Do I need to wear a mask?

By April 12, 2020 April 22nd, 2020 COVID-19
Concierge Doctors - Face Mask

It is time Australia changed its stance on the use of face masks by the general public?

One of the most discussed topics during this pandemic has been around face mask use. COVID-19 spreads via droplets that can be projected during coughing or sneezing. Face masks, which partially block inhaling and exhaling could be an additional way to minimising transmission.

Should you wear a mask? Below are five points to help you understand why Doctor Zac thinks we all should wear at least some form of face mask in public.

Australia’s Stance: healthy members of the general public should not wear any type of mask

Whilst there is a global consensus around the efficacy of face masks for health workers and those displaying symptoms, the positions diverge when it comes to their efficacy for the general public, especially those not showing any symptoms. Paul Kelly, Australia’s Deputy Chief Medical Officer, reiterated this on April 4th, going as far as indicating that wearing face masks could be more dangerous for the general public than not wearing face masks.

Up until recently, some of the main reasons invoked by the detractors of a generalised use of face masks (including the World Health Organisation until this week) were 1) face masks should be reserved to medical professional in times of dire supply shortages 2) face masks could provide a false sense of security, with people forgetting to practice essential social distancing when wearing them 3) the general public would be at an increased risk of touching their faces due to not being used to wearing face masks.

The new global consensus: everybody should wear a non-surgical-grade mask in public

Whilst Australia’s position is in line with the previous positions of most European and American governments and medical bodies, it now seems to lag behind.

A recent study regarding the propagation of droplets seems to have influenced the global shift towards more face mask usage. The study found that droplets released when sneezing could travel up to 8 meters in certain settings, which is far superior to the Centers of Disease Control and Prevention’s (CDC) 6-feet (2 meters) social distancing recommendation. Following that study, the Centers for Disease Control and Prevention announced on April 3rd that it now recommends wearing any type of cloth face masks (including bandannas) in public settings where despite your best efforts social distancing might be difficult to implement (typically, supermarkets, or public transportation).

A number of European countries have already taken similar steps in favour of increased use of face masks. Austria made wearing simple face masks in supermarkets and pharmacies compulsory on March 31, going as far as distributing free basic face masks at the entrance of such retailers. The Czech Republic made it compulsory on March 18 to encouraging results, with its curve of new infections rapidly flattening (daily increase in new cases in the single digits since end of March) and a Reproduction number R estimated to have decreased from around 2.6 at the start of the Czech epidemy down to 1.1 on April 1st. In a turn of events, Germany recently indicated face masks might have a role to play in the unwinding of its lockdown. Similarly, the French National Academy of Medicine came out supporting mandatory non-medical grade face masks for the entire population as essential to control the epidemic in France despite the French government’s no-mask-for-the-healthy policy.

Similarly and way ahead in time, Asian countries such as Japan, South Korea, China and Singapore have long supported face masks and have a high public approval of them. Hong Kong even made DIY face mask instructions available for the wider population to make their own homemade face masks (video below).

A longstanding sceptic in the discussions regarding generalised face masks use, the World Health Organisation (WHO) indicated on April 6th that whilst there needed to be more research, governments may move ahead with advising the use of non-surgical face masks by the general public.

The science behind masks: any sort of mask is better than none in public

The main issue is that the science behind generalised face mask use is currently underwhelming, due to a lack of studies considered conclusive.

It is known that one of the ways COVID-19 spreads is through droplets released when an infected person sneezes or coughs, with the droplets being able to hang in the air temporarily. Studies show that any type of mask, from surgical to homemade, confer some form of protection against this type of contamination, even if very minimal. The use of N95 and surgical masks has clearly been proven in hospital settings. Science however lacks a compelling study clearly showing benefits to the use of face masks by the general population. At best, some studies show that the use of masks might have a limited positive impact on infections. A likely reason for this lack of compelling evidence is that it is difficult to make sure people adhere to the correct mask use protocol.

In any case, this lack of compelling evidence in favour of face masks should not be a reason to fully discard their use. A group of scientists recently published a note indicating that it would make sense for governments to mandate at-risk populations to wear surgical face masks if in high-risk areas (typically indoors, prone to crowds like supermarkets, public transportation, restaurants). On the basis that whilst there is no solid evidence in favour of generalised use of masks, there is also no solid evidence against use of masks.

If anything, having a close look at the progression of the epidemic in different countries might provide an indication. China, Japan, South Korea and Hong Kong, which all have high use of masks, seem to have fared significantly better during the COVID-19 pandemic than Europe and the United States. Whilst this may be due to high level of preparedness following the SARS epidemics (high testing & contact tracing), the relatively low rate of transmission might also have to do with generalised face mask use.

Some studies seem to indicate that whilst subpar, even plain cloth masks grant some form of protection to the wearer but also to the people around the wearer. Given the latest research regarding the potential for coughs and sneezes to carry particles up to 8 meters, and given the potential that a large portion of COVID-19 infected people might show little to no symptoms, we consider that in case there is an absolute necessity for being in public, healthy-feeling as well as sick people should consider wearing some form of cloth face mask protection.

Face masks are only a secondary measure to support social distancing

In any case, the main recommendation is to continue practising strict social distancing should you be at-risk or not.

It comes as no surprise that in its recommendation in favour of cloth face masks the CDC stressed the importance to continue strict social distancing measures at all times, with cloth mask wearing only being a secondary support measure.

Should you have any questions about your situation and whether to wear a mask or not, consider getting in touch with us.

No mask? Make your own!

Any sort of mask or protective cloth is better than no mask at all. And remember, please do not stock buy medical-grade masks, our medical system workers desperately need them. If you struggle to find non-medical grade masks, it is very easy to improvise. Check out Dr Zac’s DIY video. Otherwise, below is the official CDC DIY-Mask tutorial.

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