Singapore brings forward N95 mask distribution amid worsening haze

SINGAPORE: The government has begun distributing N95 masks to vulnerable Singaporeans before the 24-hour Pollutant Standards Index (PSI) exceeds 200, amid worsening haze and calls from some members of the public for earlier access.

The phased rollout began on Wednesday (Oct 14), after 1-hour PM2.5 readings reached the very high range, with the National Environment Agency (NEA) noting in a media advisory that the PSI could also enter the very unhealthy range.

The 1-hour PM2.5 reading in the west crossed into the very high band at 2pm on Wednesday, the first time this haze season.

Masks are being made available progressively at designated collection points, including community clubs and vending machines at selected public transport hubs, Social Service Offices and People's Association venues. NEA said they may not be immediately available at all locations.

Before Wednesday's announcement, CNA had spoken to 21 members of the public about the government's plans for N95 mask distribution.

Close to three-quarters said they wanted masks to be made available before the 24-hour PSI exceeded 200.

Among them is 72-year-old retiree Mohammed Yusof, a stroke patient who has largely stopped going out since the haze worsened.

Mr Yusof, who goes out to exercise and meet friends, said he now stays close to his block and started wearing a mask last week after developing a cough.

“Why must we wait for 200? They should start giving out masks now, instead of playing the waiting game,” he said.

“It’s important for our health. We are old people. If not, we would fall sick.”

Mr Yusof added that he and his wife did not know where to buy N95 masks themselves.

Under the original plans announced by the government's haze task force on Oct 9, distribution was to begin when the 24-hour PSI exceeded 200, which is in the very unhealthy range.

Eligible groups include pregnant women, children aged seven to 16 and people with medical conditions such as asthma. The task force has said N95 masks are generally not required for short outdoor exposure, such as commuting from home to school or work, or when indoors.

Assistant Professor Seow Wei Jie from the National University of Singapore's (NUS) Saw Swee Hock School of Public Health said the PSI remains an established indicator for assessing daily air quality and planning broader public health measures.

“Much of the scientific evidence on the short-term health effects of particulate matter is based on daily average concentrations,” she said.

The one-hour PM2.5 reading, meanwhile, provides a more immediate indication of air quality, particularly when conditions change rapidly.

“Both indicators therefore serve different but complementary purposes,” Asst Prof Seow said.

Health risks also depend on the duration of exposure, physical activity and individual health conditions, she added.

These factors should be considered when deciding on appropriate precautions, particularly for vulnerable groups.

Dr Chew Wei Yang from Our Family Nest said fixed thresholds provide a broad guide for population-level measures, but described the figures as "quite arbitrary" when applied to individuals, who may respond differently depending on factors such as age and underlying health conditions.

People who develop symptoms at lower readings should take steps to reduce their exposure rather than wait for a fixed threshold to be reached, he added.

Retiree Lindy Foo, 78, said some regular participants of her exercise group had stayed away because they were concerned about the haze.

Ms Foo, who said she has a "bad lung" and coughs easily, said that N95 masks should be made available before PSI reaches 200.

“I think they should give out earlier,” she said, adding that waiting until pollution levels become higher could “defeat the purpose of protecting yourself”.

Rachel Lim, a 34-year-old sales executive who is 22 weeks pregnant, also wants earlier distribution.

“At least we can all be prepared,” she said.

Ms Lim, who started wearing a mask when PSI readings reached around 150, said beginning distribution only after the threshold is crossed could mean a further wait.

“Even now at 150, I feel N95 is a good time to use,” she said.

She keeps most of the windows at home shut, runs an air purifier around the clock and reduces outdoor activities when air quality worsens.

“What concerns me is health more than comfort,” she said.

HEALTH RISKS VARY, MASK FIT MATTERS

Medical experts CNA spoke to said N95 masks can reduce exposure to fine particulate matter when worn correctly, but the point at which people need to take precautions can vary.

“In reality, the health effects of PM2.5 do not suddenly start or stop at a threshold,” said Associate Professor Miranda Loh from NUS Saw Swee Hock School of Public Health.

Some people, particularly those who are vulnerable, may experience effects below fixed PSI thresholds while others may not, she said.

“Those who experience discomfort or symptoms at lower levels should not wait for a threshold to be reached before taking action.”

Duration also matters, Assoc Prof Loh said, with prolonged exposure posing greater potential health risks than brief, unavoidable outdoor exposure.

For people who cannot tolerate or are unsuitable for N95 masks, reducing outdoor activities and creating cleaner indoor air are among the alternatives, said Dr Farah Khairi from Dr+ Medical and Paincare Telok Blangah.

