A face mask: To Wear or Not To Wear and How To Maximise Your Protection Against COVID-19
There is currently a heated debate over the issue of whether wearing a face mask should be made compulsory in public or not in light of the COVID-19 pandemic declared on 11th March 2020 by the WHO (World Health Organisation).
Let’s see what research suggests about how efficient masks and face cloth coverings are against COVID-19 and what new habits we could establish in an attempt to potentially protect ourselves against COVID-19.
SARS-CoV-2 virus causing COVID-19 and its transmission
Although there were other outbreaks of coronaviruses in the past such as SARS and MERS, the SARS-CoV-2 virus causing COVID-19 is the only one that has become a pandemic affecting almost everyone worldwide.
As discussed in my previous article here, one of the mysteries and dangers of the SARS-CoV-2 virus causing COVID-19 is the fact that some people remain asymptomatic, not displaying symptoms of COVID-19, despite being infected. This greatly complicates the efforts of everyone trying to combat the spread of COVID-19.
A study “Asymptomatic cases in a family cluster with SARS-CoV-2 infection”
published by the Lancet in February 2020 states that “although all individuals within the same family cluster tested positive for SARS-CoV-2, only patient 1 showed clinical symptoms, decreased lymphocyte count, and abnormal chest CT images. However, any of the three individuals could have been the first one to become infected and thus transmitted the virus to the other two family members. Importantly, asymptomatic patients (such as patients 2 and 3) might be unaware of their disease and therefore not isolate themselves or seek treatment, or they might be overlooked by health-care professionals and thus unknowingly transmit the virus to others.”
If you don’t see that someone next to you is coughing or sneezing, it does not mean they are not infected. SARS-CoV-2 virus present in the respiratory droplets containing mucus is spread while we talk, shout, sing, sneeze and cough.
Research suggests that respiratory droplets travel around 6 feet and that is why social distancing along with handwashing are preventative measures that should not be neglected.
If you are 6 feet apart from me, you are less likely to receive a significant portion of respiratory droplets (that might be infected) from me. Therefore, my wearing of a face mask will protect others from getting infected whether I am asymptomatic or already displaying symptoms of COVID-19; however, social distancing should not be ignored as well as hand washing or using a hand gel.
70% alcohol hand sanitizers (or hand rubs) kill the germs and are easy to use instead of hand washing. In addition, hand rubs are handy if you are not around a bathroom or don’t want to use the public one to expose yourself to extra risks of contracting COVID-19 from surfaces or encountering others there.
Wearing a cloth face covering and decreased number of cases of COVID-19
The experience of other countries, for instance, Singapore, South Korea and Japan, suggests that wearing a cloth face covering is essential for lowering the number of people getting infected with COVID-19.
In Europe, the Czech Republic and Slovakia made masks compulsory and have seen a drop in COVID-19 cases.
In addition, Austrian government required everyone to wear a cloth face covering on 6th April 2020 and saw a 90% drop in COVID-19 cases too.
The advice from the WHO organisation to date states “If you are healthy, you only need to wear a mask if you are taking care of a person with COVID-19”.
By contrast, the CDC recommends wearing a cloth face covering in the public. It recommends avoiding using surgical masks and N-95 respirators as they are already in shortage and should only be used by healthcare and medical staff.
So what types of masks are there and how efficient are face masks and cloth face coverings against COVID-19?
There are different types of masks and they provide different levels of protection.
Prior to the wide use of masks by the general public due to COVID-19 pandemic, workers in pharmaceutical, agricultural and construction industries used dust masks to protect themselves against powders and dust.
Masks are able to filter particles of 0.007microns, whereas coronavirus particles are 0.06-0.14 microns, so masks are able to protect you due to their filtering capability.
For instance, FFP1 masks are able to filter 96.6% of particles 0.007 microns or larger, which, you should agree, is not a bad protection against catching COVID-19.
FFP2/N95 and FFP3/N99 masks offer even greater filtration.
FFP2 masks sometimes have valves that release unfiltered air upon exhaling of the mask wearer and this puts others at the risk of exposure to COVID-19. That is one of the drawbacks of masks with valves. Some places have now banned masks with valves for this reason.
A medical or surgical mask is able to filter out large particles in the air and this reduces the risk of catching droplets of the one who wears a mask. The melt-down layer in the middle of the surgical mask acts as a filter. However, this type of mask does not provide a tight face fit and leaves potential gaps for the virus particles to travel in and out.
It is important to remember though the surgical masks protect the environment from the wearer, whereas the respirators are supposed to protect the wearer from the environment as per this study.
Another type of mask is cloth masks/cloth face covering that include multiple fabric layers and can be reused. People can make their own masks at home and reuse them.
Here is a 45 second video from CDC about how to make a cloth face covering for the use in the public
Here is how you could wash your cloth face covering according to CDC if you decide to wear one.
A study by the Cambridge University published in 2013 suggests that “an improvised face mask should be viewed as the last possible alternative if a supply of commercial face masks is not available, irrespective of the disease against which it may be required for protection.”
