Evidence-Based Recommendations to Remain Healthy During Travel and Outreach Work

Our evidence-based recommendations to staff, schools, health or mental health services include:

A – Alcohol gel (wash or disinfect hands before eating or touching your face).  

At least 7/10 individuals confirm that they neglect this behaviour, due to “everything to remember, it is too much” and “I wear the face mask, I follow the rules and stay home”.

It is also important to wash or disinfect your hands before handling your mask, WHO guidelines, to prevent increased risk.

Most individuals report that they do not engage in the above behaviour when handling a mask.

B – Be at home and stay at home, if you feel sick, have symptoms or have been in recent contact with a confirmed case – and contact health services immediately for advice.  

At least 7/10 individuals confirm that they do not follow rule B – many report that the mask will protect others and that they “carry on as usual”. Many report “face masks are enough”.

C – Cover your nose and mouth if you cough or sneeze whether you wear a mask or not (and no spitting). 

We observe 9/10 individuals with face masks coughing and sneezing without covering their mouths or noses. Many report “face masks are enough”. Some countries now give fines for spitting.

D – Do not share food, drinks, cigarettes or #hookah / #shisha or anything relevant in this same context – think mouths, noses, eyes and hands.

We observe these behaviours on a daily basis in more than one country.

E -#Environment – the 3 important factors:  Avoid #restaurants, #shops, #musicperformances, #artperformances, #sportsevents or any other context or situation, if possible, where good ventilation and social distancing are not facilitated and maintained, and where recent contact with a confirmed case, temperature and symptom screens are not in daily use, before entry is allowed. Many schools in countries in Asia ask for these screens to be completed by staff and pupils at home, before leaving home, with good results.  

If you absolutely have to be in these contexts, for work for example, follow WHO and ECDC guidance and wear a mask safely.    

Restaurants, shops and #schools must be encouraged to open #windows and #doors to facilitate #ventilation or improve ventilation in any way appropriate. We have observed, firsthand, that good ventilation and social distancing are possible in most context including #airports and #airplanes during the pandemic through our #travels.

We personally usually aim to avoid indiscriminate mandatory face mask settings where possible and allowed by government rules or policies, we opt for environments and contexts where social distancing and good ventilation are maintained.

As mentioned before, we have never presented with #symptoms, a raised #temperature or a positive test for SARS-CoV -2 after the pandemic was reported in January 2020, despite our #travel through more or less 20 countries. Simple evidence-based (based on good clinical #evidence – longstanding well established good clinical #research) risk reducing and protective factors are effective. If good clinical evidence is not followed risk often increases; #risk from a #medical point of view, as well as #developmental, mental health and #social point of view.

Unfortunately we have observed indiscriminate mandatory mask wearing initiatives indoors and outdoors, whilst hundreds of people sit at restaurants or coffee shops, close together, for hours at a time, often more than once per day. This makes no clinical sense, is not based on clinical indications or good clinical evidence, and will significantly increase risk and harm. Restaurants, shops, #hairdressers, #liveperformances etc should be open – but with the advice worded in a different manner. In our opinion – it is important to word it in this way – good ventilation and social distancing is a MUST – the first priority – and where it is absolutely impossible to facilitate, and individuals MUST be in this context, such as doctors responding to emergencies, a mask must be worn safely.

Many individuals report “we don’t have to do social distancing, because we wear masks”, even in restaurants – evidence does not support this theory.

Clinical indications and good clinical research are essential to reduce risk and harm, and protect the public, high and low risk individuals equally.

F – Focus on evidence-based protective factors to #protect mental health and general #health – such as remaining #calm, #positive and #hopeful, spending positive time with loved ones, outside and in #nature, #eating healthy and #exercising, #enjoyment and #normalcy.  Evidence-based protective factors significantly improve #prognosis, #morbidity and #mortality #statistics, in terms of mental health, general health and social risk. Please see previous comments on evidence-based protective factors, children’s development, normative activities and the immune system. 

G – Good Food Hygiene: We prefer that food for sale in public is covered, especially when you are not going to wash or cook it, such as #pastries or #breads at #buffets or #bakeries or #farmstalls (people often cough and sneeze whilst walking around planning their meals). We prefer contexts where children are supervised (children sometimes touch food, put food back, of course adults also do the same sometimes). We will provide thoughts on general tips to remain healthy when travelling or visiting high risk areas or countries, which includes items re food.

