When the epidemic seemed to be confined to Asia, it was deemed unnecessary. When the peak of the epidemic was reached in France, its recourse was reserved for caregivers and the sick. Before it is recommended for all during deconfinement. From now on, the generalized wearing of the mask is under study, affirms this Sunday Prime Minister Jean Castex, in particular in closed places, suspected of being more favorable to the propagation of the coronavirus.
It is therefore not the first time that the government has changed its mind about wearing these protections against Covid-19. For six months, official advice has continued to evolve as the epidemic, and our knowledge of the virus, progresses. Back on six months of procrastination on the wearing of this protection if discussed.
A mask deemed "useless"
In January, the epidemic was not yet qualified as such in France. Only three cases of contamination are officially detected in France. The risk of alert is then considered "moderate, even almost zero" by the Minister of Health Agnès Buzyn. However, airport pharmacies are seeing more and more customers - often Asian customers returning - wanting masks.
But in France, the message is clear: wearing a mask is only recommended for patients with symptoms associated with the coronavirus, such as cough, headache or fever. Wearing a mask for the rest of the population is "useless," says even Agnes Buzyn.
Same story on the side of Public Health France, the agency responsible, in particular, for health monitoring. “Wearing a surgical mask is recommended for sick people who have symptoms, that is, when they cough or sneeze. This avoids spreading the disease through the postilions, "she said, soberly, in a Q&A note published on February 2.
This position, however, contradicts recommendations provided almost ten years earlier. "When we go back in time, we see that in 2011, the influenza pandemic plan launched after the H1N1 virus in 2009 provided for a measure for the wearing of anti-splash mask for all, from stage 1 of the epidemic", or the stage where we detect early cases on the territory, remembers the general practitioner Michael Rochoy, based in Pas-de-Calais, and co-founder of the stop-postillons site, which promotes the wearing of masks. A plan still available on the government website.
These recommendations were shared, in part, by the High Council for Public Health in 2013. However, they did not materialize in the street. “The mask was not worn at all. It is not in our culture, unlike Asia where we wear it a lot to protect others, ”says Michaël Rochoy.
Empty stocks
These recommendations also seem to have been forgotten by the government. It's that at this stage, stocks are dwindling ... and are not being replenished at the same speed. Freshly appointed Minister, Olivier Véran ensures, on February 22, to prepare for a pandemic. “We are also continuing to wear masks. Public Health France works with French companies that manufacture them, in addition to orders already placed abroad, "he says. In the meantime, the wearing of the mask is widening to travelers returning from particularly affected areas, such as China, or northern Italy.
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The alerts on the lack of masks emerge. Faced with stock-outs, the prices of mask packs are soaring on the Internet. Just like the scams. To avoid rushes in pharmacies, the government ordered pharmacies, in late February, to limit the sale of masks to only patients who have a prescription. At the same time, tens of millions of masks are ordered by the state. They are mainly intended for caregivers.
“No one needs to wear a mask if a doctor doesn't ask you to wear one. Rushing to pharmacies can give rise to a shortage, "defends the Minister of Health. Message shared by the Director General of Health, Jérôme Salomon on March 4: "the masks have no interest for the general public," he says.
The government is confident in its posture. And for good reason: all this time, the World Health Organization (WHO) ensures that wearing a mask is useless for healthy people. It is recommended to wear it only when you are symptomatic or when caring for a sick person, she reminds in mid-March.
Homemade masks?
On the other side of the planet, images of masked passers-by in the streets of major Asian cities have something to impress, and suggest that these protections would be more useful than they say. But the stocks of masks are still insufficient, according to health care unions which, at the end of March, seized the Council of State to launch a massive production of masks for the whole population.
Then begin the debates around the homemade mask. Useful, not useful? Whatever the answer, guides for sewing masks at home - sometimes from hospitals - are widely shared on social networks.
"From 2011, it was considered that we no longer needed a stock of masks"
Sibeth Ndiaye explains why we are in shortage of masks today pic.twitter.com/lHRn7WV7yQ
The DGS, it always recommends to get rid of the mask. "Without even talking about the quality of the mask or its filtering power, there is a question of handling the mask," she explains. “The mask is protective equipment which must in principle be worn by a professional trained for this purpose. A mask that is improperly handled can itself become a risky element rather than a protective element, ”she says. An argument already relayed by the government spokesperson, Sibeth Ndiaye, who, on the set of BFMTV, is also worried about seeing French people wearing the mask badly.
