Coronavirus: India makes face masks mandatory for more than 300m people, punishable by up to six months in prison

Orders by major cities and states come despite WHO advice and amid a ‘massive shortage’ of protective equipment

A man with a child, both wearing face masks, walk past closed shops in the old city of Delhi on Thursday 9 April (AFP)

India has made the wearing of face masks mandatory when people leave their homes across several of the country’s largest states and cities, despite the World Health Organisation still advising that such measures are not necessary to stem the coronavirus pandemic.

The orders that came into effect on Thursday apply to Delhi and Mumbai, India’s two largest cities, as well as some of its most populous states, including Uttar Pradesh.

Combined, they make face masks compulsory for more than 300 million people at a time when the country’s health workers say there is “panic” in some hospitals over a lack of personal protective equipment (PPE) for those who need it most.

Announcing the decision after a meeting of Delhi’s most senior officials, the city’s chief minister Arvind Kejriwal insisted that the “wearing of facial masks can reduce the spread of coronavirus substantially”.

In Mumbai, those who are caught flouting the new rules face arrest and up to six months in prison. Punishments in other jurisdictions remained unclear, but all the measures were passed under the same colonial-era Epidemic Diseases Act (1897).

On its website, the WHO states that “if you are healthy, you only need to wear a mask if you are taking care of a person with suspected [Covid-19] infection”, or if you are exhibiting symptoms of the disease yourself, such as coughing and sneezing.

Dr Mike Ryan, executive director of the WHO health emergencies programme, said last week that the organisation stood by this policy on the basis that “there is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit”, adding that “there also is the issue that we have a massive global shortage”.

Acknowledging the latter point, most Indian authorities have recommended that non-essential or high-risk workers make their own masks at home – some state governments have even produced their own guides for how to craft them. “Facial masks will be compulsory for anyone stepping out of their house – cloth mask shall be eligible too,” Mr Kejriwal said.

Yet this also begs the question of how effective the measure will be from a public health perspective. If an N95 filter mask is the gold standard – a 10/10 – then a simple cloth covering rates “about 3/10 for effectiveness” said, Dr Giridhar R Babu, a professor of epidemiology at the Indian Institute of Public Health who has been advising the government.

Dr Babu nonetheless told The Independent that while social distancing might be sufficient in more developed countries, masks were an effective low-cost tool “in the Indian setting, given that we have urban slums and other completely overcrowded areas where physical distancing might be a problem”.

Other countries have set a precedent in compelling citizens to wear masks. Turkey has done so nationwide, and Spain has said it will once it has the supplies to meet demand. Wuhan in China, the epicentre of the outbreak, made masks compulsory weeks ago, and recently the US government shifted its stance to say face coverings were recommended for healthy people too – although Donald Trump suggested he would not wear one.

In a news conference on Thursday evening, a senior Indian government official suggested that the optics of everyone wearing a mask together was also important. Their wide usage, five days after the Modi administration said it recommended people do so, was evidence of “the fact that Indians at every level of society are doing their best to follow instructions”, said Indian foreign ministry additional secretary Vikas Swarup.

Asked if India was disregarding the WHO’s guidance, Mr Swarup told The Independent that India has “factored in the various elements of WHO advice on these and other matters”, alongside “best practices in other countries, and specialist advice”.

“I don’t think that we are going in a very extreme direction [on masks],” he said. “Each state will take whatever steps they deem to be in their best interest, and I think what is important, is that the public has responded quite well to this.”

With India’s coronavirus caseload rising fast to nearly 6,000 on Thursday, and more than 170 deaths, the country has moved quickly to start building its own PPE to meet the demands of the crisis. Mr Swarup said the number of firms producing PPE domestically had gone up from zero to 32 since January, and that the aim was to produce 17 million sets of PPE and N95 face masks combined, although the time frame for this was unclear.

Amid popular newspaper campaigns like the Times of India’s call to “mask up and save India”, even before the latest orders for the adoption of masks was widespread on Delhi’s otherwise deserted streets – the country is under a national lockdown, the largest of its kind, until at least midnight on 14 April.

But Dr Babu warned that such messaging risked overlooking the other practices, such as regular hand washing and social distancing, needed to prevent infection. “I would say it is physical distancing, masks, plus personal hygiene [that is needed],” he said. “If we try to oversimplify and promote one thing out of proportion, by not understanding the science behind it, then we are at the risk of actually contributing to more infections.”

And he said that the decision to make masks mandatory – and compliance enforced by the police – was “not recommended, at least in public health”.

“Anything that is coercive in nature might actually be counterproductive,” he said. “I worked in polio eradication for a long time, and whenever you use police to force people to be immunised, you create a lot of fear and stigma around it.

“If people don’t understand the importance of wearing a mask, and they just do it because the police tell them, it is not going to be much use. Because people will forget about physical distancing, focus only on wearing masks, but then only do it when police are around. The rest of the time, you’re freely spreading the infection.”