Coronavirus

WHO calls on nations to encourage public to wear fabric face masks where coronavirus is spreading

ORLANDO, UNITED STATES - MAY 14, 2020: Guests wearing face masks visit the Universal Orlando's CityWalk as sections of the entertainment and retail district opened today for limited hours for the first time since Universal Orlando closed on March 15, 2020 due to the coronavirus pandemic. In addition to face coverings, temperature checks are also being required. Universal's theme parks will remain closed until at least May 31.- PHOTOGRAPH BY Paul Hennessy / Echoes Wire/ Barcroft Studios / Future Publishing (Photo credit should read Paul Hennessy / Echoes Wire/Barcroft Media via Getty Images)

(CNN) — The World Health Organization is now calling for nations to encourage the general public to wear fabric masks in areas where there continues to be intense spread of the novel coronavirus — and for all health workers and caregivers to wear medical masks throughout their shift while in clinical areas.

These updated recommendations, announced on Friday, are a shift from what WHO previously advised on masks, which was to not wear them if you are not sick or not caring for someone who is sick, in an effort to keep masks available for health workers.

“In areas with widespread transmission, WHO advises medical masks for all people working in clinical areas of a health facility, not only workers dealing with patients with Covid-19,” WHO Director-General Tedros Adhanom Ghebreyesus said during a media briefing in Geneva on Friday.

“Second, in areas with community transmission, we advise that people aged 60 years or over, or those with underlying conditions, should wear a medical mask in situations where physical distancing is not possible,” Tedros said, and third, “WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments.”

Tedros added that the new guidance was updated based on evolving evidence.

“Our updated guidance contains new information on the composition of fabric masks, based on academic research requested by WHO,” Tedros said.

Fabric masks encouraged when physical distancing is difficult

WHO recommends that where there is widespread transmission, limited capacity to contain Covid-19 outbreaks and physical distancing of at least a meter can not be achieved, then governments should encourage their public to wear a fabric mask, Maria Van Kerkhove, WHO’s technical lead for coronavirus response and head of the emerging diseases and zoonoses unit, told CNN.

“What we are encouraging is that in situations where you have intense transmission, in situations where you can not do physical distancing, that a fabric mask should be worn — can be worn, should be worn — it’s something that needs to be considered very seriously,” Van Kerkhove said.

The new guidance recommends for these fabric masks — which can be homemade — to be at least three layers: an inner layer of an absorbent material such as cotton; a middle layer that acts like a filter or barrier, such as non-woven material polypropylene; and an outer layer of a non-absorbent material, such as polyester or polyester blend.

Van Kerkhove said to avoid materials that may be silk, stretchy or porous.

“What we are trying to do with the guidance that we’re putting out is to provide some parameters on, if you’re going to use a fabric mask, here are the best fabrics that you can use based on the evidence that we have,” Van Kerkhove said, adding that other guidance, such as maintaining physical distancing and frequent handwashing, remains important too.

“We feel very strongly that masks alone are not enough and we’re worried that people thinking that if they put on a mask, a homemade mask or a fabric mask, that they’re fully protected against this virus and they’re not,” Van Kerkhove said. “So we want to ensure that people still do physical distancing, people still adhere to the measures that their leaders are telling them to adhere to, and the bottom line is that anyone ill, anyone who is feeling unwell, should already be at home.”

In general, more research is needed to determine how effective fabric masks are at both preventing the mask-wearer from possibly spreading Covid-19 and protecting the mask-wearer from possibly catching the disease.

“The thing that needs to be understood about a mask is that it’s a barrier. So it can be used both for a barrier for somebody who’s wearing it. It can be used as a barrier for somebody who’s looking at the person who’s wearing it,” Dr. April Baller, WHO medical officer in infectious prevention and control, told CNN.

With a fabric mask, “right now we only know that it provides a certain level of barrier, but we don’t know if that’s enough to prevent,” Baller said. “With the data that there is available right now, we know that it provides some barrier, but we don’t know if it’s to the extent that it can be used for prevention.”

Guidance for health workers and caregivers

WHO also has new guidance for all health workers and caregivers in communities where there has been a lot of Covid-19: Those who work in clinical areas should wear a medical mask throughout their shift while in clinical areas — apart from eating, drinking and changing masks when necessary after caring for a patient.

“A lot of the transmission that’s happened is transmission that’s happening in the community and one of the concerns is that what’s happening in the community can be brought into the health facility,” Baller said. “It is definitely strategic and it’s looking at trying to address some of the transmission that could be happening and then at the same time ensuring that the health workers feel confident no matter what type of patients they’re seeing within the health facility.”

The updated guidance builds on previous recommendations that WHO made around caring for Covid-19 patients and wearing medical masks — including surgical masks and N95 respirators, which must be fitted to the faces of health care workers to protect them during certain procedures — along with other personal protective equipment.

