NAVIGATING THE NEW NORMAL: A GUIDE TO WEARING FACE MASKS

Medically Reviewed and Updated by Dr. Sony Sherpa (MBBS) - October 08, 2024

Millions were impacted by the COVID-19 pandemic, which altered our way of life and social interactions. One of the most common and effective measures to prevent the spread of the virus was the use of face masks. However, as the pandemic came to a close, thanks to the availability of vaccines and treatments, many people were left wondering whether they still needed to wear masks in the post-COVID era. Moreover, as new variants of the virus and other infectious diseases emerged and posed new challenges, some countries reintroduced mask mandates or recommendations, sparking debates and controversies.

In this article, we will analyze the implications of wearing face masks for personal and public health moving forward into the post-COVID era, as well as the social and psychological aspects of this practice.

Should I Still Wear a Mask?

The purpose of face masks is to form a barrier that prevents the transmission of respiratory droplets that may contain infectious agents, such as the virus that causes COVID-19. You can shield yourself from breathing in these droplets by using a mask and also protect others if you are infected. Wearing a mask can also lower the risk of environmental contamination and subsequent infection.

According to the World Health Organization (WHO), wearing a mask was one of the key tools that slowed the spread of COVID-19^[1], along with getting vaccinated, washing hands, and maintaining physical distance. The WHO recommends wearing a mask in specific situations, such as when you are in a crowded, enclosed, or poorly ventilated space or when you have or suspect you have COVID-19^[2]. The WHO further cautions that, depending on a risk assessment, a mask may be recommended in other situations considering the local epidemiological trends, the level of vaccination coverage and immunity in the community, and the setting you find yourself in.

Double masking—such as wearing a cloth mask over a surgical mask—can enhance protection by improving filtration and fit. This method is especially recommended in high-risk settings, but it’s important that both masks fit snugly to maximize effectiveness.

Wearing a mask is still relevant in the post-COVID era for several reasons. Here are some of the main benefits of wearing a mask:

Firstly, while many regions have transitioned away from strict COVID-19 restrictions, the virus continues to circulate globally. Even if you are fully vaccinated, you may still get infected or transmit the virus to others, especially if you encounter a new variant that can evade the immune response. You can also spread the virus without having symptoms or pick it up from those who do not show any symptoms. Therefore, wearing a mask can help reduce the chances of getting sick or spreading the virus to others, especially in high-risk settings or populations.^[3] In the current scenario and always, it is essential to stay informed about local health guidelines and adjust personal precautions accordingly.

Secondly, wearing a mask can also protect you from other respiratory viruses that may circulate, such as influenza, RSV, and the common cold. These viruses can cause mild to severe illness and sometimes lead to complications and death, especially in vulnerable groups such as the elderly, children, and people with chronic conditions. You can lessen your exposure to these infections by wearing a mask and also prevent them from spreading. In fact, some studies have shown that during the COVID-19 pandemic, mask-wearing significantly reduced the occurrence of influenza and other respiratory diseases.^[4]

Thirdly, wearing a mask can also have positive effects on your health and well-being beyond preventing infections. Wearing a mask can help you avoid allergens, pollutants, and irritants that may trigger respiratory problems, such as asthma or allergies.

Types of Face Masks and Their Effectiveness^[5]

• Cloth Masks:
  • Effectiveness: Less protective than N95s, but still useful in low-risk settings if made with multiple layers and fitted properly.
  • Fit: Must cover nose and mouth snugly, with no gaps.
• Procedural and Surgical Masks:
  • Effectiveness: Moderate protection; mainly blocks large droplets. Less effective than respirators but useful in public or healthcare settings.
  • Fit: Looser fit than respirators, reducing overall filtration.
• KN95 Masks:
  • Effectiveness: Filters up to 95% of airborne particles, similar to N95 but follows different standards.
  • Fit: Snug and secure fit, offering high protection.
• N95 Masks:
  • Effectiveness: Provides the highest level of filtration (95% of airborne particles).
  • Usage: Essential for high-risk environments such as healthcare settings.
  • Fit: A tight seal around the face is crucial for effectiveness.

The Future of Face Masks

While mask-wearing remains pertinent, albeit to a lesser extent, everyone is wondering, ‘When can we stop wearing masks?’ Will wearing a mask become a permanent feature of our lives, or will it go away like a secondary pandemic?

Wearing a mask may become more or less necessary and common in the post-COVID era, depending on new outbreaks and the effectiveness of current treatments. There is also the possibility of other respiratory infections and pandemics that have yet to emerge, which may demand masking up. As one study reports, the probability of extreme epidemics might increase up to threefold in the decades to come.^[6]

Some experts predict that mask-wearing will become a seasonal or situational practice, similar to how some people already wear masks during flu season or in polluted areas. Others suggest that mask-wearing will become a permanent or long-term habit as part of a new normal of hygiene,  infection prevention, and overall health.

