









































                                                                                                                         2021, Vol. 1 (S5) 4-6 
 https://doi.org/10.47488/dhrp.v1iS5.30 

 
http://dhrproceedings.org 4 © DHR Health Institute for Research and Development 
 

 

COMMENTARY 

Don’t abandon your mask (and other public health 
measures) quite yet  
R. Armour Forse MD, PhD, FRCS(C), FACS,1 Anthony O. Obinna  RN, BSMT, MBA-
HCA, CIC 2 and Manish Singh MD, FACS 3  
 
1 Chief Academic Officer and Designated Institutional Official DHR Health, 5501 S. McColl Road, 
Edinburg, Texas, 78539 
2 Director of Infection Prevention and Control, DHR Health, 5501 S. McColl Road, Edinburg, Texas, 
78539 

3 Chief Executive Officer, DHR Health, 5501 S. McColl Road, Edinburg Tx 78539 and DHR Health 
Bariatric and Metabolic Institute, 500 Raphael Drive, Edinburg, TX 78539  
ORCID: Manish Singh: https://orcid.org/0000-0003-4146-3282  
 
Received 10/25/2021 
Accepted for publication 10/27/2021 
Published 10/28/2021 

Keywords:  COVID-19; Public health measures

The impact of Covid-19 vaccinations continues to make a 
significant difference with the pandemic. Recent CDC 
guidelines provide advice on being able to do more activities 
without the mask if you are fully Covid-19 vaccinated. But 
before you put that mask away there are a few things to 
remember. When the pandemic broke out there were no 
vaccines and no medications to combat the Covid-19 virus. 
Four key public health measures were instituted. One, if you 
were infected, you needed to quarantine, two wear a mask, 
three keep your social distance and four, always perform 
proper hand hygiene. 

These public health measures really worked and had a 
synergistic impact. In fact, in our hospital, DHR Health, the 
only outbreaks in the hospital occurred when someone 
infected and sick with Covid-19 came to work and when 
Health Care Workers (HCW) congregated together such as for 
a coffee or meal at which time they did not wear a mask and 
were not social distancing. Otherwise, the public health 
measures were effective in controlling the spread of the 
Covid-19 (DHR Health Infection Prevention and Control 
data). It is important to understand that vaccination does not 
prevent you from becoming infected with Covid-19; it 
prevents you from becoming very ill or dying from Covid-19. 
Even then the vaccination effect is not absolute. Vaccinated 
people have become very ill, have been hospitalized, and yes, 
vaccinated people have died from Covid-19; usually due to 
having comorbidities such as obesity and diabetes or they are 
immunocompromised.  This is why the CDC has continued to 

recommend that Health Care Workers in the hospital continue 
to wear masks, social distance and observe good hand hygiene 
no matter what their vaccination status (CDC Ref).  

What has been very educational is the effect of these public 
health measures on other infectious diseases. The best 
example was the influenza viruses.  Over the past year of 
2020, influenza became almost extinct as compared to all the 
years of influenza reporting. Adult infections were 
dramatically decreased, not only in North America but 
globally. The WHO organization data for all continents 
showed a similar effect (WHO). Not only were influenza 
infections decreased but influenza deaths as well.  

This effect was also evident in children where there was a 
significant, 65.7%, decrease in respiratory infections.  
Associated with this decrease in infections was a 60% 
decrease in outpatient visits, and a significant decrease in 
hospitalization and hospital Length of Stay (LOS). Even more 
impressive is that the CDC reported only one pediatric flu 
related death in the 2020-2021 flu season versus 196 in the 
2019-2020 season. This decrease in pediatric respiratory 
infections represented cases of adenovirus, influenza A, 
influenza B, and respiratory syncytial virus (RSV). These data 
help to illustrate that the public health measures are effective 
in controlling infectious diseases, particularly those for which 
there is no medical therapy nor vaccine.These public measures 
have an interesting history and by no means are new…they are 
historic. The important concept of quarantine has been around 

https://orcid.org/0000-0003-4146-3282


DHRP, 2021, Vol. 1 (S5) 4-6  Protective Effect of Public Health Measures 

 
http://dhrproceedings.org 5 © DHR Health Institute for Research and Development 
 

for a long time. The term comes from “quaranta” meaning 40. 
Started in Venice, Italy to control the plague, the number 40 
was the chosen number of days of isolation. The data behind 
the 40 days is quite variable ranging from being derived from 
Hippocrates theories to the number of days Jesus spent in the 
wilderness. Since then the quarantine process has evolved and 
is quite effective. The principle is to isolate the infected person 
until they are beyond the infectious state. For Covid-19 it was 
for 10 days in the asymptomatic persona and up to 21 days for 
those severely ill or hospitalized. Longer times were 
recommended based on the severity of the disease and the 
health status of the infected person. An extension of the 
quarantine principle is social distancing which is based on the 
effective distance to minimize aerosolization based 
contamination. Initially it was 6 feet for the Covd-19, but it 
has been suggested that it might be increased to 10 feet based 
on the highly contagious delta variant.  

