Nasal Negligence: a catalyst for COVID-19 spread

BY: Zadok Kwame Gyesi
File photo: Source: BBC
File photo: Source: BBC

The world is yet to come to terms with the impacts of the novel coronavirus disease, popularly referred to as COVID-19. Many are still brooding over the pains that the disease brought them—some lost their loved ones to the disease.

Globally, more than four million people have lost their lives since the disease broke out in the latter part of 2019. A report by Worldometer as of October 20, 2021, indicated that the world has recorded 242,528, 136 COVID-19 cases; 4,932,213 deaths; and 219, 800, 985 recoveries. This data is supported by the statistics of the World Health Organisation (WHO) of October 19, 2021.

According to the Ghana Health Service, for instance, Ghana has since the outbreak of the disease recorded a total of 129,592 COVID-19 cases. Out of the number, 126,085 have recovered while 1,169 have died. Currently, there are over 2,000 COVID-19 active cases in the country. This information was published on the COVID-19 dashboard of the Ghana Health Service on October 15, 2021.

Origin

COVID-19, which is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects different people in different ways. It affects all genders and people of all ages and races. Detection of the virus was first reported in Wuhan in China and has since spread throughout the world, attaining the status of a global pandemic.

“WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction. We have therefore made the assessment that COVID-19 can be characterised as a pandemic,” the Director-General of WHO, Dr Tedros Adhanom Ghebreyesus, said at a press conference on March 11, 2020.

Why nose masks

Since becoming a global pandemic, one of the earliest interventions that the WHO recommended to help contain the spread of the disease was the wearing of nose mask, particularly when one finds himself or herself in a public place.

The WHO in its updates on the disease said nose masks should be used as part of a comprehensive strategy to suppress transmission and save lives. Other measures that the WHO recommended included physical distancing, keeping rooms well ventilated, avoiding crowds, regular hands washing, and coughing into a disposable tissue or at least a bent elbow.

Following the WHO recommendations on the wearing of nose mask, the practice became a norm across the world, with some countries punishing individuals who do not wear nose mask in public places.

In Ghana, for instance, on September 3, 2021, persons who were found without nose masks around Agbogbloshie, a suburb of the Greater Accra Central Business District, were summarily sanctioned to desilt drains at the Ablekuma District Hospital. This was done to discourage people from going about without wearing as nose mask.

To further re-echo the importance of wearing nose masks as a COVID-19 protective measure, many institutions have “no nose mask, no entry” notices or stickers on their doors and entrances.
Similarly, many institutions, including airline companies, churches, mosques, and banks require people who patronise their services to be in nose mask before assessing their premises.

Wearing of nose mask is considered part of the major strategies to slow or stop transmission and spread of SARS-COV-2 and to mitigate the impact of the virus on the health system, social activities, and economies of countries and communities.

More importantly, the evidence of presymptomatic (the presence of illness before the appearance of symptom) and asymptomatic (producing or showing no symptoms) transmissions of SARS-COV-2 also necessitated the wearing of nose masks to help prevent the spread of the virus.

Transmission

It must be noted that COVID-19 preventive measures are based on research and depending on the new discovery, new preventive method is adopted.

Another factor that equally promoted the wearing of nose masks was the evidence by scientists that the disease also spread through the air—that it is airborne.

And because it is airborne, it makes the disease much easier to spread. Hence, wearing nose masks helps to protect one from contracting the disease through the air.

The virus can also spread from an infected person’s mouth or nose in small liquid particles when they cough, speak, sneeze, sing, or breathe. These particles range from larger respiratory droplets to smaller aerosols. Some of these particles cannot be seen by the physical eyes.

One can also get infected by breathing in air contaminated with the virus or by touching a contaminated surface and then touch the eyes, nose or mouth with the hand with which you touched the contaminated surface.

A study titled: "SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes", published on April 23, 2020 by Nature Medicine, disclosed that: “nasal cells in particular contain high levels of the proteins that SARS-CoV-2 attaches to in order to enter the body.”

These proteins are called ACE2 and TMPRSS2.

Also, in the article: "Why Wearing a Face Mask Halfway Can Be Dangerous", published by Wilson Chapman on October 6, 2020, the author explains that COVID-19 spreads effectively through the nose and that “it’s a very easy place for the virus to get in and then once it gets in, a place to replicate.” For Wilson, the nose acts as the main pathway for the COVID-19 virus.

According to the Centers for Disease Control and Prevention (CDC) guidelines, face masks are meant to cover both the nose and the mouth and fit securely under the chin.

Apathy

Sadly, in spite of nose masks being evidently life-saving particularly in this COVID-19 period, it has become a major challenge for a number of people to wear it.

Many people who also wear the nose mask do not wear them correctly as prescribed by health experts.

Some people prefer to wear their masks pulled down so it only covers their mouth, leaving their nose exposed.