Change of speech
A week later, Edouard Philippe and Olivier Véran announced a massive order for a billion masks, still intended for caregivers. International pressure is intensifying. In early April, George Gao, the director general of the Chinese Center for Disease Control and Prevention, lashed out at Europeans who limit the wearing of masks to caregivers and the sick. A few days later, it is its American equivalent, the CDC, which recommends the wearing of cloth masks for the general public, in transport and shops. In France, the Academy of Medicine follows the movement, recommending the obligation to wear a mask for everyone, well before deconfinement, and during each outing.
The message from the health authorities eventually changes. Jérôme Salomon said he was in favor of wearing alternative masks this time "for professionals or individuals who have occasional contact with other people".
For its part, the WHO still sticks to its initial position, fearing that the widespread use of the mask would give a “false sense of security” and make people forget the essential barrier measures (social distancing, hand washing, etc.). With a nuance: his boss, Dr. Tedros Adhanom Ghebreyesus, admits wanting to "assess the potential use of the mask more broadly". "The pandemic is evolving, the evidence and our opinions too," he slips.
Deconfinement and compulsory port
In the street, wearing a mask, whether alternative or surgical, seems to have become popular. Several mayors decide, on their own scale, to make it compulsory to wear it in public buildings. Obligations that they eventually retract, or cancel, following court decisions.
Then follows a press release from the European Center for Disease Prevention and Control, which, like its international equivalents, is in favor of wearing masks. Emmanuel Macron formalizes the importance of the mask in his address on April 13, where he announces the first phase of the deconfinement of May 11. And promises that everyone can get a "general public" mask by this deadline.
Everything is accelerating. The town halls promise to distribute masks to each of their inhabitants. The Academy of Medicine is once again ruling on the obligation to protect themselves from projections, whether homemade masks or industrial masks.
To better control sales, and avoid the drifts known a few weeks earlier, the government capped the price of surgical masks at 95 cents per unit in early May.
Towards a relaxation
This time, the government is no longer worried about the French who would wear the mask badly, and is betting on intense communication. In a video shot for Konbini, Olivier Véran shows, facing the camera, how to put on the mask, how to remove it, and how to throw it away. And comments: "Even in February, I said that, for the mask to be effective, at least 60% of the population would have to wear it well and all the time. And I don't think that in February, even in March, we were ready for that. "
May 11 arrives, and with it the end of confinement. It is also the formal start of new obligations, such as wearing a mask in public transport and shops. As of June 2, for the second phase of deconfinement, these obligations are maintained. Lines of masked voters line up in front of the polling stations for the second round of municipal elections on June 28. But already, reports of relaxation have been made on social networks.
In early July, the President of the Scientific Council, Jean-François Delfraissy, visited the media to remind the French of the importance of barrier gestures. “It is clear that in shops, bars, the wearing of masks is less and less respected. We must continue to wear it. We have to go back to distancing measures, otherwise there is a risk that the epidemic will start again this summer, ”he worries in the columns of Le Parisien.
Calls from doctors
A forum of doctors supported his message, calling for making the wearing of the mask mandatory in closed public places. A letter addressed to WHO and signed by 239 scientists, underlines that the virus is very likely to be transmitted by aerosols, in particular in closed places - a suspicion already made by many health professionals around the world. WHO will later recognize that "evidence is emerging" about the airborne transmission of Covid-19. What confirm the importance of the role of the mask.
Messages possibly heard by Jean Castex. While France has passed the 30,000 dead mark, the new Prime Minister Jean Castex recalls Sunday that wearing a mask is "one of the ways to prevent the spread of the epidemic". And adds that the "question of developing the use and wearing of the mask was well under study", with, as a priority, "all places, whatever they are, closed".
This recommendation is a step in the right direction, but it is too late, judges doctor Michael Rochoy. "We are now saying that we are at the study stage, when we should recommend it. It is like saying that we are going to study road safety after a car accident. It's too late, ”he lambasted. “We need to educate people about wearing a mask, that it is a simple and effective prevention method. At worst, we wore it for nothing, but that's okay, there is no risk. At best, we will have saved lives, ”thunders the doctor.
An opinion shared by the Association Victims Coronavirus France and the collective of health professionals C19, who, Monday afternoon, announced to urgently seize the Council of State to enjoin the State to make the mask mandatory in enclosed places receiving from the public.