DocQ COVID-19: to mask or not to mask, that is the question

Image: @drewsrainbows1 Twitter

DocQ, Fiona Bisshop addresses the contentious issue of masking. Don’t forget Dr Bisshop’s QNews LIVE Q&A Saturdays at 2 pm. Ask her about how to mask safely and any other medical questions.

Should everyone be wearing masks at the moment because of COVID-19?

This is a hotly debated question, even amongst health professionals. Indeed, even large organizations like the World Health Organisation (WHO) and the Centre for Disease Control find it difficult to agree.

True — a lot of droplets can hit you if someone coughs or sneezes near you. However, even ordinary breathing releases millions of microparticles into the air. These can hang around for ages. (Need proof? Horrifying video here: )

Masks can be very useful, but it’s important to understand the different kinds and how to use them.  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 earpieces, not the front.

Types of masks

P2 or N95 masks. These masks give the greatest level of protection. They filter viral particles most effectively.  They require changing 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 facemasks. These are the cheapest and most common facemasks you might see. Surgical masks stop the spread of respiratory droplets that the wearer exhales. 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.  People tend to reuse them and 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.

A mask alone is insufficient protection

Let’s remember how this virus spreads. 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. We know this virus can exist for a few days on different surfaces (think door handles, shopping trolleys, ATM and lift buttons, bannisters, seats). Therefore, a mask alone will never suffice to stop the 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, WHO now recommends widespread community use of masks. WHO reasons that community transmission is occurring and that we can limit that by masking infected people as yet unaware of their infection.


And a final word about gloves – I’ve seen people out and about in public wearing latex or vinyl disposable gloves.  This is not a great idea!  Gloves should only ever be worn temporarily for protection during certain procedures.  They prevent you from washing your hands or effectively sanitizing them. Gloves collect residue and viral particles and promote viral spread from one surface to the next.  They offer a false sense of safety whilst 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 and how close they get to others.

Ultimately, it is social distancing measures, avoiding going out, rigorous repetitive hand washing and hand sanitizing that will stop the spread – social lockdown has helped facilitate public awareness of this.

The message is to STAY HOME and avoid being close to anyone outside your immediate household.

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Dr Fiona Bisshop

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