Do we face a future of wearing masks?

Take a deep breath and prepare yourself for the latest Covid-19 essential soon to sweep the world.

After months of being instructed not to trouble ourselves with wearing masks during the coronavirus outbreak, the topic has become a hot one again.

Dr David Nabarro, a senior British scientist with the World Health Organisation (WHO), has claimed people will have to get accustomed to a “new reality” of wearing a facial covering while out in public.

Masks are routinely worn in China, South Korea and other countries in the Far East that have dealt with previous coronaviruses.

At the beginning of this outbreak, much of the talk in the West was of how mask-wearing was a cultural issue and the scientific evidence was scant.

Until now, the British Department of Health and Public Health England (PHE) have been against face masks for members of the public as a matter of orthodoxy.

However, increasingly they appear to be isolated in this position. The Centres for Disease Control in the US, which previously followed the UK approach, is now recommending Americans wear “cloth face coverings” in public.

In Europe, the likes of Germany and Spain are all including face masks and other forms of personal protective equipment (PPE) in their lockdown exit strategies, with commuters in Madrid being handed masks as restrictions on movement slowly started to be lifted.

According to Trisha Greenhalgh, a professor in primary healthcare at Oxford University, the evidence so far has focused on whether the masks can stop a wearer from being infected, when in fact the realisation is gradually dawning that if we all wear even rudimentary masks, there will be a lot fewer germs floating around in the first place.

“It doesn't have to be perfect,” Prof Greenhalgh says. “If you were wearing a mask to protect yourself from everybody else's droplets, it would need to meet official standards. But we are talking about everybody as good citizens wearing them to protect other people.

“So, from home-made versions crafted out of vacuum bags and panty liners (yes, really) to bandannas that transform even the most genteel shopper to roadside bandit, as well as the urban cycle masks beloved by Gwyneth Paltrow that make the rest of us resemble a poorly equipped Power Ranger — the question is, what kind of face mask do you have to hand and how can you wear yours better?

Surgical masks

The most common design that everyone clambered to buy from Amazon in the early days of lockdown. Effective to a point, protecting the wearer against large droplets although not so much with airborne particles, due to the loose fit. And, once they get damp through a person's breath — which can happen in as little as 15 minutes — they become permeable.

The masks also cannot be reused and must be disposed of after wearing. Which is possibly bad news to all those you spot wearing theirs under their chin as they answer their phone/sip their coffee/go for a crafty cigarette. Once removed from the mouth, they should not be put back on again.

Note to care home staff: current guidelines state that the masks can provide some protection if standing more than a metre from infected patients.

N95 respirators

The most effective mask in circulation (although still in critically short supply). These masks take their name from their ability to screen out 95 percent of airborne particles. Experts do not recommend the public use these masks as they are intended for health workers in close contact with patients and require careful fitting. The mask is only properly effective if worn with full PPE.

Cycle masks

Top of the range are the so-called “urban air masks” developed by the Swedish firm Airinum, which sold out after Gwyneth Paltrow was spotted in one, and are now being peddled for hundreds of pounds on online auction sites.

Fredrik Kempe, the brand's co-founder, says daily sales have soared beyond 10 times what is normal. The rest of us must make do with the sort of neoprene anti-pollution face masks first modelled by Hannibal Lecter and later taken up by overzealous cyclists.

The masks remain untested with regard to coronavirus and don't have to abide by the same standards as medical equipment, so check their filters are N95 grade (or an equivalent).

They also need to be washed or have their filters changed regularly, depending on the design.

Home-made masks

A PHE study in 2013 looked at the various suitability of household materials to filter bacterial and viral aerosols when used as masks. Vacuum cleaner bags seemed to be particularly good; less so, breathable materials such as 100 percent cotton, linen and silk.

However, there is no evidence that your mask needs to be made with any particular expertise or care to be effective for controlling the spread of germs.

Prof Greenhalgh has created her own mask out of a bandanna with a panty liner folded inside, which she currently wears when she leaves the house.

“Waterproof, sterile and thin, they are just the thing,” she says.

Scarves and bandannas

A recent study in South Korea found that if you have Covid-19 and cough on someone from eight inches away, wearing a cotton mask will reduce the amount of virus you transmit to that person by 36 times. At a press briefing earlier this month Donald Trump, the US president, even claimed scarves were often “better” than masks.

In actual fact, Centres for Disease Control guidance states that scarves and bandannas (broadly deemed to be similarly effective) should only be used as a last resort. Bandannas are  catching on in the UK. This week, wedding dress maker Joanne Millburn has started a new Birmingham-based business, Millie's Masks, designing cotton bandannas inspired by her 10-year-old daughter.

The skull pattern is the most popular, though she says other designs are available. “The masks are not going to stop people getting the virus but certainly they will help prevent its spread,” she says.

Dust masks

These masks protect workers against airborne particles such as dusts and powders and are designed with different levels of protection (FFP1, FFP2 and FFP3) to help reduce workers breathing in moderate levels of dust, as well as solid and liquid aerosols. They offer a tight fit, which scientists say is essential to blocking out airborne particles. As with other makeshift masks, people have taken to spraying them with a high-percentage alcohol spray to sterilise between wearing. However, do so with care, as studies in China have suggested this can lower filtering efficiency. — The Daily Telegraph

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