To wear a mask or not to wear a mask is very much the big question. Having initially been told by the Government that there was ‘no evidence’ to support healthy people wearing them, last week a Cabinet source suggested that covering up with a face mask may be a requirement for everyone returning to work once lockdown is lifted.
And just yesterday, 100 top doctors signed a letter calling for the public to wear home-made face masks whenever they leave their homes.
Meanwhile, Dr David Nabarro, special envoy for Covid-19 at the World Health Organisation (WHO), suggested during an interview last week that ‘some form of facial protection is going to become the norm’.
Already it is compulsory to wear masks while shopping or using public transport in Austria and parts of Italy, and those living in the Czech Republic and neighbouring Slovakia must wear masks whenever they go out.
Yet while some believe wearing a mask can act as a physical barrier to prevent infection with coughed or sneezed particles, others argue that people can accidentally infect themselves when taking a mask off, and that a mask can make people less fastidious about adhering to measures proven to slow the disease’s spread, such as hand-washing.
Paul Hunter, a professor in medicine at the University of East Anglia, recently reviewed 31 studies researching the efficacy of face masks in preventing respiratory illness, such as flu, and says the quality of the research is poor.
‘It would be as easy to make an argument for opposing the widespread use of masks as it would be to make an argument promoting their use,’ he says. ‘It’s no wonder the public is confused.’
We asked three experts — Professor Hunter, David Heymann, professor of infectious disease epidemiology at the London School of Hygiene & Tropical Medicine, and Dr Jenna Macciochi, a lecturer in immunology at the University of Sussex — just what we should do.
A woman wears a face mask covering her mouth and nose to stop droplets entering the body
SHOULD I WEAR A MASK TO PROTECT MYSELF?
Face masks provide a physical barrier between you and coronavirus particles in the air, but some are more effective than others.
Thin disposable surgical masks protect from large droplets but won’t block very small particles that may carry the virus.
More advanced masks contain filters that will block the smaller particles — but these are hard to find outside of medical settings. (FFP2 and FFP3 masks are the respirator masks commonly used by doctors and nurses in Europe, while N95 is used by medics in the U.S.)
Dr Macciochi says that ‘to be effective, a mask has to be fitted correctly, worn correctly and disposed of correctly — which is not something the general public has been trained in’.
Not wearing a mask properly, is, she says potentially more hazardous than not using one at all, as you may infect yourself with the very particles the mask is protecting you against when you take it off.
So, which face masks will actually keep you safe?
HOMEMADE MASK
Homemade mask (Stock image)
WHAT IS IT? From vacuum cleaner bags to sanitary towels and scarves, look online and you will discover that just about anything can be turned into a mask.
COVID-19 EFFECTIVE? A 2013 Public Health England study looked at the suitability of various household materials that could be used as masks to filter bacterial and viral aerosols — and vacuum bags came out well.
Aim for multiple layers — U.S. researchers found that a double layer of tightly-woven cotton with a thread count of at least 180 was one of the best barriers.
WHERE CAN I GET ONE? Search your house and see what’s already there.
SURGICAL MASK
The surgical mask (stock image)
WHAT IS IT? The disposable mask that you see surgical staff wearing. These 3-ply masks are fluid-resistant and prevent infected droplets from the surgical staff entering the respiratory system of the patient.
COVID-19 EFFECTIVE? Thin surgical masks protect from large airborne droplets, but won’t block very small particles that may carry the virus. Once wet their efficacy is reduced, which is why they are disposable. But they are considered to offer better protection than a cloth mask.
WHERE CAN I GET ONE? In short supply. The advice is that medical masks should be saved for medical professionals. We found a box of 50 for £65.99 on medisave.co.uk.
DIY STORE DUST MASKS
DIY store mask (stock image)
WHAT IS IT? Dust masks and other disposable face masks all look similar, but levels of protection against particles that can pass through vary. If it says FFP1 then it’s a basic kind of dust mask (picture left).
COVID-19 EFFECTIVE? More protection than a surgical mask (only if it fits well). But with the lowest level of filtration for this kind of respirator mask (to meet European standards, they have to be able to filter at least 80 per cent of particles) it can’t filter out tiny particles associated with viruses and bacteria.
WHERE CAN I GET ONE? Normally at DIY stores from £1 a mask. Your best option is seeing if a local independent DIY store has stock and delivers.
CYCLING MASKS
Cycling mask (stock image)
WHAT IS IT? Neoprene anti-pollution masks. They contain an air filter to stop cyclists breathing in pollution in heavy traffic. But they are not regulated to the same standard as medical masks so protection levels can vary.
COVID-19 EFFECTIVE? While they are untested regarding coronavirus, they are intended to provide a layer of protection from airborne particles. Some are marketed as N95 or N99 grade (the U.S. equivalent to the European regulation rating: Filtering Face Piece, or FFP), which refers to airborne particles filtered — 95 or 99 per cent.
WHERE CAN I GET ONE? UK brand Cambridge Mask Company is taking pre-orders (pictured). Cycling masks are available from Amazon.
