COVID-19: do you need to wear a mask to avoid coronavirus?

There are two well-accepted routes for the spread of coronavirus:

  • Droplet spread - droplets sprayed into the air when an infected person coughs, talks or sneezes.
  • 'Fomites' - contaminated surfaces where virus has landed. People can pick the virus up on their hands and then touch their eyes, nose or mouth (routes through which the virus can enter the body).

The third route, aerosol spread, has been more controversial. Recent studies suggest that it may be possible for an infected person to spread the virus by breathing. What is not known is how 'effective' a route of transmission this is compared to droplet spread.

To prevent the spread of the virus, some countries like Germany have made it compulsory to wear a face mask whilst on public transport or out shopping. The US public health institute, Centers for Disease Control and Prevention (CDC), is recommending that even healthy people wear masks or some kind of clean mouth and nose covering when leaving their homes. So far though, no such recommendation has been made in the UK, although the Scientific Advisory Group for Emergencies (SAGE) has been looking into the issue.

Supply and demand

Unfortunately it's not as clear-cut as saying that masks are good or bad for preventing the spread of coronavirus. For clinicians or other key workers who may be exposed to coronavirus, personal protective equipment (PPE) is crucial for them to be able to carry out their jobs. But many countries, including the UK, are experiencing a shortage of the necessary equipment.

As you might expect, with every country in the world trying to order face masks to protect their most vulnerable from coronavirus, manufacturers haven't been able to keep up with demand. The World Health Organization recommends that only people who are sick and showing symptoms or caring for people who may have coronavirus should be wearing protective masks. This is largely so that the limited supply of masks can be prioritised for healthcare workers.

In hospitals, FFP3, N95 and FFP2 masks are used to provide the highest level of protection against coronavirus. For NHS staff in lower-risk situations, surgical masks can be used to provide some protection against the virus, especially if caring for patients who are coughing and you cannot socially distance.

Self-protection

For most of the general public, wearing a face mask offers very little protection from coronavirus even if supplies of surgical (rather than FFP3) masks were available. This is because:

  • Air breathed in tends to take the 'path of least resistance'. Surgical masks are not closely fitted, so most air travels round the edges of the mask rather than through it. They therefore only protect against large droplets, not small, airborne particles.
  • Following social distancing and handwashing guidelines is more effective than wearing a mask. Large droplets are highly unlikely to spread more than 2 metres.
  • Wearing a face mask might also make you more likely to touch your face because they are uncomfortable or affecting your breathing.
  • Face masks can offer a false sense of security, making you think you're protected against coronavirus and so more willing to take risks.
  • Most people don't know how to put on, wear, take off or dispose of face masks effectively. This means they could expose themselves to the virus when putting the mask on or taking it off. 

Cloth masks are, relatively speaking, extremely ineffective at preventing virus getting through to the nose and mouth. The argument for wearing these to protect yourself against infection are even less compelling.

  • Up to 90% of particles penetrate cloth masks.
  • Once damp (after you've been breathing while wearing one for more than a few minutes) they may actually retain virus on their surfaces.
  • The European Centre for Disease Control states 'common fabric cloth masks are not considered protective against respiratory viruses and their use should not be encouraged'.

Protecting others

The main reason for members of the public wearing masks, particularly non-surgical masks, would be to reduce the risk of passing coronavirus to someone else. That's why the German government and the CDC are telling people to use masks when they go out, as people who are asymptomatic or pre-symptomatic might not realise they are infected and spreading the virus.

In the UK, there hasn't been any change in the guidance. If you have any symptoms of a new, continuous cough or a temperature you should stay at home and self-isolate for seven days. Anyone in your household should self-isolate for fourteen days or seven days from the onset of their own symptoms.

A recent study shows many people test positive for coronavirus before they develop symptoms. Another suggests people may be infectious for over 2 days before symptoms begin. However, the majority of the time period during which people are infectious is in the first week after developing symptoms. And under current UK guidance, anyone with symptoms should self-isolate immediately.

But in addition, we should all be following social distancing measures to reduce our risk of infection. This means always staying at least 2 metres from people outside of your household and washing your hands frequently. You should make sure to cover your mouth and nose when you cough or sneeze and avoid touching your face, nose, eyes and mouth. These measures are crucial in stopping the spread.

So if you choose to wear a mask, it should be as well as following these rules. Wearing a mask doesn't mean you can take more risks or increase your contact with others.

DIY masks

If you do want to wear a mask to protect others, you might think about ordering one online. However, many sellers have sold out, prices have been inflated and the safety of their masks can't be guaranteed. Many supplies of masks are being redirected into the NHS and to other key workers. So should you make your own?

It's important to remember that any face mask you make at home won't be regulated or have to meet the safety requirements of officially manufactured masks. 

If you are going to make your own face masks, make sure to cover from the bridge of your nose to your chin. Use a very closely woven fabric, using multiple layers to limit the penetration or escape of droplets as much as possible. 

And once again, this is for the protection of others, not yourself - you still need to follow social distancing and handwashing measures. The European Centre for Disease Prevention and Control suggests that they "may even increase the risk of infection due to moisture, liquid diffusion and retention of the virus." They say their only use is in the case of severe shortages of PPE in which no medical masks are available, and only as a last resort.

How to wear a face mask safely

If you decide to wear a face mask, special measures need to be taken to avoid contamination.

  • The face mask should cover the face from the bridge of the nose to the chin.
  • Wash your hands for twenty seconds with soap and water or use hand sanitiser before putting on or taking off a face mask.
  • Remove it from behind and avoid touching the front of the mask.
  • Dispose of the face mask safely and wash your hands or apply hand sanitiser if it is disposable.
  • If the mask is reusable, wash the mask as soon as possible after use, using normal detergent at 60°C. Wash your hands or apply sanitiser as soon as possible after touching the mask.

https://patient.info/news-and-features/covid-19-do-you-need-to-wear-a-mask-to-avoid-coronavirus

jason kim