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Face masks for coronavirus – your questions answered

20 May 2020

Not long ago the idea that we’d be discussing wearing face masks in public would have seemed preposterous. And yet, here we are. So, let’s look at the facts

Quick facts

  • From 15 June, in England you must wear a face covering on public transport
  • Wearing a mask is not a replacement for social distancing and hand hygiene
  • Safe mask use is vital - masks can be ineffective or even detrimental to your health if not worn or treated correctly
  • Different masks have different uses - respirator masks should be reserved for frontline medical staff
  • 25-44% of Covid-19 infections are from asymptomatic or pre-symptomatic people so wearing a mask protects other people
  • Even a homemade mask or face covering may help stop the spread of Covid-19 in a crowded place
  • The decision to wear a mask should be personal but informed

Every country has handled the Covid-19 crisis differently. This is particularly the case when it comes to guidelines on wearing masks.

The World Health Organisation (WHO) now advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments.

The European Centre for Disease Control (ECDC) suggests that masks could be effective alongside strict hygiene measures and social distancing.

Meanwhile the US Centers for Disease Control and Prevention (CDC) now recommend people should wear cloth face coverings when out in public, but not surgical-grade ones, as these are in short supply.

Everyone agrees that nothing should make us relax rules on social distancing and hygiene. We don’t want masks to create risky behaviour.

What’s going on in different countries?

There is no one-size-fits-all global advice when it comes to face masks and coronavirus. In the UK it was suggested that masks may have a marginal positive impact on spread where there is crowding, after new evidence emerged from doctors and scientists campaigning for community mask wearing.

From June 15, in England you must wear a face covering on public transport and are advised to wear masks when you’re shopping and in other enclosed places where social distancing is difficult.

In Sweden social distancing and hygiene are still considered most effective.

In Germany masks are advocated on public transport and in shops, with many people making the decision themselves to wear them.

France has announced that everyone must wear face masks in public – and the government is now distributing them.

How exactly does Covid-19 spread?

We are likely to become infected either by breathing in a certain amount of viral particles or by touching an infected surface and then touching our eyes, nose or mouth.

A simple cough or sneeze can contain a huge number of virus particles.

The virus enters through mucus membranes – eyes, nose and mouth. Touch your face after touching an infected surface and you may be at risk. Touching used masks or reusing masks can lead to self-contamination.

Who does a mask protect?

We often think of masks protecting the wearer. But if you are spreading infected droplets (even if you’re asymptomatic) and they are caught by a mask, you are mainly protecting those around you.

Scientists estimate that 25-44 per cent of all Covid-19 infections are from people without any symptoms at all (those who either had the virus without knowing it or were pre-symptomatic).

Distancing works – the risk of spreading the virus at one metre distance is 10 to 30 times greater than at two metres. But the discussion gets more complex where social distancing becomes tricky – such as on transport, while shopping and in the workplace.

How do different masks compare?

Respirators (called N95, FFP2 and FFP3) have a filter and valve. They protect the wearer from small and large particles and are used in hospitals as part of PPE. Most countries recommend these be prioritised for frontline healthcare staff.

Surgical face masks cover the mouth, nose and chin. They stop splashes of large droplets from outside (but not tiny airborne particles) and stop some infection spread from the wearer. They’re loose fitting so can allow leakage of droplets around the edges.

Non-surgical face masks can be self-made or bought. These can be cloth, textiles or paper. They’re not standardised or designed for healthcare and the evidence for their effectiveness is less clear. The CDC says any face covering is better than none.

How to use a mask

According to the CDC, the correct use of masks is essential, or there is little point. So,

  • Clean hands with soap and water or sanitiser before putting the mask on
  • Ensure it snugly covers from bridge of the nose to chin
  • Remove the mask by touching the straps (or inside surface) only
  • Dispose of the mask immediately or,
  • If washable throw immediately into the washing machine and detergent wash at 60 degrees. Then make sure it still fits. Some masks have instructions for decontamination
  • Continue to follow all hygiene and social distancing advice – don’t let your mask give you a false sense of security
  • If you have existing breathing problems, talk to your doctor first

Children and masks

This can be a potentially frightening time for children but different countries and schools are making rules they feel comfortable with.

Children under 2 should not wear a mask unless advised by a doctor due to choking risk as they can’t remove it themselves. For older children here are some tips:

  • Make it fun and comfy - your little medical superhero!
  • Still educate about handwashing and touching faces

A decision to wear a mask if you are well is personal but should be informed and take into account the government’s advice.

Hemal Shah
Lead GP, Livi
Last updated:

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