FACEMASK FACT FROM FICTION: WEARING A FACEMASK THE RIGHT WAY, MASK MYTHS & MORE

Updated 17th August 2021

After a few months of living under lockdown restrictions, many are beginning to question the efficacy of wearing a facemask in terms of disease prevention. Through the progression of the pandemic, media outlets have only contributed to public skepticism by presenting opposing points of view on the matter.

As it stands, there is more than enough evidence to support the efficacy of wearing a facemask for slowing the spread of respiratory infections - provided it is worn correctly and used in combination with other prevention measures.

The efficacy (and limitations) of facemasks are discussed below, followed by a brief look at the best types of facemask, how to wear a facemask properly and myths about facemasks that you might like to retire for good.

Question: Do Facemasks Actually Work?

This is possibly the biggest question on everyone’s mind right now as lockdown restrictions ease up across the globe.

The answer is yes - wearing a mask is still one of the most effective preventative measures one can take to slow the spread of COVID-19 and other respiratory infections. [1]

In spite of reports that imply facemasks are completely ineffective and that there is no evidence to support their use against COVID, there is actually a decent body of evidence to back up the rationale behind mask wearing.

Facemasks Immobilize the Majority of Moisture Particles

Respiratory infections, such as the common cold, SARS and MERS, are transmitted via the moisture droplets we expel every time we exhale, talk, cough or sneeze.

Wearing a facemask acts as a barrier that shields the people and objects around the masked individual, catching any large moisture droplets before they’re capable of transmitting a respiratory infection.

Masks have been critiqued for not being able to block out viral particles that are smaller than the pores they contain, rendering them ineffective at disease prevention. As far as the research is concerned, the preventative benefit of wearing a facemask significantly outweighs the hypothetical negatives that have been circulating mass media.

According to a study in which facemasks were tested on manikins for their capacity to protect against airborne infection, the following was concluded[2]:

• Most facemasks block the transmission of the majority of large viral particles with great success.
• Facemask use has proven to provide particle protection that can range anywhere from 33 to 100%.
• Proximity was the greatest factor that influenced facemask protection efficacy.
• The further the distance maintained between individuals, the higher the degree of protection that their facemasks offer.

(Proper) Mask Use Lowers the Risk of Accidental Face Touching

As we need to use our hands all the time to interact with the world around us, our hands are exceedingly prone to accidental contact with viral particles. Thus it is common for viral transmission to occur through touching the face, particularly via contact with the eyes, nose or mouth.

A well-fitted facemask (that does not require constant readjustment) naturally acts as a face-touching deterrent and promotes less viral hand-to-face transmission. This is another way in which wearing a facemask contributes to slowing the spread of COVID and is enhanced by frequent hand washing.

COVID-Specific Evidence to Support Facemask Use

For the true skeptics out there, we now have data to confirm the efficacy of wearing a facemask in order to slow the spread of COVID-19.

Thanks to the collaborative efforts of nearly 200 countries around the globe, there are plenty of statistics that reflect just how well facemasks worked as a preventative measure. According to a review of COVID-19 deaths throughout these countries, the nationalities that favored mask wearing (either culturally or as a strict mandatory precaution) had a lower COVID mortality rate. [3]

Specific case reports and studies conducted during the pandemic’s progression have also managed to confirm the following:

• No single prevention intervention is 100% effective in practice, however multiple interventions employed together can dramatically reduce the spread of airborne illness.[4]
• Mask use, in combination with hand-washing, eye wear and distancing of at least 1 meter (3.3ft) confer the best protection against viral transmission.
• Facemasks are effective at lowering the risk of COVID-19 transmission in most public settings, particularly in the context of public transport where adequate social distancing is trickier to maintain.[5]
• Surgical masks, respirators and other similar multi-layered facemasks offer better protection for healthcare workers against COVID transmission than single-layered masks.

What Type of Mask is Most Effective?

The most effective type of facemask depends on the person and the situation for which it’s required.

For any facemask to be effective, it needs to be utilized in tandem with strict hygiene, eye protection and proper use.

The Best Facemask for Healthcare Workers

While respirators and surgical masks offer the best protection, they are most suited to protecting healthcare workers who are exposed to many more viral particles on a daily basis.

According to a study that took 19 trials into consideration, respirators offered better protection than surgical masks to healthcare workers. [6] Other publications have highlighted that healthcare workers do not benefit from wearing cloth facemasks or single-layered masks.

Respirators, such as the N95, filter the air going in but not the air going out, therefore the wearer is still capable of spreading infectious media. Additional use of a facemask under the respirator is recommended to avoid this outcome.[7]

NOTE: Wearing a heavy-duty facemask for long hours every day can cause blistering and other forms of skin damage as a result of excessive friction. Healthcare workers may want to invest in some form of inner mask padding that is covered by a breathable, skin-friendly material.

The Best Facemask for Everyone Else

Members of the general public are encouraged to save respirators and surgical masks for healthcare workers.

Cloth face masks are better suited for everyday use, offering a similar degree of protection in public settings to medical masks (however, not in clinical settings), as well as being more comfortable and cost-effective.

