situation does not reach the levels already seen, as in times when ICU beds and oxygen were lacking. “However, we do have an overload in emergency rooms for respiratory diseases and I am not seeing the construction of a capillary network that can increase beds as happened at other times.”