Recently I wrote a post called “Gloves on, or Gloves off” about whether the use of gloves by the general public can limit cross-contamination and one’s risk of contracting COVID-19. The piece proved to be extremely popular here on Insights, and so we planned to do a similar, follow up piece on whether or not to wear a mask.
And yes, that’s me in the image above, getting ready to do some essential grocery shopping. If you had told me 3 months ago that I’d head to Woolies looking like I was going to rob the place, well…. you can imagine my response. They say life is what happens while you’re making other plans, and this is certainly true for the COVID-19 pandemic, during which guidelines are constantly changing as more information about the virus comes to light. The question of whether or not to wear a mask has - of course - become null and void with the Government making masks a mandatory part of moving to level 4 lockdown.
So instead of debating the pro’s and con’s of wearing a mask, I thought I’d tackle the questions that my friends and family - and possibly you, our readers - are asking most often about masks and their efficacy, use and care. As you can imagine, there is a huge amount of debate and misinformation around the subject, and as a result I have based my answers on a short video that was put out by Groote Schuur’s Head of Infectious Diseases, Dr M Mendelson. You can watch the original video here.
1. Do I have to wear a cloth mask?
The short answer to this is yes, you do. On the 25th April, President Cyril Ramaphosa outlined the government's plan to ease South Africa out of lockdown and get the economy going again. With the return to work of various sectors, the government has made it mandatory for citizens to wear a fabric face mask while out in public.
“When you leave your house it will be mandatory to use a cloth face mask. We know that these cloth masks may not be easily available but you may use a cloth to cover your nose and mouth,” said Cooperative Governance and Traditional Affairs (COGTA) Minister Nkosazana Dlamini-Zuma. In addition, the guidelines also state that “All employees use cloth masks in transit and to the workplace”.
2. Why must I wear one?
Well, apart from “because the President said so”, the reason behind asking South Africans to wear cloth masks in public is to reduce the number of droplets that one spreads into one’s immediate environment when breathing, coughing, or sneezing. By wearing a cloth mask we can limit the spread of the virus to others, for example if you are infected but not aware, or are asymptomatic.
As Dr van Kets mentioned in her Ask the Expert Interview with us, wearing a cloth mask involves shifting our thinking away from “my mask is to protect me from sick people” to “my mask is to protect other people from me”.
3. Can I wear a medical grade mask like the N95?
As Dr Mendelson says in his video, medical grade masks should only be used by healthcare workers. These masks are fluid resistant, and are designed to protect healthcare workers from sick patients. They should only be used when treating patients with COVID-19 or TB. In addition, N95 masks are fit-tested to the health care professionals that use them, and if they are not fit-tested, they don’t work properly.
4. If I’m not a medical professional is any kind of face / nose / mouth protection ok? Is a buff as good as a mask?
We’ll come to what the ideal cloth mask should consist of in the next question, but if you follow the logic inherent in the “why” of why we are being asked to wear a cloth mask (see question 2) then the answer to this question is that first prize would be to wear a three layer, properly fitting, regularly washed and sanitised cloth mask, but if that really isn't possible, then second prize is that any covering is better than nothing. The Government stated in their briefing that “We know that these cloth masks may not be easily available but you may use a cloth to cover your nose and mouth.”
5. If I'm making or buying a cloth mask, what should it be made of?
Dr Mendelson explains that a good cloth mask should ideally be made of 3 layers of washable cotton - thick cotton on the outside and a thinner cotton on the inside. It should be square, pleated, and cover your face from above the nose to below the chin and fit snugly at the sides. It may either have elastics that go around your ears, or straps that tie behind your head.
Here is a simple tutorial on how to make your own cloth mask, courtesy of the CDC.
6. How do I put it on / take it off safely?
The most important part of mask hygiene is actually hand hygiene. No surprises really that you MUST wash and dry your hands thoroughly (for at least 20 seconds on the washing) before picking up your clean mask and putting it on. Start with the straps and then pull it down over your nose (not your eyes!) and chin, making sure it is snug and well fitted.
To safely take off your mask, don’t touch the front! Carefully take it off by untying the strings around your head, or lifting the elastic over your ears, and then put it straight into a container for washing.
7. How often should I change my mask?
This will depend on what you are doing, but you should only ever put on a clean mask. By this I mean that if you were to travel to work wearing a cloth mask, you could safely wear it all day and travel home in it, but should you take it off in the office, you would ideally need a clean one for the trip home.
8. How often should I wash or sterilize my cloth mask, and how do I do it?
You must wash your cloth mask after each wear. Wash it at 60 degrees, then iron it and leave it to dry in the sun (if possible).
You’ll most likely need more than one cloth mask to ensure that you have a clean one available whilst the others are in the wash. And clean masks should preferably be stored somewhere that has also been sanitised and is airtight, such as a tupperware container or zip-lock bag until you are ready to use it again.
If you do not have access to a washing machine then boiling your cloth mask for 10 minutes will also work.
9. Is there anything I should NOT do while wearing my mask?
DON’T touch your mask! If you do touch it accidentally, wash and dry your hands immediately, or if you absolutely can’t access soap and water, use hand sanitiser to thoroughly sanitise your hands. And then try your darndest NOT to touch it again!
10. What can I do to stop my glasses fogging up?
A new complaint for some of us, but not for the millions of health workers who wear masks all day in the line of duty. They shared their tips and tricks with us civilians in a recent New York Times article.
Please remember that mask wearing is just one weapon in our fight against the COVID-19 pandemic. It’s critical to remember that to protect yourself, the most important precautions we can take against COVID-19 and other viral and bacterial illnesses are still proper hand washing and drying, avoiding touching your face, and social distancing.