“The reason that we’re updating the guidance is that WHO continuously looks at all available evidence on a variety of topics — including how this virus is transmitted, how different masks are used in different settings, including health care facilities and outside of health care facilities,” Van Kerkhove said.

“What we’ve done is we’re incorporating new research findings and we are providing more practical advice to decision-makers on how to use masks as part of a comprehensive package of measures to suppress transmission and save lives,” Van Kerkhove said. “So our goal fully remains suppressing transmission and save lives — and masks are part of that package of interventions.”

Masks don’t replace other public health measures

Wearing face masks is an “altruistic act” and primarily a tool for “source control” in the community — in which the practice is more about protecting others if you are infected than protecting yourself, Dr. Mike Ryan, WHO executive director of health emergencies programme, said Friday.

Ryan added that wearing masks needs to happen alongside other elements such as “case finding, cluster investigation, widespread testing, isolation of cases and quarantining of contacts.”

WHO’s updated guidance recommends masks be used as part of a “comprehensive package” to help curb the spread of Covid-19, which includes physical distancing, frequent hand washing, people who are sick self-isolating at home, suspected cases getting tested, and their contacts being traced.

However, in situations when physical distancing is not possible, such as using public transportation, masks can help reduce the risk of spreading the virus, Ryan said.

“Let me also emphasize, if you are sick with a fever, with a cough and are sneezing, you should not be in public, you should be seeking the care of a medical professional and seeking a Covid-19 test,” Ryan said, adding that with a positive test result you need to be isolated and all contacts need to be traced.

“We need to be very, very, very careful that masks are not seen as an alternative to the other public health measures that are so desperately needed.”

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Indiana coronavirus timeline

With updated information from the Indiana Department of Health on July 2, this timeline reflects updated tallies of deaths and positive tests prior to that date.

