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DM168 Covid-19

Making the most of that pesky mask

Making the most of that pesky mask
All about masks. Graphic: Jocelyn Adamson

Next month, it will be a year since we began wearing face masks whenever we leave home. Masks have proved to be one of the most vital tools in stopping the spread of Covid-19 at source. What have we learnt about masks since and how can we improve our masks — and how we treat them — to make sure they’re working well?

First published in the Daily Maverick 168 weekly newspaper.

By July 2020, about 120 countries had made it compulsory to wear face masks outside of the home to limit the spread of Covid-19. With medical masks and respirators in severely short supply, the general public were told to make or buy their own fabric face masks.

People crafted masks in every shape, size and colour imaginable. A common mantra since then is that any well-fitting mask is better than no mask at all. But there is a certain threshold for when a mask is “good enough”. Health experts the world over have been trying to pin down what that is. There’s still much to learn, but there are some golden principles that can’t be sidelined.

How do face masks work?

Masks prevent transmission – they act as a filter. Small liquid particles from the respiratory system are hurled out into the world when people talk, sing, breathe, cough or sneeze. These tiny particles are the vehicles of the even tinier Covid-19 particles – in people who do, and don’t, have symptoms.

The criss-crossing fibres of the mask make it hard for particles to get beyond the mask when exhaled.

Wearing a mask correctly – over the nose and mouth – means the mask can effectively stop transmission, explains Professor Lucille Blumberg, the Deputy Director of Epidemiology at the National Institute for Communicable Diseases and the founding head of the institute’s Division of Public Health Surveillance and Response.

Not all masks effectively filter both ways, but research shows that masks have helped to slow the pandemic. One study of 200 countries has shown that weekly increases in Covid-19 mortality were four times lower in places where masks were the norm.

Different strokes

Health organisations and experts recommend different types of masks for different people.

Respirator masks are designed to filter out about 95% of airborne particles. They are only used in specific situations by healthcare workers. They need to be fitted to each individual, they are not reusable, they are expensive – and in short supply. If you’re not a healthcare worker, you don’t need one.

Medical or surgical masks have three layers of synthetic non-woven materials, so the fabric’s fibres cross one another randomly. They filter 60% to 80% of small particles when tested in the lab. They cannot be washed.

Medical masks are reserved for healthcare workers, those who test positive for Covid-19 or are awaiting a test result, and those who are caring for someone who has Covid-19 outside of a health facility. They are also recommended for people over 60 and anyone with comorbidities.

Everyone else will be adequately protected by non-medical fabric face masks, experts conclude. “Cloth masks are what we’ve got and they do work – if you wear them properly,” says Blumberg. They add some protection for the wearer, but are most effective at protecting those around them.

“It works on the principle of ‘I protect you, you protect me’ if everyone wears them”, she says.

They are affordable, reusable, simple to keep clean and can be personalised.

The best cloth masks are those with multiple layers and fabric dense enough to filter particles, while remaining breathable. The WHO recommends finding a mask that fits closely over your nose, cheeks and chin. When the edges of the mask lift and shift, like during speaking, air will slip through those gaps.

An uncomfortable mask might tempt the wearer to touch their face and remove or adjust it, increasing the risk of contracting or transmitting the virus by bringing the particles closer to the mouth, nose and eyes.

The science is still out on which fabrics offer the best protection, in what combination and in which settings. But there are some rules.

The WHO updated its guidance on mask use in December 2020 to include new evidence. It still recommends that the general public should make use of them. Two layers are widely recommended, but the WHO and SA government recommend three layers.

The inner layer should be made of a comfortable material, such as tightly woven cotton, which can absorb moisture from the breath.

The middle layer should be a nonwoven nonabsorbent material, such as spunbound polypropylene. This material is derived from plastic and is already in use in the clothing and furniture industries. Nonwoven materials have a random arrangement of fibres, “like spaghetti on a plate”, wrote a team of researchers from McMaster University in Canada. This presents more obstacles to the droplets.

The outside layer should also be nonabsorbent and should repel moisture, such as polyester or a polyester blend. The SA government recommends that this layer be made from tightly woven fabrics such as denim, calico or Shweshwe.

