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How, when and why should a mask be used?

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Now that the different phases of the de-escalation are taking shape, proposing the progressive return to a “normal activity”, which of course will not be normal as we enjoyed it before the Covid Pandemic19, more than ever, which ones are the behaviors that allow us to have maximum security so as not to infect others, nor to infect ourselves.

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One of the barriers that is key to avoid contagion, in addition to surface cleaning, hand cleaning, social withdrawal or avoiding touching the face, nose, eyes and mouth, is the use of masks. Although it should be noted that the use of a mask alone will not be effective, if it is not used in conjunction with the other measures.

Therefore, the return to normality will go through a widespread use of masks, along with the other measures, which will allow us to fulfill the first objective of not infecting others, because if we all wore masks, nobody would infect anyone.

COVID19 is known to be transmitted through respiratory droplets, which are 5-10 microns in size, from infected persons by speaking or coughing, and these droplets that have a limited air range of 1-1.5 meters, then they can be deposited on the surface being a source of contagion. Therefore, to avoid contagion, barriers must be put up so that these droplets do not have the opportunity to be a source of contagion through the use of masks and with a distance of 2 meters when we start conversations between people, along with the rest hygienic measures that we have discussed.

It should be borne in mind that there is currently more and more evidence showing that not only sick people who are “symptomatic”, who would be the tip of the iceberg, are those who transmit the virus, but also those who are “pre-symptomatic” (1-2 days before presenting symptoms) or the so-called “asymptomatic carriers” can be transmitters of the virus. Precisely to face this potentially contagious population that goes unnoticed, surgical or hygienic masks must be used indiscriminately and the precautions and measures that we have discussed above must be maximized. The lack of evidence meant that initially it was not recommended that people who are asymptomatic or not in charge of patients or people at risk should wear a medical mask.

What types of masks are there?

There are different types of masks depending on their degree of protection and their scope of use. The difference between the different types of masks is their complexity that directly affects the cost. On the other hand, the high demand for masks has made them scarce, causing a price increase that has recently been regulated by the state.

types of masks

Types of Masks:

Surgical masks

Also called medical masks are the simplest. They provide a barrier that prevents the transmission of an infectious agent between healthcare personnel and the patient, to control the spread of respiratory drops. It prevents an infected person from infecting another person.

Filter masks called FFP Filtering Facial Parts (FFP2 and FFP3) or self-filtering respirators or masks

They prevent the passage of particles larger than 0.6 microns and, therefore, prevent virions (including SARS-CoV2) and bacteria that cause airborne diseases from penetrating. They are considered individual protective equipment (PPE), and are used in the healthcare environment.

The FFP1, without an exhalation valve and with minimal filtration, do not protect the wearer, but they do prevent contagion.

FFP2 and FFP3 protect the user from exposure to contaminants during aerosol-generating procedures. They may or may not have exhalation valves. Those that do not have valves that protect the person who uses them and limit the spread of the virus, while those that have valves protect those who wear them, but do not limit their spread because they do not prevent the release of exhaled respiratory particles from the user to the environment.

The FFP2 have a filtering capacity of 92% of the particles in the air and are intended for personnel who access rooms in respiratory isolation, emergency personnel and consultations for patients at high risk of airborne diseases and laboratories where they work. with a biosafety level of level 2.

FFP3 are the superior protection ones with a filtration capacity of 98% of air particles and are intended for healthcare personnel in contact with procedures that can generate aerosols such as endotracheal intubation, bronchoscopy, bronchoalveolar lavage, manual ventilation, etc.

Non-medical face masks

Manufactured from cloth or other material such as paper, they are not intended for use in healthcare settings or by healthcare professionals. In these would be the “hygienic masks” with fibrous structure, with a quality certificate, which can be reusable, and which have been destined for use in the community to avoid contagion by drops. Hygienic masks are not considered a medical device and although they are not designed to protect against the virus, they limit their spread.
 

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When should I use the mask?

People with symptoms of being infected with SARS-CoV-2, health workers, caregivers of people both in the social and health field and at home, must use masks to prevent the spread of the disease to other people.

The only mask that would fulfill the double objective of not infecting and not being infected (as long as it was used correctly), is the FPP2 mask without an exhalation valve..

To avoid infecting others, do not use the FPP2 masks with an exhalation valve or the FPP3 masks, since their exhalation valves prevent them from controlling the ability to infect the wearer.

Currently it is recommended that health personnel should wear surgical masks especially when there is a distance of less than 2 meters between colleagues. When there are situations of greater risk such as direct and continued contact with COVID-19 patients, the use of FFP2 or FFP3 is recommended, and if there is the possibility of aerosol generation, the use of FFP3 masks is recommended by staff and obviously surgical masks by the patient.

