Recently there has been a movement in social media and other outlets encouraging the use of home-made masks for protection against COVID-19. At the same time, there has been a lot of noise around the CDC recommendation concerning the use of cloth face masks. So what’s the deal? Should I wear a face mask or not? What type? When? Under which circumstances?
1. A face mask alone will NOT protect you. Frequent handwashing with soap or use of an alcohol based rub, and maintaining a minimum of 1.5 meters distance with others is critical. The main concern is that we can become complacent about keeping the right distance and hand-washing because of a false sense of security when using a mask.
2. Wearing a face mask is uncomfortable. Ask any healthcare worker, they’ll tell you. Also, we’re not used to wearing them, so we are at higher risk of touching our face, which is something we want to avoid. It is also very tempting to touch the mask to rearrange it because it is bothersome or it itches. If you are going to wear a mask, be extra mindful about not touching your face or the mask. If you do touch the mask, wash your hands before touching anything else.
3. Face masks that are not correctly worn, not washed regularly (if made of cloth) or disposed of properly (if disposable), pose a risk of transmission as they may have respiratory secretions in them. If you are going to wear a mask, you need to learn to put it on correctly, and dispose of it or wash it safely.
Face masks come in different types, surgical masks (also called medical masks) and N95 respirators are the ones we hear most about, and now, home-made, cloth masks have also become widespread. Because of their very nature, home-made masks will be of varying quality, as they will be made of different materials, and have more or less good fit.
WHO has from the start, recommended the use of face masks in the following groups, in combination with frequent handwashing, respiratory etiquette and adequate distancing.
1. Are you a healthcare worker? Health care workers should use surgical masks or respirators when performing their work, according to guidelines from hospitals and health authorities. Because of the current need and global shortages of these items, surgical masks and respirators should be reserved primarily for healthcare workers
2. Do you have respiratory symptoms? - If, yes, a mask is recommended, as wearing a mask, along with frequent hand-washing, coughing in a tissue or your sleeve, and maintaining proper distance, could help decrease the possibility of transmission. People with symptoms do not need to wear a mask all the time, but only when they will be in contact with other people.
3. Are you healthy but caring for someone with COVID-19? Carers are recommended to wear a face mask when caring for/ in close contact with, the person with COVID-19, for their own protection. Again, this is along with frequent hand-washing, avoiding touching your face, disinfection of surfaces and other measures.
The evidence that we have to date on the efficacy of cloth masks is very limited and comes from small studies (1,2,3). These data suggest that cloth masks may provide marginal levels of protection against droplets which can contain viruses for the person wearing them. Cloth masks may be better at decreasing spread of respiratory secretions to others.
However, one randomized trial comparing the use of medical masks versus cloth masks (2 layers of cotton, washed daily) versus usual practice (which may or may not include wearing masks), in hospital health care workers showed that those using cloth masks had higher levels of respiratory disease than those wearing medical masks or usual practice. The authors of the study suggest that moisture retention, reuse of cloth masks and poor filtration may help explain this increased risk of infection.
Let’s bear in mind that these results are in healthcare workers, who have a much higher exposure, and who are potentially wearing masks for longer time periods than the general population. However, the study does suggest that strong precautions should be taken if someone chooses to wear cloth masks for self protection. These precautions include avoiding dampness in the masks and frequent washing of the masks.
Because of the risk of asymptomatic (those infected but without symptoms) or pre-symptomatic (those infected who have not yet developed symptoms) transmission of the virus when in close proximity with others, the CDC has issued a new recommendation on use of cloth face masks.
CDC recommends the use of cloth masks or cloth coverings in public settings where social distancing is difficult (e.g. in grocery stores, pharmacies, public transport, etc), especially in areas where there is documented high transmission (so-called “hot spots”). They have issued guidelines on how to sew them, wash them and use them properly.
As we discussed above, if you choose to wear a home-made cloth mask in these situations, make sure you can tick all the cases below:
- You’re practicing frequent handwashing and use of alcohol based rubs, and are washing your hands before putting on the mask and after taking it off.
- You change your mask regularly - if it's damp it needs to be changed and washed.
- You learn how to put it on and take it off correctly.
- You’re wearing your mask for only short periods of time when in public settings where exposure is higher.
- You’re still maintaining proper distance from others.
And please, please don’t use up surgical masks or respirators that are needed and should be reserved for healthcare personnel.