Single-use masks are also effective at reducing transmission risk, provided they are disposed of properly after their first use.

How to Wear a Facemask (The Right Way)

In a 2009 WHO report[8] on the use of facemasks for slowing the spread of influenza virus, the following statement highlights the importance of wearing a facemask correctly:

“Using a mask incorrectly however, may actually increase the risk of transmission, rather than reduce it.    If  masks  are  to  be  used,  this  measure  should  be  combined  with  other  general measures to help prevent the human-to-human transmission of influenza, training on the correct use of masks and consideration of cultural and personal values.”

According to the US Centre for Disease Control, your facemask should meet the following criteria in order to be effective[9]:

• A minimum double layer of fabric (preferably more) to catch moisture droplets.
• Fits your face securely and comfortably.
• Both your mouth and nose are covered by the mask.
• Is properly fastened in place with ties or ear loops.
• Maintains unrestricted breathing.
• Cloth masks ought to be washed after every use without taking strain.
• Masks ought to be treated as vectors for disease and kept as sterile as possible at all times.
• Before and after handling your mask, make sure to wash your hands.

Do’s & Don’ts of Mask Wearing

Consider the following do’s and don’ts to see if you’re making the most of wearing your facemask while out and about.

DO

• Wear a tight-fitting mask that you are comfortable with.
• Refrain from touching your mask as much as possible.
• Wash your hands before and after handling your mask.
• Change your mask for a fresh one in the event it gets wet.
• Store used masks in a zip-lock bag until they can be washed or disposed of.

DON’T

• Wear a loose or ill-fitting mask.
• Use a damaged or damp facemask.
• Push your mask down over your chin when removing it.
• Take your mask off when in close proximity with people you don’t live with or who have flu-like symptoms.
• Wear your mask beneath your nose or chin.
• Re-use disposable masks or unwashed cloth masks.
• Leave your used mask/s lying around where others can come into contact with them.

Who Shouldn’t Wear a Facemask

The following individuals should not wear a facemask:

• Persons suffering from extreme respiratory ailments[10]
• Those who are doing intensive exercise
• Children younger than 2 years of age
• Unconscious or incapacitated individuals who are unable to remove the facemask in the event of an emergency.

Top 7 COVID-19 Facemask Myths That Had Many of Us Fooled

If you believe any of the following statements about wearing a facemask: think again!

These 7 COVID facemask “facts” actually turned out to be myths – here’s why.

1. Wearing a Facemask Ensures Complete Protection Against COVID-19

Fact: Facemasks lower the risk of transmission of respiratory diseases such as COVID-19, SARS and MERS.

Masks do not offer complete protection on their own, with even the most advanced facemasks such as the N95 respirator only offering up to 95% protection.

When moisture is exhaled from an infected person, a fraction of the moisture droplets are small enough to penetrate through all facemasks and potentially give rise to infection.

To ensure complete success, facemasks need to be worn in combination with several other protective measures, including:

• Frequent hand washing
• Eye protection
• Maintaining a social distance of at least 2m/6ft where possible

It should be noted that facemasks are not a replacement for social distancing but that social distancing is required to make a facemask 100% effective.

2. Mask Wearing Could Cause Severe Oxygen Deficiency, CO2 Toxicity or Altitude Sickness

There has been a lot of public outcry about wearing in connection to blocking adequate air supply, lowering available blood oxygen levels, and increasing bodily carbon dioxide levels. Some speculate that wearing a facemask can cause CO2 toxicity, loss of consciousness and other symptoms akin to having altitude sickness.

When asked, healthcare professionals and health authorities have denied that any of these claims hold weight to them in regard to cloth masks. [11]

Fact: Carbon dioxide buildup becomes threatening to health the moment it reaches concentrations of 10% or more in the environment. Considering that cloth face masks still allow for air to flow in and out of them as well as through their pores, it is unlikely that such high levels are achieved when wearing one.

When choosing a mask, make sure you do not have trouble breathing while wearing it.

Fact: It is possible to be short of oxygen if wearing a respirator for a prolonged period of time.

In this respect, healthcare workers who wear respirators should take a breather where possible to normalize their oxygen levels.

3. Cloth Masks Are Ineffective

Fact: Cloth masks serve their purpose alongside multiple other preventative measures in ensuring the transmission of COVID-19 is greatly suppressed.

While it was initially asserted by health authorities that cloth face coverings are ineffective, it is now an established fact that they are just as effective as surgical masks in a community setting.

Surgical masks and respirators ought to be saved for healthcare workers in which their usefulness can truly be utilized in the face of continuous exposure. Cloth face masks should instead be employed by members of the general public as a more comfortable and cost-effective alternative.[12]

4. Only Those at Most Risk Need Bother Wearing a Facemask

Fact: The rationale behind facemask wearing is aimed at lowering the spread of moisture droplets from people to their surroundings (including other people, surfaces and objects), thereby halting the movement of airborne transmission.

Facemasks work best as a preventative strategy if the majority of people wear them. This includes everyone, from those most to those least at risk of catching COVID-19.