Wearing the mask below the nose, gives the wearer no protection against the virus. In fact it gives a false sense of protection and can potentially mislead both the individual and his immediate surroundings, including all within reach. Some people also walk in town without wearing the mask at all and all efforts by the government to get people masking up have yielded little success as many of the populace simply do not care.

The deadly nature of COVID-19 has made the wearing of nose masks a must-do activity in one’s daily life. Health experts say that wearing a mask helps slow the spread of COVID-19 by preventing the transmission of droplets that result when a person breathes, talks, coughs or sneezes.

This is because COVID-19 targets the types of cells that are found in the nose. As a result, leaving the nose unprotected makes one more susceptible to the disease, particularly when one finds himself in a contaminated environment.

Survivors’ experiences

Philip Arhin, a COVID-19 survivor, blames his contracting the disease on his own actions. According to him, he never bothered to wear the nose mask until he got the virus.

“I didn’t take the wearing of nose mask seriously initially. I thought it was a hoax until I got the disease and nearly died,” he noted.

For him, since recovering from the disease he no longer takes the wearing of nose mask for granted.

Madam Constance Boateng and Mr Mark Acheampong (not their real names), both survivors of COVID-19, also believe that wearing nose masks gives some form of protection against the virus.

“I don’t think we need to be told to wear the mask before we do so. You wear it for your own good,” Mr Acheampong noted.

Unlike Acheampong who believes wearing the nose mask would protect people from contracting the disease, many people cite “discomfort” as the main reason for not wearing nose masks. Others also report breathlessness, sweating, nausea and increased heart rate for their refusal to wear mask.

Expert views

A Public Health Advocate, Epidemiologist and Researcher, Ms Anita E. Asamoah notes that although acceptance of nose masks was high in the urban communities in Ghana during the peak of the disease, relative to rural communities.

For her, there was high acceptance of nose masks in the urban areas due to enforcement, pointing out that many people in the rural communities initially did not see COVID-19 as a disease that could affect them.

She was of the view that people in rural communities saw COVID-19 as a disease meant for the rich and affluent in the society and not rural dwellers.

Explaining why there appears to be some apathy in the wearing of nose masks in the country, Ms Asamoah said “People have taken COVID-19 vaccination as justification for not wearing the mask.”

For her, some people think that after taking the COVID-19 vaccine, they cannot be killed by the disease and therefore see no reason to still put on nose mask, adding that the COVID-19 vaccine alone is not enough for one to disregard the wearing of nose as they are all complementary COVID-19 preventive measures.

Ms Asamoah also pointed out that many people do not wear the mask on the notion that many people have taken the COVID-19 vaccine and therefore the risk factors have gone down.

For her, in spite of the fact that many people have gone or are going for the COVID-19 vaccination, people should still wear the nose mask as it helps to give them better protection against the disease.

“It is still necessary to wear the mask because COVID-19 is still on,” she noted, saying “A lot of people had had COVID-19 and didn’t want people to know about it, so wearing the mask would help to protect you from contracting the virus from such people.”

For Ms Asamoah, more education and awareness would help to encourage people to wear nose masks.

She also urged the public to be cautious about how they dispose of used nose masks, stressing that indiscriminate disposal of used nose masks was choking many drainage systems in the country.

She further encouraged the public to use the reusable nose masks since such masks would help to reduce the waste generated from the use of non-reusable nose masks.

Alhaji Awal Ahmed Kariama, a Public Health Advocate and Executive Director of RISE-Ghana, an NGO, believes that high compliance in nose mask wearing will go a long way to help Ghana’s COVID-19 fight.

“It is one thing wearing the mask and another thing, wearing it the right way,” he noted, adding that “wearing the mask is not enough; we have to wear it the right way.”

For him, you play with COVID-19 at your own peril, hence encouraging all to take the COVID-19 preventive measures seriously.

Alhaji Awal blames the apathy in nose mask wearing on weak enforcement, noting that since there is no institution mandated to enforce nose mask wearing, people do not care about it.

For him, the wearing of nose masks are very necessary because the “science behind it is reasonable”, noting that it helps to prevent the airborne transmission of the disease from an infected person to non-infected person.

He expressed the concern that people do not have sufficient knowledge on the ‘dos’ and ‘don’ts’ in the wearing of nose mask, saying “There are a lot of misconceptions; many people wear the nose mask but remove them or lower them to their chins when speaking. All this occur due to lack of education on nose mask usage.”

Alhaji Awal has therefore, called for a strict enforcement in order to push people to wear the nose mask and wear them the right way.

He thinks that ignoring the nose mask would go a long way to negatively affect the country’s efforts in fighting the virus.

He also urged duty bearers to wear nose mask in public since many people look up to them, explaining that if duty bearers failed to wear nose masks in public, it will trickle down to their supporters.

It is clear that COVID-19 is still a threat to the world’s population and Ghana is no exception. But we can defeat the pandemic collectively by supporting measures designed to combat the disease such as the wearing of nose masks in public.