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While the vast majority of people in Thailand were compliant about wearing masks correctly during the country's COVID-19 outbreak, variations in demographics and situational usage persisted, a researcher said.

Of the 10% of individuals who did not wear a mask or wear one correctly, about three-fifths of people did not wear masks correctly, such as under their chin, while two-fifths did not wear a mask at all, reported Richard Maude, DPhil, MD, of Mahidol-Oxford Tropical Medicine Research Unit in Bangkok.

Moreover, not wearing masks correctly was more common among adults ages 19-60 as opposed to young children or older adults, and men were more likely to wear masks incorrectly versus women, he said in a late-breaking presentation at the virtual annual meeting of the American Society of Tropical Medicine & Hygiene.

Mask usage has been a critical part of COVID-19 containment strategies across the world. Although debates about their protective effects flared up recently, mask mandates continue to be enacted in many states in the U.S. and many other countries.

Maude noted that while face masks are a government regulation in Thailand, there are "no penalties" for not wearing them. However, people are required to wear them when entering certain buildings, such as the mall and the supermarket.

He added mask usage was already high in Thailand due to air pollution, but actual mask usage had not been formally quantified. His team performed an observational study during several phases of the COVID-19 outbreak. Fifteen trained researchers conducted regular passive observation during daily activities, where they counted people wearing different mask types or no masks.

To date, they analyzed 33,610 individuals. The first phase took place from March 16-April 26, during the time when a number of restrictions, including lockdown, travel restrictions, and stay-at-home orders were initiated (on March 26) before gradually being lifted in May. There has been no local transmission in Thailand since late May. The second phase of the study was April 27-June 29, examining 20,121 individuals, with data collection ongoing to the present.

During the first phase of the study, 88.6% wore a mask covering their nose and mouth, while during the second phase, 91.8% wore a mask correctly. They compared mask-wearing "staff" (in healthcare, commercial, transport, and higher education) with the public in those settings.

Surgical masks were the most popular, both among healthcare staff and the public, as opposed to cloth masks. Interestingly, mask-wearing was higher in residential settings among "staff" versus the public. Maude noted face mask usage was high in weeks 5-6 of the first phase of the study, but "tailed off" in week 6.

Maude and colleagues were curious about those who didn't wear masks or wore them incorrectly, so they observed 1,000 people from July 23-Sept. 17. They found two-fifths wore no masks, while three-fifths wore them incorrectly. The most common incorrect usage was under the chin, followed by under the nose, hanging from the ear, or tied around a string on the chest. A few even carried them in their hand.

Maude said campaigns were undertaken to improve face mask usage, trying to teach the public about how to correctly wear masks through "educational videos."

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