When to Wear a Mask

Wearing a mask is still important for preventing the spread of respiratory infections, and masks ought to be worn when one is not well (if staying at home or quarantine is not possible) or living with ill individuals who might pass it on. Even though many restrictions have been lifted, they have returned in some regions^[7]. Therefore, it is important to keep a clean mask with you when leaving the house.

There are other situations where mask-wearing might be essential or prudent, depending on the guidelines issued by health authorities:

• If you start to feel borderline ill or when mild symptoms appear, such as a cough, sniffles, or a temperature. You might want to remain vigilant of this when you suspect your immune function is low due to stress or some other issue.
• Inside hospitals. Masking in healthcare settings is vital to reduce the chances of acquiring an infection from patients and to prevent infections from leaving the facility.^[8]
• When traveling in close quarters with other people.
• When entering crowded public buildings that do not have adequate ventilation or sanitation measures in place.
• Anytime mask mandates are reimposed in response to an infectious challenge.

Some studies have suggested that people may benefit from wearing masks at home, especially if living with an ill family member. If anyone starts to show mild symptoms of illness or is at an increased risk of one, wearing masks may reduce the risk of infection by as much as 79%.^[9]

How to Wear a Mask Correctly

Wearing a mask correctly is essential for ensuring maximum protection. Here are some tips:

• Proper Fit: Ensure the mask covers your nose and mouth completely, fitting snugly against the sides of your face without gaps. Masks with adjustable ear loops or nose wires can help create a secure fit.
• Positioning: The mask should sit just below your eyes and extend down to cover your chin. A snug fit around the nose will prevent air from leaking and fogging glasses.
• Securing the Mask: Always handle masks by the ear loops or straps to avoid contaminating the surface. Adjust the mask to ensure it is comfortable but not too loose.
• Choosing the Right Mask:
  • Cloth Masks: Ideal for daily use, but ensure they have multiple layers of fabric. Look for breathable materials like cotton.
  • Surgical Masks: Suitable for short-term use in public settings but less durable.
  • N95/KN95 Masks: High filtration efficiency and excellent fit, ideal for high-risk environments.

How To Deal with The Challenges of Wearing Face Masks

Despite the benefits of wearing face masks, there are obvious drawbacks, and most people are still not comfortable with masking up. While we want to lower the spread of infections, it is not in the spirit of wearing masks to stress about it and possibly increase one’s chances of succumbing to an infection.

That said, mask fatigue is a real issue. It refers to the physical and psychological weariness that people experience due to prolonged mask-wearing. This can manifest as discomfort, irritation around the nose and ears, difficulty breathing, or a general sense of frustration. Mask fatigue is especially common in individuals who wear masks for extended periods, such as healthcare workers or those in public-facing roles.

If you respond to wearing a mask in any of the following ways, understand that you are not alone and that there are things you can do to improve your mask-wearing experience:

• Physical discomfort: Wearing a mask can cause skin irritation, acne, headaches, difficulty breathing, and fogging of glasses. These physical signals let us know just how unnatural wearing a mask is for our health and well-being. Studies have shown that in some regions, this is the number one barrier to wearing a facemask, affecting up to 80-90% of those who resist masking.^[10]
• Psychological distress: Prolonged mask-wearing can affect your mood, emotions, and mental health, especially when physical symptoms start to become intolerable and create mounting pressure. Some people may feel anxious, depressed, isolated, or stigmatized by wearing a mask. Others may experience a loss of identity, self-expression, or social connection, particularly as mask-wearing does away with our ability to make use of facial expressions. People may also be put off by mask-wearing due to the over-sensationalism of the COVID-19 pandemic and a lack of perceived effectiveness.^[11]
• Social conflict: Wearing a mask can also create social tension and conflict, either due to the way it is enforced or in areas where it is not supported. Some people may face discrimination or even harassment for wearing or not wearing a mask. Others may feel judged, pressured, or coerced by others to conform to their mask preferences. On the other hand, wearing a mask might also be perceived as a sign that you are not well and struggling with a respiratory infection, which can add to the tension. Some people may feel reluctant to wear a mask because they fear losing their social appeal or identity.

There are several ways in which one can cope with these challenges. To deal with these challenges, it is important to adopt a positive and proactive attitude towards wearing face masks.

