Demystifying the conversation around face-covering
Data last updated: 27 July 2021
When is it appropriate to wear a face covering?
Authored by Natasha Dadour MPH, MPAS, PA-C
What? Why? How? When?
Demystifying the conversation around face-covering
It comes as no surprise that as lockdown restrictions continue to be eased, the same questions on how we should conduct ourselves when returning to the outside world are repeatedly being asked. Should we wear masks? Should we wear face shields? Or, should we just brave it and go ‘mask-less’?
The importance of a mask in a second wave
With the threat of a second COVID-19 wave on the horizon, the last thing we should be fretting about is whether or not to wear a mask. Yes, there may be hope for a vaccine to stop the spread of the virus but that is something that is out of our control. What we can control is our preparations for a second wave, so we can each do our bit to slow down the spread. Wearing a mask properly and at the appropriate moments will play an important role in this.
With an abundance of information circulating on social media and in our social circles, it is often hard to know where the truth lies. To help you make an informed decision on whether you should wear a face mask in public, we collected some information on the history and thinking behind medical face masks and, in accordance with the advice of the scientific and medical community, have put together a guide on how to wear them.
Why face masks are used in medicine
The use of face coverings as a means of protection for medical professionals is a phenomenon that stretches as far back as the Middle Ages. In the 16th century physicians famously wore the rather sinister ‘long-beaked masks’ to protect themselves during plague outbreaks. It wasn't however until the 1900s when face coverings, similar to the medical masks of today, were first used in surgical procedures.
In the mid 19th century it was discovered that bacteria could be carried in the air and that one’s own breath could desterilise an operation and cause a Surgical Site Infection (SSI). The revelation meant that by the late 1890s, a number of surgeons started wearing cloth masks during operations. The German bacteriologist, Carl Flugge and the Polish surgeon, Johann Von Mikuliez Radecki were among the first medical figures to openly promote the use of face coverings to reduce cross infectivity in the operating room.
While medical face masks had started to grow in popularity at the turn of the 20th century, it wasn’t however until the 1920s when the use of cloth masks for surgical procedures became commonplace. Having been previously mocked in many medical circles, masks proved most useful during the Manchurian plague of 1910 and the Spanish flu epidemic of 1918-20 and as a result, grew in popularity. In the decades that followed a number of cloth mask designs and styles were trialled and tested until the 1960s when the first disposable surgical masks were developed.
The thinking behind facial masks is that they protect the surgeon and the patient from microbes that they may not be a ‘coloniser’ of. Someone who ‘colonises’ a microbe may have the presence of a microbe on their skin, airway, mouth or intestines but not have the infection or disease associated with it. In layman’s terms, a surgical mask can stop large-particle droplets, splashes, sprays, or splatter that may contain viruses and bacteria from reaching the wearer's mouth and nose. It can also stop large droplets released from the wearer’s mouth and nose from reaching others and stops the wearer touching their mouth or nose.
How masks fit in the context of COVID-19
As we continue to learn more about COVID-19 and sanitisation in general, it is best to follow the ‘precautionary principle’ which states that those in power making decisions should take a precautionary route when there is a lack of scientific evidence. While some have published research and articles questioning the effectiveness of face masks, surely when we are faced with a pandemic of this scale the questions we should be asking should be ‘when? and ‘how?’ rather than ‘should we?’ or ‘should we not?’ when debating the wearing of face masks.
The number of COVID-19 cases globally continues to rise. Even though we may now be over the ‘first-wave’ in the United Kingdom, its impact on our healthcare system and the healthcare workers working to save lives day-in day-out on the front line has been profound. We therefore have a social responsibility to behave in a way which benefits the good of us all. Wearing a mask in the right place at the right time protects those who are not "colonising" or creating immunity to COVID-19.
How a mask should be worn
- When wearing a mask it must cover the tip of your nose to the bottom of your chin, anything short of this will not provide enough protection and may in fact be more harmful.
- Make sure your mask is comfortable so you limit the amount of times you need to alter it. Remember the more you touch your face, the more likely you are to cross-contaminate.
- Anytime you place or remove your mask, you need to wash your hands with an anti- microbial hand sanitiser or with mild soap and water.
- Do not leave your mask unattended. Once your mask goes unsupervised – it’s time to get a new one (wash if it is a reusable one).
- Cloth masks should be washed daily with soap and water.
- Disposable masks should be replaced daily or whenever they are damaged, wet or contaminated.
- Leave N95 masks for the healthcare workers.
When to wear a mask
- In mass gatherings
- When it is difficult to maintain social distancing (2 meters). This includes, public transportation, fitness studios/gyms, picking up children from school and grocery stores.
- If you are ill with or without a temperature, coughing or sneezing (hay fever/seasonal allergies included).
When it is okay to put your mask away
- When you are alone
- When exercising (outdoors)
- When you can maintain social distancing of at least 2 meters.
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