Masks should continue in schools and risk situations, says Julio Croda

Despite the improvement in health indicators, the current moment of Covid in Brazil should serve to reflect on protective actions and measures that should continue even after the pandemic. This is the assessment of Julio Croda, infectologist and researcher at Fiocruz.

For him, among these actions to be considered is to maintain the use of protective masks in some environments on an ongoing basis, such as hospitals. The use, he says, should also remain for elderly and immunosuppressed people in places of high agglomeration and in the seasonal period of respiratory diseases, such as the flu.

“We know that sick people who seek health services are generally weakened, and it is not interesting to contract a respiratory infection within hospitals, just as it is necessary to protect health professionals who are providing care”, he evaluates.

This Thursday (17), the governor of São Paulo, João Doria (PSDB), announced the end of the mandatory use of masks in closed places in the state. Protection, however, remains mandatory in some situations, such as in public transport, in addition to hospital environments and in health services (understand the rules).

For Croda, the release should not be seen as the end of use, on the contrary.

“It is important to emphasize the recommendation of use in some situations associated with greater risk, regardless of whether the state has progressed, such as closed spaces with agglomerations, schools”, he evaluates.

Croda talked to sheet about actions by states and municipalities, populations that, in their opinion, need an extra dose of reinforcement, such as the elderly, and whether the national culture will change after Covid. Read below.

The withdrawal of mandatory masks at this time of the pandemic in an unrestricted way seems reasonable? There are still some conditions where it would be important to maintain the use of masks, especially in closed places with agglomeration. The decision to keep on public transport is appropriate, as the risk of acquiring the virus in these places is very high.

Some studies already show a direct relationship between the distance from the workplace and the risk of contracting the coronavirus: the further away your residence is from your service and the longer the travel time –consequently the greater the number of types of capacity used–, the greater the risk of infection. This can also be seen when analyzing that the poorest neighborhoods and further away from the center have a higher prevalence of the disease.

Another environment in which it would also be interesting to maintain its use is in schools. Although vaccination coverage of the first dose in children aged 5 to 11 years in São Paulo is 70%, it is necessary to advance in the second dose before removing masks in schools.

It is clear that the epidemiological indicators of states such as Rio de Janeiro and São Paulo allow for flexibility, but it would need to be done gradually, first in open environments, as São Paulo did, and then there could be an intermediate stage, of flexibility in environments closed without agglomeration, and then to those environments that we believe are at greater risk.

How do you evaluate the decision of these states unilaterally or not (RJ left it to the municipalities to define whether or not to remove the mandatory masks)? We now know that the micron is causing more infections in children and unvaccinated people. In this sense, it is better to make a decision to relax more gradually, as in SP, than the decision of the RJ government, which transferred this responsibility to the municipalities.

It is important to understand that the indicators are statewide, so a decision on whether or not to maintain masks must occur in the state as a whole.

The only criticism I would make is that an intermediate step could have been taken before withdrawing the obligation in closed spaces and continuing to monitor the impact through epidemiological indicators.

In what situations should people continue to wear a mask? And in which use can be chilled out? Despite the measure to release the use, it is important to note that the recommendation of masks in some environments associated with greater risk must continue, regardless of whether the state has decided that it is time to move forward in these choices.

For example, schools can invariably continue to adopt masks, the population can adhere to face shields – preferably of the PFF2 or N95 type – and continue to use them on public transport, within schools. This measure should even be encouraged.

In the open environment without agglomeration, we can certainly think about the withdrawal of mandatory. In closed environments, with distance, can also be evaluated.

The biggest concern continues to be mass events both outdoors, but mostly indoors. Risk can be stratified into three types: the smallest risk group is the open, uncrowded environment; the intermediary, which are the ones I mentioned, such as schools, open areas with agglomerations; and the largest that is closed with agglomeration.

In this context, should Brazil apply a fourth dose of vaccine against Covid? Offering a fourth dose to the elderly public would be necessary now, as these people are reinfecting themselves, being hospitalized and, unfortunately, they can die.

We are seeing several countries with an increase in cases and hospitalizations associated with the BA.2 omicron subvariant, but also with a loss of protection in the elderly. The fourth dose in this group, as announced by São Paulo, is necessary, in addition to maintaining the use of masks in this group.

Can the high circulation of the virus in some places lead to the emergence of new variants? If this occurs, could the removal of mandatory masks lead to a new wave? Difficult to predict, we cannot say this with certainty because each country experiences a different dynamics of the pandemic, related to its past of previous infection and vaccination coverage.

The emergence of new waves depends on new variants, of course, but also on the immunological competence and the populational collective immunity that has been generated throughout the pandemic. In Rio so far we have not seen an increase in cases or hospitalizations.

Of course, the more flexible we are, the more contact between people will occur and the greater the risk of contamination, but whether this will be reflected in new cases and hospitalizations is difficult to predict. Even the best mathematical models cannot accurately convey this information.

Will the pandemic leave a legacy of wearing masks when people are sick? The great legacy of the pandemic may be to maintain the use of masks in hospitals, not only because of Covid, but also to prevent transmissions related to health services.

Today is the coronavirus, but we are now entering the seasonality period for other respiratory viruses — so much so that the influenza vaccination campaign starts on the 4th.

We know that sick people who seek health services are generally weakened, and it is not interesting to contract a respiratory infection inside hospitals, just as health professionals must be protected.

The use of masks is essential in times of increased number of seasonal cases, by immunosuppressed people and the elderly, for example, when practicing activities related to a greater risk of acquiring diseases.

Perhaps protective measures, mainly related to the use of a mask by sick people, something that was not usual for our population, are incorporated in some special situations.