To protect against the COVID-19 coronavirus, the Center for Disease Control (CDC) has recommended that most people wear some form of face covering when in public. Wearing masks serves two purposes: to protect the wearer against airborne liquid particles containing the virus, but more importantly to prevent those who may be carrying the virus, either knowingly or unknowingly to spread it to others.

However, all face coverings are not created equal, so it is important to be able to determine which masks provide the best protection given limited supplies, and different purposes. While the entire public should be considering wearing masks, due to shortages, the most effective types of masks are recommended to be reserved for those under the greatest amount of risk: namely healthcare providers dealing with patients who may have symptomatic or asymptomatic cases of the Coronavirus.

Who should wear a surgical mask?

The CDC generally recommends that everyone should wear a mask whenever in public. This is particularly true when around people who do not live within the household and also if other social distancing measures (such as maintaining 6-10 feet distance) from people are hard to accomplish.

While most masks do not provide adequate protection to the wearer against others (with the possible exception of the N95 respirator, which is not recommended for use by the general public), by wearing a mask, this will definitely help prevent the spread of the virus by those who have COVID-19 to others. Wearing one in general is a good idea quite simply because a significant number of people who carry the virus may have no symptoms but may easily spread it.

Beyond the basic general public, it is wise for anyone who works in an environment where they interact with the general public should alwayswear a mask. While the N95 mask may not be available to most outside the medical and health care professions, wearing a surgical mask can be quite effective for many employees. This includes people who work in public retail and supermarkets, any type of customer service position where there is interaction with others, should consider wearing a surgical mask. In fact, in many states, this has already been mandated by law.

Educators should always wear at least a surgical mask, to protect not only themselves (at least at a minimal level) but mainly their students. Similarly, anyone who works in any sort of profession where they care for others, a good surgical mask should be considered to be somewhat adequate protection.

Exceptions

Children under the age of two years old may have trouble breathing while wearing a mask, so they should not be required to wear one. Similarly, anyone who has breathing difficulty may not wish to

wear one, however people in this category should consider staying out of the general population, as their presence may inadvertently work to spread the virus to others, particularly if one is infected and does not know it.

Types of Masks

Let us break down the different types of facial coverings.

N95 Respirators

N95 respirators are considered to provide the best protection against the airborne COVID-19 virus.

Designed for a close fit, these masks (or more accurately, respirators) create a tight seal from the wearer’s face protecting them from the outside environment. These use protective straps and are form fitted to a person’s face. They are designed for single use (in other words, for a few hours of usage) by the wearer.

N95 respirators are tested for resistance to fluid, and how efficiently they filter various particles and bacteria, providing protection to the wearer. They are designed for single use and are disposable and should not be shared with other users or reused. They are designed to be biodegradable.

A number of conditions are required for individuals to be able to wear these masks. Some drawbacks are that they can cause difficulty in breathing due to limited air intake. The wearer must not have any facial hair so as to achieve a tight fit against the face. They are also not designed to be used by children who may have difficulty breathing wearing these.

The N95 mask is designed to be used specifically in healthcare environments. According to the CDC, these respirators are not intended for use by the general public. While these masks provide the best protection for the wearer against both small and large airborne particles, due to the expense in manufacturing and global shortage, they should be reserved specifically for health care workers and other medical first responders

There are a few professions that are recommended to use the N95 masks. Beyond those who work in a health care setting, those who work in industrial jobs which cause them to be exposed to dust and small air particles can also wear N95 respirators.

Surgical Masks

Next on the list in terms of providing good protection are surgical masks. These have been commonly used in medical environments. Surgical masks are loose fitting disposable masks designed to cover the face and mouth of the wearer. They help create a physical barrier between the wearer and others and any potential contaminants in the immediate environment.

They are designed to prevent direct contact from the wearer with liquids. If they are properly affixed to the user (worn in the correct way) surgical masks are designed to block most large particle droplets, sprays, splashes, and splatter, caused by coughing or sneezing, which may contain viruses or bacteria. Correctly worn, they are meant to cover the mouth, nose, and lower face of the wearer.

They are not as completely effective as N95 masks, as they do not filter small air particles that can be transmitted by individuals who sneeze or cough directly on the wearer. They are, however, effective at

protecting others from those who may be carrying the COVID-19 virus, as they reduce the spread of any such liquid ejections.

These are considered to be effective coverings as they cause little impediment to breathing by the wearer but work significantly well at reducing the spread of viruses or bacteria.