Sharp mind – soft hands, as the #Jamaican #Bobsledders in #CoolRunnings suggested. 

As mentioned before, we have followed these recommendations in at least 20 countries during the pandemic and have never presented with symptoms, a raised temperature or tested positive for SARS-CoV-2. We usually prefer environments where face masks are not indiscriminately mandatory, and where social distancing and ventilation are facilitated and maintained.

HOWEVER, WE ALWAYS ADVISE EVERYONE TO FIRST FOLLOW THE LOCAL GOVERNMENT’S LAWS, RULES AND POLICIES, WHICH MAY SOMETIMES DIFFER SLIGHTLY. 

We will provide further details in future blogs, including of our go-bag and medical kits, along with practical recommendations and information.

CURRENT EVIDENCE REGARDING FACE MASKS December 2020 and January 2021

Let’s follow only good clinical evidence to protect children and communities.

Indiscriminate Mandatory Face Mask Initiatives:  Evidence and Recommendations

“”At present there is only limited and inconsistent scientific evidence to support the effectiveness of masking healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2”  WHO

The WHO says when it MAY be helpful to wear a face mask – December 2020:

https://apps.who.int/iris/rest/bitstreams/1319378/retrieve.  

“Wear a mask if you cannot maintain a physical distance from others”. 

“In areas where the virus is circulating, masks should be worn when you are in crowded settings, where you can’t be at least one metre from others, and in rooms with poor or unknown ventilation.” 

“Individuals/people with higher risk of severe complications from COVID-19 (individuals > 60 years old and those with underlying conditions such as cardio-vascular disease or diabetes mellitus, chronic lung disease, cancer, cerebrovascular disease or immunosuppression) should wear a mask when physical distancing of at least one metre CANNOT be maintained.” 

“Caregivers or those sharing living space with people with suspected or confirmed COVID-19, regardless of symptoms, should wear a medical mask when in the SAME room”.

https://apps.who.int/iris/rest/bitstreams/1319378/retrieve

https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-masks

https://www.ecdc.europa.eu/en/covid-19/questions-answers/questions-answers-prevention

https://www.ecdc.europa.eu/en/covid-19/prevention-and-control/protect-yourself

The ECDC (European Centre for Disease Prevention and Control) says when it may be helpful to wear a mask – January 2021: 

“If you are infected, the use of medical face masks (generally pale blue in colour and available from pharmacies) MAY reduce the risk of you infecting others.”  

“Consider using a face mask when visiting busy, enclosed spaced, such as grocery stores and shopping centres, or when using public transport, where it is NOT possible to maintain a social distance from others.” 

“We strongly recommend the use of medical face masks for individuals with risk factors for severe COVID-19, for all people in airports, and for all passengers during flights.”

“Wear a face mask indoors and outdoor whenever physical distancing with other people CANNOT be guaranteed.”  

The ECDC have updated their advice. No good or strong clinical evidence or research supports the wearing of face masks for healthy individuals in the community.

https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission

Recommendations as published in newspapers in Singapore, February 2020, a country with experience and relative success in managing previous and current outbreaks of coronavirus:

“Do Not Wear a Mask” unless at higher risk: “Do Not Wear A Mask If You Are Well.” 

“Who Needs To Wear A Mask?  IF you have a Fever, Cough or Runny nose and IF you are Recovering from an Illness.”

Conclusion

The WHO and the ECDC therefore do not recommend indiscriminate mandatory face mask wearing as an initiative for the general public indoors or outdoors; it is clear that the WHO and ECDC specify specific contexts where this initiative will likely reduce risk on balance (balancing evidence-based risk and protective factors), which cannot be ignored, generalised or misinterpreted.  

These recommendations also make sense from a clinical point of view based on clinical training and clinical experience, along with research and statistics that risk is increased and harm is caused by these initiatives if not applied as clinically indicated.  

WE ALWAYS ADVISE EVERYONE TO FIRST FOLLOW THE LOCAL GOVERNMENT’S LAWS, RULES AND POLICIES. 

#evidence #recommendations #healthy #travel #children #schools #smoking #drinks #Cambridge #UK #ChildPsychiatrist #Mentalhealth #Health #International #ServiceDevelopment #OutreachWork