Here are some tips to help you cope with the difficulties and enjoy the benefits of wearing face masks:

• Educate yourself and consider the global benefits of masking. Remember the protective benefits of mask-wearing, not just for yourself but for others around you, which can provide a mental boost and help you persist through discomfort.
• Choose a mask that suits your needs and preferences. To avoid physical discomfort, choose a mask that fits well, is comfortable, and is made of breathable materials. It is also important to change or wash your mask regularly and to take breaks from wearing it when possible.
• Incorporate Masks into Your Wardrobe. One can make mask-wearing more attractive, use it as a mode of self-expression, and incorporate it into one’s sense of identity. Choose a mask that reflects your personality, style, and values by picking a color, pattern, or design that you like. You may also need different masks for different occasions, such as for formal events, job interviews, or casual settings. Aside from colors and textures, masks are customizable with accessories such as pins, stickers, or charms. Some people might appreciate opting for a mask that has a printed smile on it as well to avoid losing a vital facial expression.
• Take care of your mask and your face. You should wash your reusable mask regularly, either by hand or in a machine, using soap and water or detergent. It is also important to wash your face before and after wearing a mask, using a gentle cleanser and moisturizer. Avoid wearing makeup or skincare products under your mask that may clog your pores or irritate your skin. Topical creams or medications can be used to treat any skin problems that may arise from wearing a mask, such as acne, rashes, or dryness.
• Take breaks from wearing your mask. You can and should remove your mask whenever it is safe and appropriate to do so. You should store your mask in a clean and dry place, such as a paper bag or a ziplock bag, and avoid touching the front or inside of your mask.
• Stay hydrated. Mask-wearing can sometimes lead to dry throat or mild dehydration, so ensure you are drinking enough fluids.

Studies on the Effectiveness of Mask-Wearing in Reducing COVID-19 Risk

Several studies have raised questions about the effectiveness of mask-wearing in reducing COVID-19 infection rates, particularly after the Omicron wave. For instance, research from the University of East Anglia found that mask mandates had little effect on lowering infection rates during this period, especially in areas with high vaccination coverage. ^[12]

Similarly, a Cochrane review concluded that evidence for masks preventing viral infections in community settings was weak, though it stressed that this shouldn't be interpreted as proof that masks are ineffective.^[13] This report from early 2023 highlighted similar concerns, noting that inconsistent mask use, improper fit, and the widespread use of less effective masks, like cloth masks, were factors that likely contributed to limited success in reducing infection rates. Despite these findings, experts still advocate for the use of masks in high-risk environments, where they can reduce transmission when used correctly alongside other preventive measures.

When Not To Wear A Mask

While wearing a mask can have many benefits, there are also some situations when wearing a mask is not recommended or required. These include the following situations:

• You are alone or with people from your household in a private setting, such as your home or car.
• You are outdoors and can maintain a safe distance from others, such as in a park or on a hike.
• You are eating or drinking in a public place, such as a restaurant or cafe.
• You are doing physical activity that makes it hard to breathe, such as running or swimming.
• You have a medical condition that prevents you from wearing a mask, such as asthma or a facial injury.
• A child under the age of 2, or a person who cannot remove the mask without assistance.
• You should also take off your mask if you feel unwell, dizzy, or suffocated and seek medical attention if necessary.

In these situations, wearing a mask may not be necessary or beneficial and may even be harmful or dangerous. However, you should always follow the local guidelines and regulations regarding wearing masks and respect the rules and policies of the places you visit. Be prepared to wear a mask if the situation changes or if you are asked to do so by others. Wearing a mask is not a substitute for other preventive measures, such as getting vaccinated, washing hands, and keeping physical distance. By combining these strategies, you can reduce your risk of contracting and spreading COVID-19 and other respiratory infections.

Frequently Asked Questions

Can Contaminated Face Masks Cause Infection?

Contaminated face masks can increase the risk of infection if reused without proper care. Masks, particularly cloth ones, can collect bacteria and viruses over time. If they aren’t washed or disposed of properly, they can transfer germs to your mouth, nose, or skin. Handling masks by the ear loops and avoiding touching the front surface can help reduce contamination risks.

Face Masks and Anxiety: Can Masks Make You Sick?

While wearing masks can cause anxiety or discomfort, especially for those with respiratory issues, they do not make you physically sick. Some individuals may experience shortness of breath or panic, but these are psychological responses rather than physical effects. Masks do not cause oxygen deprivation or carbon dioxide buildup. Strategies to manage anxiety include taking breaks in safe areas or using lighter, more breathable fabrics.

How to Reuse an N95 Mask

N95 masks can be reused if stored properly. It’s best to keep the mask in a breathable paper bag between uses to allow contaminants to dissipate. Rotating between multiple N95 masks is advisable, and cleaning with water or disinfectants should be avoided. Discard the mask if it becomes soiled or loses its fit.

Do Face Masks Expire?

Face masks, particularly surgical and N95 types, do have expiration dates. Over time, the materials can degrade, reducing their effectiveness in filtering particles. Expired masks may still provide some level of protection, but they should be checked for signs of wear before use.

Conclusion

Wearing a mask is still a simple and effective way of preventing the spread of COVID-19 variants and other respiratory infections. Masking up can protect you and others from getting sick and can also help reduce the burden on the healthcare system and the economy. Wearing a mask when required is still an important preventive measure in the post-covid era. One can work creatively around these challenges by choosing comfortable masks that reflect our identities, wearing one only when necessary and taking breaks when required, as well as adopting a positive attitude to masking up. By doing so, everyone can contribute to minimizing the spread of illness and adapt with minimal difficulty to a post-covid world.

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