The wearing of masks has been around mankind for thousands 
of years.  The use of masks was seen with the dead and at the 
burial site and funerals. They were used as part of a religious 
ritual and it is very possible that the masks were actually used 
to protect from contamination with the dead person's infection.  
Perhaps the most memorable use of masks are the sinister 
looking masks that were developed from the carnival masks 
of Venice and were used by medieval doctors to protect them 
against the plague and the black death.  Of note is that the beak 
of these masks were used to hold herbs to absorb the noxious 
air based on the Miasma theory of disease propagation.  
Unfortunately there is no proof that this mask was effective.  
It was principally the use of the masks to cover the mouth and 
nose during the flu pandemic of 1910 to 1911 and the 
effectiveness of mandatory masks during the influenza 
pandemic of 1918 to 1919 that supported the principle that 
facemasks are a means of protecting medical workers and 
patients from infectious disease outside of places such as the 
operating room. While controversial, in the city of San 
Francisco, the decline in deaths from influenza was 
attributable to the mandatory mask wearing policies.  A 
systematic review med analysis of Public Health masks to 
prevent person to person transmission concluded that the 
facemask had good results with an 85% reduction in risk of 
infection.  The evidence from this review was stronger for the 
use of face masks as part of the personal protective equipment 
in the health care settings rather than in the community setting.  
In addition, the review supported the use of specific masks 
such as the N95 over the use of surgical or cotton masks.  
Studies particularly based in Asian countries such as China 
and Japan have shown some effectiveness in the wearing of 
masks however the overall effectiveness is a concern due to 
the lack of consistent compliance throughout the community.  
Despite this the CDC strongly supports the wearing of masks. 
It is important to point out that these must be worn properly 
covering both the nares and the mouth, and the mask must be 

changed if it gets wet. Mask changing also requires proper 
hand hygiene when handling the masks.  Advocates for 
wearing the mask believe that they will protect those from 
individuals who have been infected with Covid-19 but are 
asymptomatic.  It is certainly felt that the mask alone is not as 
effective unless it is part of the complete public health care 
measures including social distancing, isolation, or quarantine 
of the infected and proper hand hygiene. 

One of the most important aspects of Public Health control of 
Infectious Diseases is proper hand hygiene. While religious 
hand hygiene was around for thousands of years, the idea that 
hand hygiene was associated with germs, diseases and was a 
life-saving measure has only been around for about 170 years. 
This was through the work of Ignaz Semmelweis who in the 
Vienna Obstetrical Clinic demonstrated that hand washing 
reduced the maternal mortality from 18.3% to below 2%. 
Although his work was criticized, in part due to the fact the 
exact reason for the improvement was not identified, his work 
was subsequently validated with the work of Dr. Joseph Lister.  
Despite many ups and downs, hand hygiene has been 
identified as a major public health measure. Compliance with 
hand hygiene has been a moving target requiring constant 
reminders including in the healthcare settings. The WHO has 
identified hand washing as the leading public health measure 
to control the spread of disease and this is supported by the 
CDC. The WHO guidelines emphasizes that Clean Care is 
Safe Care and provides the support for regular hand washing. 
So how are we doing with this health measure particularly in 
the health facilities? In the public setting the data shows that 
we are very poor at hand hygiene. Unfortunately in the health 
facilities the data is also not promising. Previous studies have 
demonstrated hand washing compliance to be only 47.5% 
across eight hospital surveyed. Identifying barriers and 
addressing them improved the hand washing to 81% which is 
still low for a hospital. The recent pandemic can have a 
positive effect on hand hygiene, but the actual compliance is 
based on the individual’s sex, their perceived susceptibility, 
and the actual effectiveness of the hand washing.  Addressing 
these are very important in improving the hand washing. 
However, continually personnel in healthcare facilities need 
to be reminded about the importance and effectiveness of hand 
washing. That is why it continues to be a key element of The 
Joint Commission’s National Patient Safety Goals.  

So does this meaning that we need to continue to wear masks 
all the time?  No, but we do have to rethink our personal 
approach to Public Health measures and Infection Control.  
Covering ones nose and mouth particularly in doors, 
respecting social distancing, and performing regular hand 
hygiene have once again been proven to work and to be 
effective. The CDC continues to advocate these Public Health 
measures as we wait for the global pandemic to subside.  We 
have the opportunity to continue to use these measures to 



DHRP, 2021, Vol. 1 (S5) 4-6  Protective Effect of Public Health Measures 

 
http://dhrproceedings.org 6 © DHR Health Institute for Research and Development 

protect ourselves, our patients and our families from Covid-19 
and other infectious diseases even as therapies are being 
instituted: they supplement the therapies. Making them part of 
our regular routine as health care workers is what is really 
important; and is our responsibility.    

So, remember what your mother told you: “Cover your mouth 
and nose when you cough or sneeze, stay well away from the 
sick kids, and wash your hands!” ---- as usual she was right! 

Diclosures 

RAF declares no conflicts of interest.  

AOO declares no conflicts of interest. 

MS declares no conflicts of interest. 

Funding 

There is no funding associated with this publication. 

References 

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12. CDC Covid-19 Vaccinations; 
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14. WHO Global influenza program: 
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15. Joint Commission National Safety Goals: ( 
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standards/ )  

 

 

https://www.cdc.gov/handhygiene/index.html
https://dpi.org/10.1371/journal.prone.0243694
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenza-surveillance-outputs
https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenza-surveillance-outputs
https://www.who.int/teams/global-influenza-programme/surveillance-and-monitoring/influenza-surveillance-outputs
https://www.jointcommission.org/standards/about-our-standards/
https://www.jointcommission.org/standards/about-our-standards/