  • March 6: Indiana State Department of Health (ISDH) confirms the first case in Indiana. Officials say the Marion County resident had recently traveled to Boston to attend a BioGen conference as a contractor.
  • March 8: ISDH confirms a second case. An adult in Hendricks County who had also traveled to the BioGen conference was placed in isolation. Noblesville Schools say a parent and that parent’s children will be self-quarantining after attending an out-of-state event where someone else tested positive.
  • March 9: Avon Community School Corp. says a student on March 8 tested positive.
  • March 10: ISDH launches an online tracker. Ball State University basketball fans learn the Mid-American Conference tourney will have no fans in the stands. Three businesses operating nursing homes in Indiana announce they will no longer allow visitors.
  • March 11: The Indianapolis-based NCAA announces the Final Four basketball tournaments will be conducted with essential staff and limited family attendance. The Big Ten announces all sports events, including the men’s basketball tournament at Bankers Life Fieldhouse, will have no fans starting March 12. Ball State University suspends in-person classes the rest of the spring semester. NBA suspends all games, including the Indiana Pacers, until further notice. Butler University and the University of Indianapolis extend spring break, after which they will have virtual classes.
  • March 12: Gov. Eric Holcomb announces new protections that led to extended public school closings and the cancellation of large events across the state. The NCAA cancels its basketball tournaments. The Big Ten suspends all sporting events through the winter and spring seasons. The league including the Indy Fuel hockey team suspends its season. Indy Eleven says it will reschedule four matches. Indianapolis’ annual St. Patrick’s Day Parade is canceled. 
  • March 13: The Indiana High School Athletic Association postpones the boys basketball tournament. Wayzata Home Products, a Connersville cabinet maker, shuts down and lays off its entire workforce due to market uncertainty. Gov. Holcomb announces actions including the elimination of Medicaid co-pays for COVID-19 testing and the lifting of limits on the number of work hours per day for drivers of commercial vehicles. Franklin College says it will begin online classes March 18 and empty residence halls of students in two days. The Children’s Museum of Indianapolis closes indefinitely. The Indianapolis Public Library joins other libraries across Indiana and closes all facilities indefinitely.
  • March 14: The Indiana Gaming Commission says all licensed gaming and racing operations will close in two days for an indefinite period.
  • March 15: Indiana had its first death. St. Vincent Hospital in Indianapolis announces it will suspend all elective, non-urgent surgeries.
  • March 16: Indiana had its second death. Gov. Holcomb announced the first Hoosier death. He closes bars, restaurants and nightclubs to in-person patrons, but maintains carryout and delivery services.
  • March 17: Indiana had its third and fourth deaths. ISDH announces Indiana’s second death. Indiana’s Catholic bishops cancel masses indefinitely. Gov. Holcomb activates the National Guard. Purdue, Butler and Indiana State universities cancel May commencement ceremonies.
  • March 18: Indiana had its fifth death. Eli Lilly and Co. says it will use its labs to speed up testing in Indiana. The 500 Festival announces suspends all events. Simon Property Group closes all malls and retail properties.
  • March 19: Gov. Holcomb extends Indiana’s state of emergency into May. Holcomb says he’ll close all K-12 public and nonpublic schools. Standardized testing was canceled. The state’s income-tax and corporate-tax payment deadline was extended to July 15. Holcomb says the state will waive job search requirements for people applying for Temporary Assistance to Needy Families. The IHSAA Boys Basketball State Tournament was canceled. The Marion County Emergency Operations Center upgrades to Level 1 status.
  • March 20: Indiana’s death toll rose to 9. ISDH announces Indiana’s third death. Gov. Holcomb moves the state’s primary election to June 2. Indiana University says it is postponing May commencement ceremonies on all campuses.
  • March 21: Indiana’s death toll rises to 14. ISDH announces Indiana’s fourth death. Indiana National Guard says it and the Department of Transportation are distributing medical supplies to hospitals.
  • March 22: Indiana’s death toll rises to 19. ISDH announces seven deaths.
  • March 23: Indiana’s death toll rises to 24. Holcomb orders Hoosiers deemed nonessential to “stay at home” from March 24-April 7. Eli Lilly & Co. begins drive-thru testing for the coronavirus for health care workers with a doctor’s order. Ball State University cancels the May commencement.
  • March 24: Indiana’s death toll rises to 29. Fred Payne of Indiana Workforce Development says any Hoosiers out of work, including temporary layoffs, are eligible to apply for unemployment benefits.
  • March 25: Indiana’s death toll rises to 35. Indianapolis Motor Speedway announces the Indianapolis 500 is moved to Aug. 23. IndyGo suspends fares and changes its ride schedules.
  • March 26: Indiana’s death toll rises to 44.
  • March 27: Indiana’s death toll rises to 47.
  • March 28: Indiana’s death toll rises to 58.
  • March 29: Indiana’s death toll rises to 76. President Donald Trump announces in a press conference that the national social distancing recommendation will be extended by 30 days.
  • March 30: Indiana’s death toll rises to 91. Indiana health commissioner Dr. Kristina Box predicts the arrival of the surge in cases and deaths could come in mid-April to late April, but could be as late as mid-May, “but we don’t know.”
  • March 31: Indiana’s death toll rises above 100, to 113. Gov. Holcomb extends the limits of bars and restaurants to offer only “to go” and “carryout” through April 6. Health commissioner Box, asked about when Indiana will be in a surge of COVID-19 cases, says she thinks the surge is starting.
  • April 1: Officials extend Marion County’s “stay at home” order through May 1. Marion County health officials say they will start COVID-19 testing services for front-line employees. Gov. Holcomb announces the #InThisTogether campaign.
  • April 2: The state announces K-12 schools will be closed for the rest of the school year. The Indiana High School Athletic Association cancels spring sports seasons.
  • April 3: Gov. Holcomb extends the “stay at home” order through April 20. The state receives a federal Major Disaster Declaration for all 92 counties. The Indiana National Guard says it, the Army Corps of Engineers and state health officials will begin to assess sites for alternate health care facilities.
