Draft Recommendations to Wear Face Masks

March 18, 2020

We’ve been working diligently to review literature and develop recommendations that could be used to prevent the spread of CoronaVirus COVID-19. Below you will find a copy of the draft advising the use of various face masks in different situations. It also addresses the use of DIY masks, which have a role to play, when there are mask shortages. We don’t have the luxury of time at this point so something as basic as mask recommendations being appropriately implemented could mean the difference of a million lives!

This is an initial draft which is a work in progress. The plan is to have the draft reviewed by several colleagues along with some supporting literature. They can then be modified based on their collective feedback. The recommendations are meant to address 2 pertinent issues.

  1. The first is when to wear a mask. Unlike other guidelines, it relies on masks as much as other guidelines rely on social isolation and hand washing. In fact, it is very hard to accurately quantify the effect of each intervention, but research suggests that when you add additional interventions they tend to have a synergistic effect.
  2. The second is to try to establish priority for health care workers to address the shortage of masks, which is increasingly becoming a problem not only for the public but for healthcare workers. As Bloomberg news reports, hospitals are now making Face Masks from office supplies. At the same time it explains the rationale.

As masks become scarce, it is increasingly important to analyze exactly, what masks we need, why we need them, when we need them etc. Also, to ask questions. Do we need surgical masks? Are they better than other DIY versions? Why are they better? What alternatives are there?

I’m happy to see that others have been writing about the face mask topic and asking important questions. There is a growing amount of media coverage lately. Recently, an article on Time Online explained Why Wearing a Face Mask Is Encouraged in Asia, but Shunned in the U.S. which was good at exploring different recommendations. But I was rather hoping for an article similar to one published today by the NY Times in an Opinion piece titled: Why Telling People They Don’t Need Masks Backfired which goes into why being clearer with public health messaging is important and why it makes sense that masks are protective against Coronavirus.

These recommendation attempts to be as honest as possible, by letting individuals know that Face Masks do work, but that at the same time it is important that we reserve surgical masks for health care workers. The same would apply within a hospital where not everyone really needs to use those masks.

Many DIY masks, like those being made from office supplies, can achieve a similar level of protection from Coronavirus to surgical masks. They can also achieve comparable levels of source control–preventing spread from infected individuals. For purposes of Coronavirus, we need to stop large droplets, and most barriers will work to stop infecting droplets from a wearer. Even an elbow works. But it’s not as reliable as a mask that is always there to catch the droplets. The real advantage of surgical masks/ medical masks over home-made masks is that surgical masks have a slight advantage in their resistance to larger amounts of fluids. They are sort of water-proof. That is useful in an operating room where you can have splashes of fluid (usually blood). On the other hand, home made masks can be more comfortable and are probably sufficient to stop most large droplets.

Hopefully, we can get our recommendations out to the public as soon as possible. We want to have a social media peer review to see what other physicians think about the topic, but I’m fairly confident in them and that they can help to protect people including health care workers. By defining the appropriate times to wear a mask and the appropriate mask to use in a given situation, these recommendations address the need for the public to wear face masks for protection in the setting of a face mask shortage. Relying on science, these recommendations should enable more individuals to confidently use alternative face masks without depleting resources.

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