Due to the greater risk for healthcare personnel, the use of surgical masks is a priority in this area compared to other community settings.

In HOSPITALS it is recommended:

Update - 2020.07.11
  • Surgical masks for those people infected or who may be, to avoid infecting other people.
  • FFP2 or FFP3 masks for healthy personnel who may be in contact with people who are infected or who may be, to avoid becoming infected.
  • FFP3 self-filtering masks, for healthcare personnel who perform aerosol-generating procedures with patients, such as tracheal intubation, tracheostomy, cardiopulmonary resuscitation, etc.

In COMMUNITY it is recommended:

Update - 2020.07.11
  • Surgical masks in symptomatic people
    Self-isolation and use of a mask, along with hygiene measures and distance, with instructions on how to put it on, take it off and dispose of it.
  • Hygienic masks in a healthy general population
    The use of hygienic masks has been considered, since surgical masks must be prioritized for healthcare personnel and those who are caring for vulnerable people. It must be emphasized that this measure does not replace the other measures.
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What type of mask should I use?

Recommendation of surgical masks in:

Update - 2020.07.11
  • Health staff
  • Workers of Social Health centers when it involves a distance of less than 2 meters
  • People in home quarantine who contact cohabitants
  • Vulnerable groups (older people, with basic pathology and pregnant women)

Recommendation of hygienic masks in:

Update - 2020.07.11
  • People who take to the streets for work or other reasons during de-escalation.
  • General population that goes outside

It is not convenient to use masks in:

Update - 2020.07.11
  • Children under 3 years, people with respiratory problems and people with difficulties to remove the mask by themselves.
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How should I use the mask? 

If we want the use of masks to fulfill their function and not generate a false sense of protection, we must know how to handle and use them. It is necessary to take into account the recommendations of a hand hygiene before putting them on and after their removal, do it using the tapes avoiding touching the front of the mask and discarding it in a waterproof bag in the trash.

correct use of the mask
The following recommendations should be followed when putting on or removing a mask:

Update - 2020.07.11

  • Before putting on a mask, wash your hands thoroughly with soap and water or with an alcohol-based solution.
  • Cover the mouth and nose with the mask and avoid gaps between the face and the mask.
  • Avoid touching the mask with your hands while wearing it and if you wash your hands well with soap and water or with an alcohol-based solution.
  • Dispose of the mask when wet and avoid reusing single-use masks. Surgical masks are for single use only.
  • For comfort and hygiene reasons, it is recommended not to wear the mask for more than 4 hours. In case it gets wet or deteriorates from use, it is recommended to replace it with another.
  • Remove the mask from the back, without touching the front, discard it in a closed bucket and wash your hands with soap and water or with an alcohol-based solution. If they are disposable masks, they should be thrown in a waterproof bag in the trash.
  • In the case of reusable hygienic masks, they must be washed according to the manufacturer’s instructions.
  • The safety distance and the washing of hands with soap and water or hydroalcoholic solutions are of great.
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Disadvantages of the use of Mask:

The use of masks has a series of drawbacks that must be pointed out, such as:

Update - 2020.07.11
  • Self-contamination that can occur by touching and reusing the contaminated mask.
  • Possible difficulties in breathing, depending on the type of mask.
  •  False sense of security, leading to possible less adherence to other preventive measures such as physical distance and hand hygiene
  • Deviation of mask supplies and the consequent shortage of masks for health workers.
  • Deviation of resources from effective public health measures, such as hand hygiene.
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What are the benefits to society in general that we all use the mask well?

Recently the ministry has published a document “RECOMMENDATIONS ON THE USE OF MASKS IN THE COMMUNITY IN THE CONTEXT OF COVID-19” which is summarized in the following points:

Update - 2020.07.11

  • The use of masks in the general population can serve as a way of controlling the source of infection by reducing the spread in the community, since it reduces the excretion of respiratory drops from infected individuals who have not yet developed symptoms or who remain asymptomatic.
  • The use of face masks in the community could be considered, especially when going to crowded areas, closed spaces such as supermarkets, shopping centers, or when using public transport, etc.
  • Use of medical (surgical) masks by healthcare workers should take priority over use in the general healthy population.
  • The use of masks in the community should be considered only as a complementary measure and not as a substitute for established preventive measures, for example, physical distance, respiratory etiquette, hand hygiene and avoiding touching the face, nose, eyes and mouth.
  • The proper use of masks is key to the effectiveness of the measure and can be improved through educational campaigns.
  • Recommendations for mask use in the community should take into account gaps in evidence, availability, and possible negative side effects.

Dr. Marco Antonio Sempere Alcocer
Microbiology and Parasitology Specialist

Content retrieved from: https://www.hcmarbella.com/en/how-when-and-why-should-a-mask-be-used/.

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