Masks are a key measure to suppress transmission and save lives and they reduce potential exposure risk from an infected person whether they have symptoms or not, according to the World Health Organization.
People wearing masks are protected from getting infected and they also prevent onward transmission when worn by a person who is infected.
Therefore, masks should be used as part of a comprehensive ‘Do it all!’ approach including: physical distancing, avoiding crowded, closed and close-contact settings, improving ventilation, cleaning hands, covering sneezes and coughs.
Who should wear it?
Medical masks are recommended for the following groups:
• All health workers in clinical settings.
• Anyone who is feeling unwell, including people with mild symptoms, such as muscle aches, slight cough, sore throat or fatigue.
• People caring for suspected or confirmed cases of Covid-19 outside of health facilities.
When people cannot guarantee a distance of at least one metre from others, medical masks are also recommended for the following groups, as they are at a higher risk of becoming seriously ill with Covid-19 and dying:
• People aged 60 or over.
• People of any age with underlying health conditions, including: chronic respiratory disease, cardiovascular disease, cancer, obesity, immuno-compromised patients and diabetes mellitus.
Non-medical, fabric masks are advised for use by the general public when physical distancing cannot be maintained, as part of a comprehensive ‘Do it all!’ approach, including improving ventilation; cleaning hands; covering sneezes and coughs.
When should masks be worn by the public?
General public should wear masks when they are;
In the wider environments where the virus is spreading, in settings where it is not possible to maintain at least one metre from others.
Examples of these settings include indoor locations that are crowded and have poor ventilation, public transport and places of high population density – among others.
In enclosed settings, especially where there is poor ventilation, it is also very important to increase the rate of air change, reduce recirculation of air and increase the use of outdoor air.
How to put on and wear a fabric mask:
• Before touching the mask, clean your hands with an alcohol-based hand rub or soap and water.
• Inspect the mask for tears or holes; do not use a mask that is damaged.
• Adjust the mask to cover your mouth, nose, and chin, leaving no gaps on the sides. Place the straps behind the head or ears.
• Avoid touching the mask while wearing it. If you accidentally touch it, clean your hands.
• Change your mask if it gets dirty or wet.
How to take off and store a fabric mask:
• Clean your hands before taking off the mask.
• Take off the mask by removing it from the ear loops, without touching the front of the mask.
• If your fabric mask is not dirty or wet and you plan to reuse it, put it in a clean plastic, re-sealable bag. If you need to use it again, hold the mask at the elastic loops when removing it from the bag. Clean your mask once a day.
• Clean your hands after removing the mask.
How to clean a fabric mask:
• Wash fabric masks in soap or detergent and preferably hot water (at least 60 degrees Centigrade/140 degrees Fahrenheit) at least once a day.
• If it is not possible to wash the masks in hot water, then:
• Wash the mask in soap/detergent and room temperature water, followed by either boiling the mask for one minute, OR;
• Soak the mask in 0.1 per cent chlorine for one minute and thoroughly rinsing the mask with room temperature water (there should not be any toxic residue of chlorine on the mask).
General tips:
• Make sure you have your own masks and do not share it with others.
• Resist the temptation to pull down your mask or take if off when speaking to other people.
• Do not store your mask around your arm or wrist or pull it down to rest around your chin or neck. Instead store it in a clean plastic bag.
How to put on and take off a medical mask:
• Before touching the mask, clean your hands with an alcohol-based hand rub or soap and water.
• Inspect the mask for tears or holes; do not use a mask that has previously been worn or is damaged.
• Verify which side is the top – this is usually where the metal strip is.
• Then, identify the inside of the mask, which is usually the white side.
• Place the mask on your face covering your nose, mouth and chin, making sure that there are no gaps between your face and the mask. Place the straps behind the head or ears.
• Pinch the metal strip so it moulds to the shape of your nose.
• Remember, do not touch the front of the mask while using it to avoid contamination; if you accidentally touch it, clean your hands.
How to take off a medical mask:
• Before touching the mask, clean your hands with an alcohol-based hand rub or soap and water.
• Remove the straps from behind the head or ears, without touching the front of the mask.
• As you remove the mask, lean forward and pull the mask away from your face.
• Medical masks are for single use only; discard the mask immediately, preferably into a closed bin.
• Clean your hands after touching the mask.
• Be aware of the condition of the mask; replace it if it gets soiled or damp.
Fabric masks should be secured with elastic loops or ties, include multiple layers, be washable and reusable.
They should ideally be made of three layers of fabric.
• Inner layer of absorbent material, such as cotton.
• Middle layer of non-woven non-absorbent material, such as polypropylene.
• Outer layer of non-absorbent material, such as polyester or polyester blend.
The composition of medical masks, which are also known as surgical masks should be as follows;
• Made of three layers of synthetic nonwoven materials
• Configured to have filtration layers sandwiched in the middle.
• Available in different thicknesses.
• Have various levels of fluid-resistance and filtration.
Respirator masks are designed to protect healthcare workers who provide care to Covid-19 patients in settings and areas where aerosol generating procedures are undertaken. Healthcare workers should be fit tested before using a respirator to ensure that they are wearing the correct size.
WHO does not recommend the use of masks with exhalation valves. These masks are intended for industrial workers to prevent dust and particles from being breathed in as the valve closes on inhale.
However, the valve opens on exhale making it easier to breathe but also allowing any virus to funnel through the valve opening, making the mask ineffective at preventing the spread of Covid-19.
WHO also does not recommend the general use of gloves by people in the community. Instead, in public places, such as supermarkets or public/private buildings, the WHO recommends the installation of public hand hygiene stations at the entrance and exit, so people can easily clean their hands.
By widely improving hand hygiene practices, countries can help prevent the spread of the Covid-19 virus and other infections.
Health workers are the most likely to be exposed to Covid-19 because they are in close contact with patients with suspected, probable or confirmed Covid-19.
Where Covid-19 is spreading, health workers and caregivers should wear a medical mask in all clinical areas of any medical facility. Masks should be worn throughout their shifts, apart from when eating, drinking or needing to change the mask for specific reasons:
• Health workers and caregivers include: doctors, nurses, midwives, medical attendants, cleaners, community health workers, and any others working in clinical areas.
• Clinical areas of particular importance are: screening/triage and emergency rooms, family physician/GP practices, outpatient departments, Covid-19 dedicated units, obstetrics, haematological, cancer and transplant units, long-term health, community care facilities and residential facilities.
Therefore in areas where there are patients – any patients – the WHO recommends that workers in the health facility wear a medical mask, even if physical distancing can be maintained.
• Respirator masks are recommended for use where aerosol generating procedures are in place for a suspect/confirmed Covid-19 patient. In these settings, WHO recommends the use of airborne and contact precautions.
As there are reports of health workers being infected with Covid-19 outside of health facilities, it is critical that health workers, as all people, follow the guidance to protect themselves from infection when outside of a health facility.’.
Children aged five years and under should not be required to wear masks. This is based on the safety and overall interest of the child and the capacity to appropriately use a mask with minimal assistance.
WHO and UNICEF advise that the decision to use masks for children aged 6-11 should be based on the following factors:
• Whether there is widespread transmission in the area where the child resides
• The ability of the child to safely and appropriately use a mask
• Access to masks, as well as laundering and replacement of masks in certain settings (such as schools and childcare services)
• Adequate adult supervision and instructions to the child on how to put on, take off and safely wear masks
• Potential impact of wearing a mask on learning and psychosocial development, in consultation with teachers, parents/caregivers and/or medical providers
• Specific settings and interactions the child has with other people who are at high risk of developing serious illness, such as the elderly and those with other underlying health conditions.