Dr Fiona Bisshop

Should everyone be wearing masks at the moment because of COVID-19?  This has been a hotly debated question,  and even respected organizations like the WHO and the CDC have found it difficult to agree. 

Some recent research into exhaled micro-particles has shown that we are constantly surrounded by a miasma of other people’s exhaled residue – watching this video may convince you never to go near people again!  So, masks do have some utility in stopping exhaled droplets from getting to other people.  Very high quality masks with the finest weave will also protect the wearer.

Masks become ineffective once they are damp – this happens fairly quickly due to the moisture in our exhaled breath, and means that they have to be changed after a few hours.  It’s important not to touch your mask once it’s on – remember it is filtering virus, which means that there may be virus on the external surface.  When taking off a mask, touch only the ear pieces, not the front of it.

There are several main types of masks:

P2 or N95 masks – these are the masks that give the greatest level of protection, as they filter out the viral particles most effectively.  They must be changed regularly and cannot be reused.  Health care workers on the front line wear these masks (when they can get them).  They are in very short supply and prices have skyrocketed thanks to profiteers and limited stockpiles.

Surgical face masks – these are the cheapest and most common masks you might see. 

They are designed to stop the spread of respiratory droplets that the wearer breathes out, in other words, if you are infectious and you wear one of these masks they can help protect people around you.  They are not reliable protection against COV-SARS2, as viral particles can get through, and they often don’t fit snugly over the mouth and nose.  Your doctor may be wearing one of these during consultations (but they would prefer a P2 if they could get them!).

Handmade fabric masks – these are becoming popular since it’s harder to find properly manufactured disposable masks.  They are really the mask of last resort.  The weave in most fabric is not fine enough to prevent viral particles from getting through, and they usually are not a snug fit on the face.  People reuse fabric masks and and tend to touch them a lot, rendering them ineffective, and they may possibly aid spread for exactly this reason.  If you are using fabric masks, remember to change them often and wash them well before wearing again.

Let’s remember how this virus is spread – yes, it’s in respiratory droplets, so if someone is infected and you are up close to them, then a mask on both of you will help.  But, and this is a big but, there are loads of respiratory droplets that end up on people’s hands, clothes and any surfaces they touch, and we know this virus can exist for a few days on different surfaces (think door handles, shopping trolleys, ATM and lift buttons, banisters, seats), so a mask alone is never going to be the way to stop spread.  One of the common behaviours that helps spread the virus is touching your face – so wearing a mask is counter-productive if you are constantly touching it or adjusting it.

We also know that spread can happen from people who have not yet developed symptoms.  So, the WHO and the CDC have now suggested that widespread community use of masks is recommended – the reasoning behind this is that in areas where community transmission is occurring, we can limit it by masking infected people who don’t know they’re infected yet, thus preventing them from passing it on.

And a final word about gloves – I’ve seen people out and about in public wearing latex or vinyl disposable gloves.  This is a terrible idea!  Gloves should only ever be worn temporarily for protection during certain procedures.  They prevent you from washing your hands or effectively sanitizing them, they are dreadful collectors of residue and viral particles, and they promote viral spread from one surface to the next.  They offer a false sense of safety whilst actually preventing cleansing.

I fear that when people don a mask and gloves, they see themselves as protected by a force field, a viral “suit of armour” if you like, which causes them to drop their guard and stop paying attention to what they touch.  You can wear both of these things but be mindful of the fact that there could be virus on their surfaces!

Ultimately, it is social distancing measures, avoiding going out, rigorous repetitive hand washing and hand sanitizing that is going to stop the spread – social lock-down has helped facilitate public awareness of this.  The message is to STAY HOME and avoid being close to anyone outside your household. 

Disclaimer: please note that Ollie volunteered to wear this mask on the condition that I let him chew it to death afterwards (a promise I of course went back on….)