THE FFP3 mask
Medical-grade FFP3 mask (Stock image)
WHAT IS IT? Another respirator mask that eliminates even more small airborne particles than the N95/FFP2. FFP3 masks draw air through a filter embedded in the fabric that catches almost all airborne particles.
COVID-19 EFFECTIVE? Short of being a full-on gas mask affair, this is the best protection as long as it fits correctly. The mask blocks out 99 per cent of airborne particles.
WHERE CAN I GET ONE? In short supply, you can normally buy one at Wickes for under £3. The next step up is a heavy-duty reusable respirator used when spraying paint or chemicals — but not comfortable to wear all day.
Report by BETH HALE
There is also the possibility that wearing a mask brings a false sense of security. Countless studies have shown that when people feel safe, they take more risks.
Masks are also limited in the protection they offer as coronavirus is transferred when the virus comes into contact with any mucus membrane — not just the nose or mouth, but the eyes, too.
‘Protective eye covering is just as important as wearing a mask, because if coronavirus droplets hit the mucus membranes of the eyes, they can be a source of infection,’ says Professor Heymann.
‘Wearing a mask for personal protection by the general public has not been shown to protect against infections such as influenza and has no role to play in personal protection against Covid-19.’
‘If you’re in a situation where you can’t physically distance — if you’re working in a care home, for example — then a properly fitting mask should be worn as a precaution to protect the elderly, because if a carer is infected, virus-containing droplets could infect them, too.’
Medics wear face masks as they transport a patient at the Royal London Hospital on April 19
WILL A MASK PROTECT OTHERS?
The other consideration when wearing a mask is that they can work both ways, protecting others from droplets that are released from our mouths and noses. As a result, some experts say that if you are sick, you should wear a mask to protect those around you — even at home, particularly if you can’t isolate yourself in one room.
How to make a face mask from a T-shirt
You can make your own face mask at home, although Professor Paul Hunter points out that the evidence for the efficacy of cloth masks — as home-made versions will be — isn’t as strong as for other types of mask.
‘Surgical masks have multiple layers, including an inner layer that attracts liquid to it, so that any virus droplets that get through the outer layer will be caught,’ he says.
Woman makes a face mask (stock image)
Nevertheless, ‘even a cloth mask, if not wet and if changed periodically, can form some sort of physical barrier that will protect other people from your coughs and sneezes,’ says Professor David Heymann. In the U.S., the Centers for Disease Control and Prevention has given detailed instructions for how to fashion old T-shirts and elastic bands into home-made face masks (see tinyurl.com/diycoronamask).
Research at the Wake Forest Institute for Regenerative Medicine in the U.S. found that the best masks were constructed from two layers of heavyweight ‘quilter’s cotton’ with a thread count of at least 180 and an especially tight weave. A double-layer mask with a simple cotton outer layer and an inner layer of flannel also performed well. Multiple layers of other tight-weave fabrics might also be effective.
‘People who are coughing and sneezing and can’t physically distance themselves from others — for example, in a household when they are isolated with other family members — should wear a mask to protect others from infected droplets they may be producing,’ says Professor Heymann.
Even if you don’t have symptoms, you could be shedding the virus and infecting other people without knowing. A study in Singapore suggested that around 6 per cent of all cases began this way. So it may be considerate to wear a mask if you’re out in public, even if you don’t have any symptoms.
‘This argument has merit,’ says Professor Hunter. ‘Some have said that one of the reasons that Asian countries may have been less hard hit by the virus is because they have a culture of wearing masks whenever they’re ill.’
WHERE CAN I BUY A GOOD MASK?
If you’re looking for a surgical face mask, you’re probably going to be paying over the odds, and/or facing a lengthy wait. Most of those on amazon.co.uk are being shipped from China and won’t turn up until early May.
Meanwhile, casetify.com is selling reusable cloth masks, with a filter built in, for £12 — and for every one bought, they will donate another to a health worker. But is it even ethical to be buying masks when the NHS doesn’t have enough?
Some trusts say they have a shortage of PPE, with staff being told to clean and reuse the supplies they have — even masks that are intended to be disposable.
At a press conference on April 12, Health Secretary Matt Hancock said ‘face masks should be saved for those in health and care who really need them’.
While it is nigh on impossible to identify if the mask you’re looking at buying online or in your local shop is one that might otherwise have gone to the Health Service, Professor Hunter says it seems ‘logical’ to suggest that if masks are being bought up by the public, then they are not available to NHS workers or those working in care.
A nurse in Cambridgeshire pictured wearing PPE equipment to protect herself from virus
Realistically, if you want to do the right thing, then you should be leaving medical ventilator masks (such as FFP2 or FFP3 and N95) masks to the professionals.
In the U.S., the leading public health protection agency — the Centers for Disease Control and Prevention (CDC) — is advocating that the general public uses home-made cloth face masks.
HOW SHOULD YOU HANDLE A MASK?
ALWAYS wash your hands before putting on or removing your mask. Take care not to touch your eyes, nose and mouth, and wash your hands again immediately after removing it. Don’t touch the mask while wearing it.
The WHO recommends that a mask is replaced as soon as it is damp, and surgical masks should only be used once and then disposed of.
It would be sensible to use your home-made mask just once before washing it on a 60c setting to kill any virus particles that may have settled on it.