  • April 4: Indiana’s death toll rises above 200.
  • April 6: The state reports a Madison County nursing home has had 11 deaths. Gov. Holcomb extends the “stay at home” order through April 20. He also limits additional businesses to carry-out only.
  • April 7: Indiana’s death toll rises above 300. Indiana health commissioner Box says four long-term care facilities have 22 deaths that appear to be related to COVID-19.
  • April 10: ISDH said 24 residents of a long-term care facility in Madison County have died from COVID-related illness.
  • April 11: Indiana’s death toll rises above 400.
  • April 14: Indiana’s death toll rises above 500.
  • April 16: Tests ID more than 10,000 Hoosiers with coronavirus. The governor says he expects Indiana to experience a reopening in early May.
  • April 17: Indiana’s death toll rises above 600. The governor says that he will extend the “stay at home” order through May 1.
  • April 20: Indiana’s death toll rises above 700. Gov. Holcomb extends the “stay at home” order to May 1. The governor also says, if the medical supply chain is in good shape, other elective medical procedures can resume April 27.
  • April 22: Indiana’s death toll rises above 800. The Tyson facility in Logansport voluntarily closes so 2,200 employees can be tested for COVID-19.
  • April 24: Indiana’s death toll rises above 900. The Indianapolis City-County Council approves $25 million to help small businesses. Fishers City Council creates a city health department with a plan to test every resident.
  • April 25: ISDH says it will launch an antibody testing study for Hoosiers; thousands of residents were randomly selected to participate in the study.
  • April 27: Indiana’s death toll rises above 1,000.
  • April 28: Indiana officials say they will open COVID-19 testing to more Hoosiers, with expanded criteria and new testing services at 20 sites around the state.
  • April 29: The state says it will spent $43 million on contact tracing.
  • April 30: Indianapolis extends its stay-at-home order through May 15.
  • May 1: Gov. Holcomb announces a phased reopening plan for the state of Indiana. He also extends the stay-at-home order to May 4.
  • May 3: Tests ID more than 20,000 Hoosiers with coronavirus.
  • May 4: Indiana enters Stage 2 of its Back on Track plan, which excludes Cass County until May 18, and Lake and Marion counties until May 11.
  • May 6:The state begins testing for all Hoosiers at 20 sites, with plans to expand the number of sites to 50 in a week. Ivy Tech Community College says it will continue virtual classes when summer courses begin in June. 
  • May 8: Cris Johnston, director of the Office of Budget and Management, says the state missed out on nearly $1 billion in anticipated April revenues; all state agencies will be given budget-cutting goals. Purdue University OKs plans to reopen for the fall semester with social distancing and other safety measures.
  • May 10: Indiana’s death toll rises above 1,500.
  • May 13: Indiana’s death toll rises above 1,600.The first phase of a state-sponsored study of the coronavirus estimated about 186,000 Hoosiers had COVID-19 or the antibodies for the novel virus by May 1. Indianapolis Mayor Joe Hogsett announced plans for limited reopenings of worship services, retail establishments, libraries and restaurants.
  • May 16: Indiana’s death toll rises above 1,700.
  • May 17: Marion County’s death toll rises above 500.
  • May 18: Indiana reports its first case of multisystem inflammatory syndrome in a child. The Farbest Foods turkey-processing plant in Huntingburg is closed for three days; 91 people have tested positive there.
  • May 19: Indiana’s death toll rises above 1,800.
  • May 21: Tests ID more than 30,000 Hoosiers with coronavirus.
  • May 22: Indiana advances to Stage 3 of the Back on Track reopening plan. Indianapolis closes portions of five streets to allow restaurants to reopen with outdoor dining only.
  • May 23: Indiana’s death toll rises above 1,900.
  • May 27: The U.S. death toll rises above 100,000. Indiana University says the fall semester will have in-person and online courses, plus an adjusted calendar through May 2021. Ball State University says the fall semester will be 13 straight weeks of in-person classes with no day off on Labor Day and no fall break.
  • May 28: Indiana’s death toll rises above 2,000.
  • May 29: Places of worship in Marion County can begin holding indoor services at 50% capacity with proper social distancing. Jim Schellinger, Indiana secretary of commerce, said the federal Paycheck Protection Program has made 73,430 loans in Indiana totaling $9,379,164,461, the federal Economic Injury Disaster Loan program has made 5,070 loans in Indiana totaling $445,428,500, and the federal Economic Injury Disaster Loans Advance program has made 38,365 grants in Indiana totaling $136,554,000.
  • June 1: Marion County restaurants begins serving customers indoors and outdoors with 50% capacity. Marion County salons, tattoo parlors reopen by appointment only. Marion County gyms, fitness centers and pools reopen with 50% capacity and no contact sports. However, a Marion County curfew that began the night of May 31 and continued into the morning of June 3 after rioting impacted the reopening of some businesses.
  • June 3: Indiana’s death toll rises above 2,100. Phase 2 of statewide testing of random Hoosiers by the Indiana University Richard M. Fairbanks School of Public Health at IUPUI and the Indiana State Department of Health begins.
  • June 5: Indiana reports May tax revenues were 20% short of projections made before the coronavirus closings started.
  • June 8: Indiana’s death toll rises above 2,200. Indianapolis leaders agree to spend $79 million in coronavirus relief funding on contact tracing, rent relief, personal protective equipment and support for small businesses.
  • June 12: Indiana, excluding Marion County, advances to Stage 4 of reopening plan.
  • June 15: Indiana’s death toll rises above 2,300. Casinos and parimutuel racing reopen in the state.
  • June 19: Marion County advances to Stage 4 of state’s reopening plan.
  • June 15: Indiana’s death toll rises above 2,400.
  • June 24: The governor says the state’s moratorium on the eviction on renters will be extended through July. Indiana announces it will create a rental assistance program July 13. Indiana Pacers guard Malcolm Brogdon says he has tested positive for COVID-19.
  • June 27: Indiana hospitalizations for COVID-19 begin to increase, with about 33 new patients a day through July 1.
  • July 1: Tests ID more than 46,000 Hoosiers with coronavirus. The governor pauses Stage 5 final reopening plan, announces Stage 4.5 from July 4-17.
  • July 4: Stage 4.5 reopening plan begins.

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