Like the N95 masks, they are intended to be used only one time, and should not be shared. They should be discarded after use. These are designed to be used in surgical settings to protect patients against infection from potential pathogens which may be carried by attendants in operating rooms.

While they do not provide full protection fromairborne particles, they are helpful in preventing their spread, so can be used in many professions outside the medical environment.

Cloth face coverings

At the very least, all people in public should wear a cloth face covering. They may be helpful for preventing those who may have the virus but are unaware of this from transmitting it to others.

This is recommended to be included with regular hand washing, and maintaining 6 feet of social distancing from all others

These are not considered to be useful in medical environments, as they may not provide protection from fluids and may also not filter particles. They are generally not considered to be personal protective equipment (PPE). They are, however, helpful in reducing the spread of many large droplet airborne particles.

If one is in the general public (and not in a professional capacity) these may be effective. When choosing such a mask there are a few guidelines that one should consider the following:

 

●  Be sure that if you are to be using a cloth mask covering, that it includes 2 or more layers of washable fabric, that it completely covers the nose and mouth of the wearer, and that it should fit snugly (with no gaps).
●  Make sure that it is not made of a fabric which makes it difficult to breathe, such as vinyl.
●  One important factor to consider is that while they may look appealing, effective masks should not​ have exhalation vents, due to the fact that virus particles can escape through these. Do not use any masks that are specifically intended for healthcare workers such as N95.

However, many of these complications can be avoided by simply using disposable surgical masks, which are better at fluid protection.

 

Strategies for maintaining resources for health care professionals

While adequate access to PPE is ideal for medical staff, due to global shortages, there may be a need to make exceptions where access to N95 masks is not possible.

One way of looking at this is to manage the “surge capacity” of a healthcare facility, or its ability to manage its supplies if there is a sudden increase in patients or need.

Under ​conventional capacity​, access to various forms of PPC should be available to all staff within healthcare facilities, with a priority going to those who work directly with those infected or suspected to

be infected with COVID-19. Other members of staff within a healthcare facility should have regular access to PPE, including surgical masks, and should be required to wear them whenever on the premises.

In some cases, under contingency capacity, if there are shortages of N95 masks, it makes sense to provide large amounts of surgical masks to members of the community. In this case, it is important to ensure that there is an adequate supply of these backup masks on hand.

In worst case scenarios, or a crisis capacitystrategy may need to be implemented which do not necessarily meet recommended CDC guidelines. This occurs in situations where there are known shortages of facemasks. In these cases (and only in these cases), it may be necessary to use facemasks for a period beyond the official industry-designated shelf-life of the product. In cases where these are not available, some limited reuse of facemasks may be permitted

In these cases, especially while removing these masks, care must be taken by healthcare providers. It is important to never touch the outer surface of the mask while using it or removing it. Ideally the masks should be reserved for use with the same patient and not run the risk of spreading the infection to others.

If the mask becomes soiled or damaged, it should not be reused under any circumstances. It is important also that the health care provided always leave the patient area prior to removing a facemask, and the mask should be folded so that the outer surface is kept inward and not in contact with any remote surface, and it should be stored in a clean sealable paper bag or other container that allows for air circulation.

Prioritization of Use

Surgical masks should be given highest priority for activities such as surgeries or other procedures, or any normal care activities where there is a likelihood of splashing or spraying. In other words, if a patient is sneezing or coughing, a mask should always be worn.

If there are periods where there will be prolonged contact with a patient, particularly those who may be infectious, a mask should always be worn.

If procedures will be occurring where normally an N95 mask would be worn but they are unavailable, a surgical mask should be worn.

When no facemasks are available

If any healthcare providers are at an increased risk (age, past illness, other health issues) they should be excluded from providing care. If there are any providers who may have already recovered from COVID-19, they may be at reduced risk of a recurrence of the disease. This group may be prioritized for providing care.

If no masks are available, while they are not considered to be effective at the prevention of transmission of the virus, facemasks which extend beyond the chin and below, and cover both sides of the face should be considered.

In some settings if no facemasks are available, while homemade cloth masks are not considered to be PPE, they may be used. Extra caution should be applied if using these masks, and they should be used in conjunction with the aforementioned face shields.

Conclusion

While N95 masks provide the most protection, they are generally unavailable to the general public and should be reserved for healthcare professionals or those who come in regular contact with known people infected with COVID-19.

Excepting these, surgical masks provide the best protection both for preventing the transmission of the virus, and potentially protecting the users. Professions which are best suited for these are the medical profession, particularly in cases where the N95 mask is unavailable, educational professions, retail and supermarkets, and any position where regular contact with the general public is required.

 

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