Vaccine in Focus
Why health experts say you should wear a mask as well as vaccinate against COVID-19
While vaccination remains our first line of defence against COVID-19, especially with the emergence of the Omicron variant, experts say mask wearing remains crucial.
COVID-19 cases are surging in New South Wales and continue to rise in other parts of Australia as authorities warn transmission of the Omicron variant has a doubling time of around two days.
It's an anxious time, with thousands preparing to travel around the country over the summer break, and as some experts claim governments may not be doing enough to control the virus' spread - particularly in NSW.
Health Minister Greg Hunt says Australia remains "overwhelmingly towards opening up" and no states or territories had indicated further restrictions at this point in time.
"The clear direction is higher vaccination and less restrictions," he said on Sunday.
With Omicron expected to fast become Australia's dominant variant, research by a team from the University of Hong Kong (that is yet to be peer reviewed but has been widely published) shows the variant could be 70 times more infectious than Delta.
The Executive Director of World Health Organization (WHO)'s health emergencies programme, Dr Mike Ryan, says Omicron's highly infectious nature is because the virus has changed the shape and ability of its spike protein over the past two years to make it more transmissible among humans.
At the same time, preliminary research appears to show current vaccines are less effective against the new variant, which means other health measures such as distancing and mask wearing are in the spotlight.
So, how much do current vaccines protect us and how important is mask wearing in Australia as Omicron takes hold?
How much do current vaccines protect us?
Recent research from the UK has shown that having two doses of a COVID-19 vaccine offers less defence against symptomatic infection from the Omicron variant than with Delta.
But the good news is a booster does appear to raise protection considerably to 70 or 75 per cent, though it remains unclear whether the vaccines will protect against hospitalisation and deaths with the new variant.
Different COVID-19 vaccines have been found to be safe and effective as boosters. The results of the Cov-Boost trial, published in December, looked at the use of seven different vaccines as boosters after two doses of either the AstraZeneca or Pfizer vaccines: AstraZeneca, Curevac, Johnson and Johnson (Janssen), Moderna, Novavax, Pfizer and Valneva.
The trial found that all vaccines (except for Curevac) boosted the immune response, although the level of antibodies differed significantly, depending on the mix of vaccines.
Epidemiologists and health experts agree triple vaccination is a crucial line of defence against Omicron, but claim other measures such as social distancing, mixing outdoors where possible and mask wearing remain important in stopping the spread.
Dr Benjamin Veness, executive member of OzSAGE - a multi-disciplinary network of Australian experts that offers advice on the pandemic response - and co-founder of Health Care Workers Australia, says mask wearing is key.
“Masks have always been important even with Delta or ancestral strains. It’s long been recognised that the current crop of vaccines don’t provide what’s called sterilising immunity, which means that they don’t always stop you from being able to contract or transit the virus," Dr Veness told SBS News.
"Although they were obviously more effective against Delta and other strains compared to Omicron.
“With Omicron, the good news is that once you get a booster dose and seven days have elapsed, you’re likely to have similar levels of protection that were afforded against the Delta strain.”
Dr Veness said ‘Vaccines-Plus’ is the term many experts are using to try and promote the idea that you need both vaccination and other measures to combat Omicron, which include well-fitted masks and better indoor air ventilation, because the virus lingers in stale air.
What are current mask requirements in Australia’s states and territories?
Across Australia’s states and territories, mask mandates are in place in airports and on aircraft, on public transport and in high-risk facilities such as detention centres and residential aged care facilities in many jurisdictions.
Beyond that, mask mandates vary. South Australia mandates masks in all indoor public places, whereas Queensland requires masks in retail centres but not hospitality venues at this point in time.
In Tasmania, masks will be mandatory across all indoor settings, public transport and ride shares from Tuesday.
Victoria lists masks as required in various settings including in retail centres (except at hairdressing and beauty salons) and among workers in hospitality venues.
On Sunday, Acting Premier James Merlino said mask wearing and boosters were Victoria’s current focus.
“We're at the early stages of the Omicron variant and that's why we need to be prudent. It's why we made the common sense decision, based on public health advice, to continue the wearing of masks," he told reporters.
In NSW and ACT, masks are no longer required in retail and hospitality settings (NSW only mandates masks among hospitality staff who are not double vaccinated).
NSW Premier Dominic Perrottet said on Sunday NSW "strongly encourages" masks but won't mandate them, given "there's always different views, there are always different debates".
