[Column] It’s too early to take off face masks

Chun Eun-mi
The author is a professor of pulmonology at Ewha Womans University Mokdong Hospital.

The Covid-19 crisis is now entering its fourth year. After the virus mutated since 2020, the Omicron variant was all the rage this year. It is estimated that more than 70 percent of Koreans have been infected more than once and have natural immunity. Globally, most countries are lifting indoor mask mandates after natural immunity increases. Korea has high vaccination and natural immunity rates, but still keeps an indoor mask mandate.

As the effectiveness of the mask mandate is questionable, attention is on whether the disease control authority should change the requirement to a recommendation around the Lunar New Year holiday. But the timing of lifting the mask mandate is still controversial. It is now the peak winter months when the virus spreads faster. Also, there are concerns about the “twindenmic” of flu patients and Covid patients surging among the age group that has not acquired immunity in the past three years.

For infectious diseases with no vaccine or treatment, face masks and distancing are disease control measures that can prevent and reduce severe cases. By wearing masks, the number of confirmed cases and the death rate in Korea, Japan and Taiwan was relatively low before the Omicron variant.

However, Korea was hit by Omicron — which spreads faster and can avoid existing immunity — when natural immunity rates were still low due to the mask mandate and distancing. Despite the high vaccination rate, confirmed cases surged rapidly and more than half of the citizens were infected with omicron.

China, which had long maintained a “zero-Covid” policy, was pressured by the simultaneous “blank sheet protests” of people opposing strict distancing and lockdown and recently switched to a “with Covid” policy. But the timing is the problem. The number of confirmed cases increased rapidly with the prevalence of the Omicron variant, and the Spring Festival, the holiday where people travel across the country, is approaching. The sudden lifting of disease control measures is causing serious chaos.

In the next three months, more than 50 percent of Chinese people are expected to be infected with the Omicron variant. While the severity of Omicron is about 70 percent lower than that of the Delta variant, it is similar for the elderly. In the current medical situation, it is expected that there would be more than 1 million deaths in China. When confirmed cases surge in a short period of time, there is a possibility of a new variant emerging. If a new variant is introduced to Korea, a new wave of the pandemic could be triggered.

Meanwhile, countries that had a low rate of mask-wearing or vaccination have acquired natural immunity equivalent to herd immunity through phased infections. By administering antiviral drugs to high-risk groups, severity and death rates have decreased significantly.

Considering overseas cases, making Covid-19 endemic can be attained not by avoiding infection completely but by being infected at least once, just like flu, and gaining natural immunity. Vaccination is a way to minimize damage by extending the timeframe for the medical system to handle cases and reducing severity until herd immunity through infection is achieved.

In order to protect high-risk groups and prevent a rapid spread, it is reasonable for Korea to keep a mask-mandate in public transportation and nursing facilities as well as high-risk facilities in hospitals until Covid-19 becomes endemic like the flu. Phased implementation from low-risk groups to high-risk groups would be an effective disease control strategy.

High-risk groups are likely to develop severe cases if treatment is not applied early due to their poor immune system. The administration of antiviral treatment within five days of symptoms prevents severe development for 89 percent of non-vaccinated people and for 60 percent of vaccinated people. Therefore, active administration of effective anti-viral treatment is an essential condition for lifting the mandatory mask.

However, in the medical field, the prescription rate of antiviral drugs is at a standstill. As a result, a considerable number of high-risk groups are in a blind spot when mask mandates are lifted. For Covid-19 to become endemic and for mask-wearing to become a choice, anyone should be able to get anti-viral drugs if needed. Prescription procedures also should be simplified. Government policies must be revised to increase the participation of medical staff.

I believe this will actually help end the Covid-19 era in 2023 when mask mandates can be lifted safely.

Translation by the Korea JoongAng Daily staff.