In a phenomenal U-turn, the WHO and governments are now advising that masks are a low-cost opportunity to minimise the spread of infectious respiratory droplets. Part of this message is that masks are useful for protecting others. But do masks offer the wearer any protection? In a time where the market is inundated with a variety of masks, let’s look at whether surgical or cloth masks have an advantage over the other.
But first, a disclaimer
1. I’m not a medical professional. What you’ll find here are personal learnings about using masks as part of a toolkit to safeguard against COVID-19
2. I also strongly agree that doctors, nurses and other frontline professionals should have first access to PPE. Governments around the world need to take a proactive role in sourcing and producing high quality equipment to keep these individuals safe
3. When referring to surgical masks, I’m not talking about the gold standard N95s you often see medical professionals wear. These green, fluid resistant respirators have the ability to protect the wearer from airborne particles in high risk situations. The surgical face masks I’m referring to are pleated 3-layer masks and are also known as medical or dental masks
4. This article is not an attempt to redirect neccessary PPE away from our frontline members. But it is a response to the community having greater access to both surgical and cloth masks. It is also to add to discussions around the benefit of mask-wearing and to help others better understand the key differences between these types of masks
Why wear a face mask now (and not back in February or March?)
Let’s start here. In the early months, it was believed that social distancing, frequent hand sanitising and good cough etiquette was best suited to combating the Coronavirus. Although Asian countries quickly donned face masks out of SARS PTSD or cultural practice, the West largely relied on WHO and government advice stating that masks were ineffective for a multitude of reasons.
We also heard about medical staff facing a persistent surgical face mask shortage. To detract from panic buying, the public was asked to reserve masks solely for frontline staff. But as we see community transmission rise globally, face masks have now been touted as an important pandemic measure.
This is largely a response to a better understanding of how the Coronavirus transmits. Most importantly, we have learnt that infectious individuals can be pre-symptomatic or asymptotic. Updated medical advice around mask-wearing may also be a result of increased face mask availability in the market. In Australia, surgical face masks are now available for sales in Coles, Bunnings, Priceline, Kmart, Big W, Chemist Warehouse and others. Cloth masks can also be purchased from these retailers. More importantly, Australian manufacturers are now producing surgical face masks for local consumption.
How do surgical face masks work?
Surgical face masks are single-use products which consist of 3-layers:
Layer 1: A fluid resistant outer layer to prevent larger droplets getting onto you
Layer 2: A dense meltblown layer, which can trap smaller bacteria and virus particles
Layer 3: An absorbent layer designed to stop your respiratory droplets from spreading
Surgical face masks are tested against different standards and offer varying levels of breath resistance, flammability and protection against bacteria, particles, fluids and more. Two commonly cited test guidelines include America’s ASTM FM 2100 and Europe’s EN 14683.
When tightly sealed around your face and fully covering your mouth and nose, these certified surgical face masks are designed to protect both the user and those around you by:
1. Limiting the spread of your saliva and other respiratory secretions
2. Shielding the wearer from external droplets, splashes and sprays depending on the mask’s level of protection
Other sources which indicate this include:
– The FDA – surgical face masks ‘block large-particle droplets, splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth and nose. Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others’.
– The European Centre For Disease Prevention and Control – surgical face masks ‘prevent large respiratory droplets and splashes from reaching the mouth and the nose of the wearer and help reduce and/or control at the source the spread of large respiratory droplets from the person wearing the face mask’
– Australia’s Department of Health and Human Services Victoria in July 2020 – surgical face masks ‘provide a protective barrier that prevent the spread of larger droplets from the wearer to others, as well as protect the wearer from inhaling larger droplets, and from fluid splashes or high velocity streams of bodily fluid’
Are face masks effective against the Coronavirus?
A National Centre of Biotechnology research paper found that Coronavirus particles are 0.125 microns and are transmitted through respiratory droplets, sized at 0.5-3 microns. An article in The New England Journal of Medicine looking specifically at COVID-19 also concluded that the virus is approximately 0.125 microns, with the smallest particles being 0.06 microns and the largest being 0.14 microns.
In order for a surgical face mask to be effective against the Coronavirus, it must successfully pass a Particle Filtration Efficiency (PFE) test at 0.1 microns. This test is generally a feature of ASTM F2100-11 certified masks, with a Level 1 surgical mask being designed to filter out ≥ 95% of particles at 0.1 microns.
Admittedly, one of the biggest issues with surgical face masks is that they often don’t form a complete seal around the wearer’s face. When compared to highly prized N95s, airflow can leak along the sides of the surgical face mask. As a result, surgical face masks are usually not advised to be used in high risk medical situations where particles are airborne.
However, for circumstances where the wearer is able to socially distance, surgical face masks can offer them a level of protection against droplets.
Surgical face masks vs cloth masks: Which is better?
New modelling has found that the widespread use of cloth masks, bandanas or scarves can play a key role in reducing virus transmission. But their effectiveness depends on the covering’s material. This research also found that cloth masks work primarily as ‘source control’ to reduce how much the wearer expels and not to protect the user.
Surprisingly, there is a lack of academic and clinical research examining to what extent surgical face masks can protect the wearer. However, surgical face masks might be a more reliable option because they are the only type of mask that can be constructed to a specific certifiable standard aside from N95s.
While undoubtedly a more environmentally friendly choice, cloth masks are generally not lab tested to any specific standard meaning that their effectiveness varies. Moreover, there are many questions about cloth masks that have yet to be answered including how many washes does it take before they become ineffective and can filters be washed without damaging its ability to trap particles?
Also read: Where to Buy Australian Made Surgical Face Masks
Surgical face masks aren’t a silver bullet
Prior arguments about the ineffectiveness of surgical face masks still stand.
You could be wearing a poor quality surgical mask which can give you a false sense of security. You could also be touching your mask which is contaminated with infectious particles and then rub your eyes. You could also be pulling the mask down at the nose bridge for a ‘breath break’ and then move virus particles to other parts of your face.
There are many variables which can make surgical face masks ineffective. However, aside unknowingly purchasing a poorly constructed mask, it’s more about individual behaviour which stops the wearer from gaining its advantages. This is why it’s important to adopt new mask habits and recognise that they are to be used in conjunction with a suite of other preventative practices such as social distancing, adequate hand sanitising and cough etiquette.
Where to from here?
When purchasing a surgical face mask, look for certified products that have been tested for PFE. Also, remember to sanitise your hands before and after you put your mask on by the earloops or head-tie. Don’t touch it when you’re wearing it. Discard your surgical mask in the bin immediately after removal.
It’s a simple tool to keep you and me safe in these testing times.