N95 masks work by reducing the amount of fine particulate matter a person inhales, but their effectiveness depends on getting a proper fit, experts said.

Assoc Prof Loh said the mask needs to fit the size and shape of a person's face and form a good seal.

A poorly fitting N95 can therefore provide less protection.

For some people with respiratory conditions, wearing an N95 can be difficult.

Asiya Bakht, a media professional, said that as a person with asthma, wearing masks makes her feel “very suffocated” and "very breathless".

“I find it very uncomfortable, and that is the reason I'm not at all able to wear it,” the 52-year-old said.

Instead, she has reduced her exposure in other ways, including working from home and going out less.

Despite being unable to tolerate masks herself, Ms Bakht strongly supported distributing N95 masks earlier for those who can use them.

“For people who can wear it, that is the best defence,” she said.

A 76-year-old retiree who only wanted to be known by his surname, Tan, also felt earlier distribution would particularly benefit those who may struggle to afford N95 masks themselves.

“I think it's better to give,” Mr Tan said. “Don't wait until when the thing happens, then you start distributing.”

If conditions improve, people can meanwhile keep the masks.

“Not everybody can afford to buy masks,” Mr Tan said. He recalled once buying a box of masks for S$5 (US$3.9) during a previous severe haze episode.

Unlike Ms Bakht, however, Shreya Ahuja, who also has asthma, did not feel masks needed to be distributed before PSI 200.

“I think it's a good threshold,” the 22-year-old student said.

She said her asthma has not been significantly affected at current air quality levels and acknowledged that others with asthma may be more sensitive to polluted air than she is.

Dr Lee Kai Xin from GoodHealth Medical and Surgery said the level at which people experience symptoms can vary depending on their health.

“Some people probably don't get triggered at 200, and some people will get triggered at 80,” she said.

People should take their own medical conditions into account rather than relying strictly on the numbers, she added.

“It’s important to stop what you’re doing and take a rest."

Not all seniors CNA spoke to wanted earlier distribution either.

Mrs Arumugam, a 77-year-old retiree who only wanted to be known by her last name, said she had not experienced any effects from the haze and still had masks left over from the COVID-19 pandemic.

“Wait and see. See how the situation is," Mrs Arumugam said.

PARENTS WANT EARLIER ACTION

Similar questions have arisen over the haze task force's announcement on Oct 9 that the Ministry of Education (MOE) will consider closing schools when the following day's air quality is forecast to be in the hazardous range, with the 24-hour PSI exceeding 300.

Schools also monitor 1-hour PM2.5 readings throughout the day and adjust activities as conditions change. During haze conditions, students are kept in enclosed indoor spaces with air purifiers, while outdoor activities are avoided and lessons may be modified.

Some parents CNA spoke to felt action should be taken before the 24-hour PSI exceeds 300.

Amanda Towers, 41, said she was comfortable sending her children to school at current pollution levels but would become concerned as readings approached 250.

“I think 300 is a bit too high,” said the executive assistant. “It should be about 250.”

Software engineer Jonathan K, 43, whose 10-year-old daughter has asthma, is already considering taking her out of classes.

His daughter uses an inhaler regularly and has recently seen a doctor. 

“I don't want her to sit in class all day long exposed to the outside air,” he said

Unlike Mrs Towers, Mr Jonathan does not have a specific indicator at which he would keep his daughter home.

“It's only down to what she's feeling,” he said.

Vidya Iyer, a 38-year-old PhD student whose eight-year-old daughter also has asthma, would prefer schools to offer hybrid or home-based learning if conditions deteriorate.

Her daughter's doctor recently advised the family to use her inhaler daily during the haze, she said. She also has a 10-year-old who attends a school for children with special needs.

“Although they will be glued to the laptop, I guess there's a trade-off,” she said.

However, not all parents fully supported closing schools earlier.

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For Nur Akirah, 26, who works in civil service, earlier closure presents a complicated trade-off.

Her six-year-old daughter has mild asthma and was recently unwell.

Ms Akirah said she worries about her daughter having an asthma attack while she is at work.

But when asked whether schools should close before PSI reaches 300, she said: “I think as a working mom, I will say yes and no.”

"The main concern is how frequently I can keep an eye on her when I'm at work and sometimes, I need to be out from my desk for meetings," she added.

She said parents could instead be given additional childcare leave or temporary work-from-home arrangements during severe haze periods.

Kenneth Chew, 36, whose children are three and five, said he would prefer schools to remain open below PSI 300, activities moved indoors and additional masks made available.

“If it's more than 300, of course, I feel that it should close and (the children) stay at home,” the data engineer said.

He added that earlier closures could force working parents to take leave to care for their children.