Immune-compromised individuals who are at a higher risk of contracting illness may wish to take extra precautionary measures, such as maintaining adequate sleep and nutrition to keep the immune system functioning at its best.

5. Facemasks Do Not Need to be Worn in Cold Climates

Fact: COVID-19 is known to infect persons in all climates and no weather conditions or temperatures are yet known to confer a protective advantage.

Cold weather, snow, humidity and numerous other environmental conditions have been implicated as being protective against COVID-19. As a result, some feel that facemasks and other precautionary measures do not need to be adhered to in these climates.

As the body maintains a constant temperature range, it is not likely that external temperatures will affect the outcome of infection.

With certain forms of infectious disease, it is true that the climate and temperature favors the growth and spread of certain viral pathogens, as seen in tropical illnesses. This is not true for all disease though and most viral respiratory infections operate regardless of climate[13], with a few exceptions[14].

As it stands currently with regard to COVID-19, there has been no research done to confirm that certain environmental conditions would offer more protection over others. Statistical data currently confirms that the virus is able to transmit under any weather conditions, suggesting it is not limited by climate.

6. Respiratory Discomfort While Wearing a Mask Means You Have COVID-19

Fact: COVID-19 infections may manifest as entirely asymptomatic, while respiratory discomfort may be present in uninfected persons for a wide variety of reasons.

There is a myth circulating media that the World Health Organization has recently called into question. It implies that holding one’s breath for 10 seconds or longer without respiratory discomfort or symptoms means you are covid-19 free. [15] This extends to facemask wearing which could be an issue for those with pre-existing respiratory ailments.

Smokers, anyone with mild airway blockages or those with asthma and other respiratory conditions are prone to having weaker lungs and more respiratory complaints on average.

Moreover, the symptoms of COVID-19 overlap with many other conditions and not enough is currently known about the virus for doctors to make accurate diagnosis purely based on the clinical presentation of such symptoms.

To find out if you have COVID-19, you need to opt for proper testing[16]:

• RT-PCR testing picks up viral genetic material and is currently the most accurate form of testing available for those currently fighting an infection.
• Antibody testing may detect if you’ve previously had the virus but is prone to a high degree of error.

7. COVID-19 Immunity Trumps Mask Wearing

Fact: Not enough information is known about COVID-19 to make any assumptions about how potential immunity against it might work.

Individuals who have faced the virus and have emerged from quarantine victorious with a healthy pool of anti-COVID antibodies may feel that they are now immune and no longer need to wear a facemask.

While it has been long understood that immunity is related to having antibodies against a pathogen, the generalization ends there with regard to COVID-19 and other unknown infections.

Unfortunately, immunity is not as simple as merely having the right antibodies to counter an infection – the mode of infectious action, antibody amount, timing and state of the person’s immune system are all factors that come into play when looking at immunity.

There are a lot of unanswered questions pertaining to COVID-related immunity, such as how many exposures are required before effective immunity has been achieved and how long does such immunity last? Whether the virus is a latent virus, the extent to which it hijacks the body’s resources to replicate and how it works to evade the immune system are all still being researched to add extra insight on how we might go about achieving full immunity.

In light of this, individuals who have successfully survived COVID-19 after quarantine ought to practice strict preventative measures as they are more likely to be viral carriers post infection.

Conclusion

Facemasks form part of an effective COVID-19 prevention strategy when adopted by the majority of the population, and used in combination with frequent hand-washing and social distancing.

In spite of public outcry, facemasks have only proven to be damaging to health when used incorrectly and pose no threat to most individuals.

Too little is known about COVID-19 to make any further assumptions about its successful prevention at this current time, however it can never hurt to strive for optimal health and well-being in the form of leading a healthy lifestyle.

If you suspect you are infected or would like more information on what you can do to lower your risk, book a telehealth consult with a world-class healthcare professional through the Mya Care platform today!

Source:

• [1] https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks-prevent
• [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306645/
• [3] https://www.researchgate.net/publication/342198360_Association_of_country-wide_coronavirus_mortality_with_demographics_testing_lockdowns_and_public_wearing_of_masks_Update_June_15_2020
• [4] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
• [5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253999/
• [6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191274/
• [7] https://www.mayoclinic.org/coronavirus-mask/art-20485449
• [8] https://www.who.int/csr/resources/publications/Adviceusemaskscommunityrevised.pdf
• [9] https://www.umms.org/coronavirus/what-to-know/symptoms-prevention/masks/wearing-mask
• [10] https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html
• [11] https://www.health.com/condition/infectious-diseases/coronavirus/does-wearing-face-mask-increase-co2-levels
• [12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191114/
• [13] https://reader.elsevier.com/reader/sd/pii/B9780702039355000586?token=6266C6AB555BA7A379F8A5AC6577B58C4494BE9170A234167C90D37086DB534F8E79B3D2449076D5FE5A8FF6B8DECD35
• [14] https://www.astmh.org/education-resources/tropical-medicine-q-a/major-tropical-diseases
• [15] https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters#5g
• [16] https://www.healthline.com/health-news/how-accurate-are-covid-19-diagnostic-and-antibody-tests#Two-tests-that-diagnose-an-infection

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