WHO advice, meanwhile, continues to recommend mask wearing in indoor public settings.
“For indoor public settings such as busy shopping centres, religious buildings, restaurants, schools and public transport, you should wear a mask if you cannot maintain physical distance from others," it says on its website.
"If a visitor comes to your home who is not a member of the household, wear a mask if you cannot maintain a physical distance or the ventilation is poor.
"When outside, wear a mask if you cannot maintain physical distance from others. Some examples are busy markets, crowded streets and bus stops.”
What do experts suggest regarding masks?
Calls from epidemiologists and public health experts to mandate masks in all indoor settings, particularly in NSW, have been getting louder.
The Australian Medical Association (AMA) has called on the NSW government to reimpose restrictions across the state following a steep rise in infections that AMA President Omar Khorshid described on Saturday as “almost vertical”.
Mr Korshid told ABC News that to try and flatten the curve and prevent an increase in hospital numbers, “we can reduce the impact through simple measures” such as mask wearing.
“Masks are not a huge impact on individual freedoms, we've been living with them for such a long time now, and it's very bizarre timing from the NSW government to pull out a mask mandate just when you are seeing an incredible spike in cases that matches what's happening around the world," he said.
Mr Khorshid said “while governments aren’t acting”, it’s up to “individuals to make sure that every time that you are out of the house you've got your mask on, that you avoid mass gatherings as we come through the rest of the Christmas period, so that you are not having to isolate when it comes to Christmas Day. And of course, as soon as you are eligible for a booster, go and get one.”
A study published in the American journal of Preventative Medicine in November shows that nations that imposed mask mandates at the beginning of the pandemic had significantly lower death rates per million than countries that did not enforce mask rules.
The study examined 44 countries in Asia and Europe, 27 countries with mask mandates and 17 without, between February and May 2020. It found the average COVID-19 mortality per million in countries without face mask policies was 288.54 per million compared to the 48.40 per million in countries with national mask mandates.
And, this was before the emergence of the highly transmissible Omicron.
Dr Veness said people should be wearing a mask regardless of how many vaccinations they’ve had.
“If you’re double vaccinated, a mask is absolutely essential but frankly if you’re triple vaccinated, you should still be wearing a mask because no vaccine will completely protect you or other people from the virus and masks are a very simple and low cost intervention which make a big difference.
“Anywhere that there is community transmission of COVID-19, wearing masks indoors is an important public health control measure. It doesn’t matter whether you are in Tasmania or NSW - right now, if you’re going indoors other than your own home you should be wearing a mask, and that’s to protect yourself and other people.
“This is regardless of how many vaccine doses you’ve had but you should be trying to get your third dose booster as soon as possible.”
Deputy Chief Medical Officer Sonya Bennett on Sunday pleaded with Australians to continue to wear masks, even in the absence of a mask mandate.
"First and foremost, I'd probably encourage everyone to think about continuing to wear masks, particularly in settings that are indoor, public indoor spaces that may not be well-ventilated. Think about wearing a mask. It's a simple, easy thing to do," she told the media.
"My plea to the community is we don’t need to wait for mandates to tell us what is sensible to do. That particularly applies to masks. They’re simple, we’re used to it ... I ask the community to consider that they use that. That they make their own choice to use a mask when necessary."
Which masks are best?
Dr Veness says the quality of a mask is determined by its fit - how snug it is around the mouth and nose - and the type of filtration it provides.
Cloth masks, a staple of the pandemic, are usually inadequate, he says.
Cloth masks have been banned on some airlines and in public spaces across Germany and Austria because there are no standards guiding their efficacy.
“The problem with cloth masks is often the filtration is not so good, and depending on the cloth mask, the fit may not be so great either," Dr Veness said.
He says the N95 respirator is the ideal standard, followed by a surgical mask, which has better filtration than a cloth mask.
“The closer you can get to the N95 level of protection the better," he said.
Dr Veness says the best way to ensure you are getting the best better protection from cloth masks is to put a surgical mask underneath the cloth mask.
“It’s called double layering. If you have the surgical mask against your mouth and nose and a reasonably tight fitting cloth mask on top, that’s better than either of those alone."
Dr Veness also recommends the “tuck and fold” technique to make a surgical mask fit more tightly around the mouth and nose.
“Anywhere where you feel a leak of air, and people with glasses will notice this particularly, these leaks of air indicate that air with viral particles could be coming in or out around those gaps.
"The less of those leaks the better.”