However, a recent study conducted by McMaster University in 2020 has found that cloth masks, especially those with several layers of cotton cloth, may help against COVID-19 as they reduce contamination of air and surfaces. "Our review suggests that cloth can block particles, even aerosol-sized particles, and this supports Canadian public health policy on the issue."
In addition, in January 2009 the Medical Research Council published the findings as to the effectiveness of masks. The findings established that “adults who wore masks in the home were four times less likely than non-wearers to be infected by children in the household with a respiratory infection”. This supports the fact that “face masks can protect against respiratory illnesses such as flu and the common cold.”
A recent cohort study in Beijing, China, demonstrated that wearing a mask at home was around 80% effective in COVID-19 prevention if masks were worn before any of the family members starting experiencing COVID-19 symptoms.
This study is not without its limitations, but it has a practical application, especially now when the lockdown in the UK is being eased slowly and people would be engaging with more households and possibly colleagues soon making their own household members more vulnerable to the infection brought in from outside.
To summarise, wearing a mask or a cloth face covering is currently recommended by CDC. A surgical mask protects first of all the people around you from catching your droplets that might be infected with COVID-19, even if you are asymptomatic(not displaying symptoms at present). A respirator protects you from catching COVID-19.
In addition, valved masks protect you, however, they place others at risk of catching the virus from the exhaled air that leaves the valve of your mask and therefore best to be avoided.
Lastly, masks should be used in conjunction with regular and good hand hygiene, good respiratory etiquette, social distancing as well as testing, tracing and isolation strategies with the first three being our own responsibilities.
Knowing your data and treating some data with caution
As COVID-19 is a novel disease caused by SARS-CoV-2, everyday we learn something new about it. And if you think about the fact that we came in contact with this virus in 2020 despite its first outbreak in 2019, you will be amazed by how much we already know about it. There has never been such rapid progress in science and research as in this pandemic situation.
Every week new studies come out and the issue with the findings of these studies is sometimes the fact that they are not “peer-reviewed”. In other words, they are not verified by other researchers to understand how reliable their findings are.
It is therefore important to remember that those that are published on bioRxiv, preprint repository, “are preliminary reports that have not been peer-reviewed. They should not be regarded as conclusive, guide clinical practice/health-related behaviour, or be reported in the news media as established information”.
The same warning is displayed by arXiv, an archive of pre-prints, reminding that “e-prints are not peer-reviewed by arXiv and therefore cannot be relied on to guide health-related behavior”. In addition, “they should not be reported in the news media as established information without consulting multiple experts in the field”.
New Habits, New Life: How To Maximise Your Protection Against COVID-19
As we have established above, different masks offer different types of filtration capacity and tehrefore protection. Wearing a mask in combination with other measures is efficient in preventing the spread of the disease including COVID-19.
Remember, do not touch the front of your mask while wearing it to prevent cross-contamination. If you touched some infected surface and then touched your mask, cross-contamination is likely to occur.
United Nations COVID-19 response/Unsplash, source World Health Organisation
If you are infected but asymptomatic and touch your mask, your hands then would be the source of infection for others. Touching any surfaces with infected hands would then put others at risk.
We need to start developing new habits during this pandemic that could be life-saving.
One of them, for instance, is to learn not to touch our face AND clean our hands regularly(either wash with soap or use an alcohol-based hand rub) which will make it less likely to contribute to the virus finding a way to our bodies.
Research confirms that “A substantial portion of human respiratory tract infection is thought to be transmitted via contaminated hand contact with the mouth, eyes, and/or nostrils. Thus, a key risk factor for infection transmission should be the rate of hand contact with these areas termed target facial membranes.”
As COVID-19 is conquering all spheres of our lives, we need to find new ways of doing old things. For instance, this study found that biometric fingerprinting for visa applications (that involves a device with a procedure of placing your fingers on the screen) is a risk factor for infection transmission.
“Transmission risk exists for enteric viruses (rotavirus, norovirus, and hepatitis A virus), respiratory viruses (respiratory syncytial virus, rhinovirus, influenza virus, etc.), and enteropathogenic bacteria with low infectious doses (Shigella dysenteriae, Enterohemorrhagic Escherichia coli, etc.).”
It further states that “Using Monte Carlo risk analysis on US data, transmission of human rotavirus is estimated at 191 [95% credible intervals (CI) 0-289] per million fingerprint-capturing procedures. Application of 70% isopropyl hand rub and 85% ethanol hand gel reduces the risk to 77 (95% CI 0-118) and 0.3 (95% CI 0-0.3) transmissions per million procedures, respectively”.
Despite being conducted many years ago, the study does provide a practical application to today’s life considering the fact that the same biometric fingerprinting procedure is still being used for visa applications all over the UK.
We need to continue persevering with the research but we should not forget that knowledge without implementing it into our lives is unlikely to save lives and make a difference.