Blumberg recommends that a fabric mask be made of two layers of closely woven cotton with a layer of polypropylene between them. You can test for breathability. “There should be some resistance to airflow, but you should be able to breathe freely when using the completed mask,” she wrote in May 2020. The mask should be washable and heat-tolerant to make cleaning easier. A proper fit cannot be stressed enough.

Double-masking

Some have taken to wearing a medical mask underneath a cloth mask – for aesthetic reasons and supposedly extra protection. There is currently no scientific evidence to support this, says Blumberg. “It is better to be compliant with one mask of good quality cloth and wear, wash and store it properly,” she says.

What about valves?

The WHO’s most basic mask advice states: “Don’t use masks with valves”.

These masks are meant to stop industrial workers from breathing in dust and other particles; the valve closes on inhale. When they exhale, there is no filtration, so on its way out, the breath of someone who has Covid-19 will spread it whenever they breathe out.

Gaiters

A neck gaiter, sometimes called a “Buff” after the well-known brand, is a tube of thin, stretchy knitted fabric. It can be worn around the neck and pulled up to cover the nose and mouth. A 2020 study caused alarm when it said gaiters offer very little protection. Blumberg says it’s not as protective as a fabric mask, but is “permissible”. It is at least accessible and comfortable.

And face shields?

Face shields are designed to protect the eyes from splashes of fluids. They are used by healthcare workers as part of their personal protective equipment in combination with a medical mask or respirator.

Face shields do not offer as much protection as a fabric face mask, says Blumberg. “Some people cannot wear masks for a number of reasons, so it is an option but it needs to be cleaned properly.” It must cover all the facial areas at risk. “A visor on top of the head is hopeless.”

The WHO warns that smaller particles may come into contact with the nose, mouth and eyes because the visor is open on the sides. It recommends face shields as a “last resort” for healthcare workers when medical masks are not available. For the general public, it recommends shields designed to cover the sides of the face and below the chin.

How to handle it

Blumberg emphasises that a mask has to be worn correctly – over the nose and mouth – or it is “definitely not effective”. And they only reduce transmission when used alongside physical distancing, good ventilation and sanitising.

It is crucial to wash your hands before you put your mask on, and before and after you remove it. Act as if the outside of the mask and your hands were covered in the virus.

Blumberg recommends removing the mask by moving your hands forward so that you can fold the front over itself. Put it in a resealable bag. If it does have Covid-19 on it, it could contaminate other surfaces. Don’t “store” the mask under your chin or on your arm, wrist or neck. If you need to put it back on, use the ear loops to do this.

Dispose of a medical mask in a garbage bin every day. A fabric mask can be cleaned using soap or detergent, preferably in water of at least 60º Celsius. Dry it in the sun and iron it.

The WHO recommends that masks be worn whenever ventilation is poor and/or when physical distancing isn’t possible.

No face covering provides full protection against Covid-19. Masks must be used along with regular hand cleaning and physical distancing to provide the greatest barrier to Covid-19. DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for free to Pick n Pay Smart Shoppers at these Pick n Pay stores.

Gallery

"Information pertaining to Covid-19, vaccines, how to control the spread of the virus and potential treatments is ever-changing. Under the South African Disaster Management Act Regulation 11(5)(c) it is prohibited to publish information through any medium with the intention to deceive people on government measures to address COVID-19. We are therefore disabling the comment section on this article in order to protect both the commenting member and ourselves from potential liability. Should you have additional information that you think we should know, please email [email protected]"

Comments - Please in order to comment.

  • Belinda Roxburgh says:

    This article simply adds to the absurdity of what is happening in our world.. Quotes from above “And they only reduce transmission when used alongside physical distancing, good ventilation and sanitising.” And…”The WHO recommends that masks be worn whenever ventilation is poor and/or when physical distancing isn’t possible.” Meanwhile in SA people are being arrested by the hundreds for being without a mask in bright sunshine while breathing fresh healthy air.

    • Shaun Mbhiza says:

      True but sometimes one walks through a crowded place like the tunnel at smal-street in JHB CBD. The thing about this tunnel is that it is pseudo outside. How would we police and legislate those environments? The best thing to do is to ask people to always wear masks as soon as they leave their houses.

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