A broad definition of a face mask would be a covering of the nose and mouth. Are all masks for COVID 19 the same? No. they are not. Masks (in the ascending order of efficacy) would include a simple bandana, a single layer cloth mask, a surgical mask, an N95 mask, an N99 mask and a reusable respirator mask.
Types of Masks for COVID 19
The word bandhana is is derived from the Sanskrit word “bandhana” (bond). The bandana a triangular piece of cloth tied around the nose and mouth for protective or decorative purposes. They are insufficient protection against COVID 19 even in low risk areas.
Cloth Masks for COVID 19:
A cloth mask stitched from thick cloth in multiple layers offers some protection in low risk areas. Cloth masks can be reused and washing does not degrade its quality. Some cloth masks have an additional filter incorporated which make them more protective. Cloth masks are sufficient in low risk areas.
Surgical Masks for COVID 19:
A surgical mask is three layered, is fluid resistant and provides protection from large droplets, splashes or sprays of body fluids and secretions. It is loose fitting. Leakages occur around the edges. It is disposable (discard after single use).
Washing degrades its quality. It does not provide protection from smaller airborne particles. They provide only barrier protection but have no protection by filtration. It is adequate protection in low risk areas but inadequate protection in high risk areas.
N95 / N99 Masks for COVID 19:
N95 and N99 are standards of the The United States National Institute for Occupational Safety and Health (NIOSH). “N” stands for “not resistant to oil,” while “95” represents its minimum 95 percent filter capacity. Corresponding European standards are referred to as Face Filtering Piece (FFP) FFP1, FFP2 and FFP3. According to the European standards, each type can filter 80, 94 and 99.95 particles down to 0.3 microns.
These masks (N95, N99 or FFP2, FFP3) filter out 95% / 99% (or more) of the smallest particles in the air. They however have to fit very snugly in order to be effective. They may come with and exhalation valve. They are essential in high risk areas.
Reuseable Respirator Masks for COVID 19:
Offer the highest level of breathing protection. The respirator has to be worn correctly as a very snug to be effective. An incorrectly worn respirator mask offers very little protection. All respirator masks have to meet a minimum set of filtration and snug fit standards. All facial hair has to be removed for a respirator mask to fit snugly. A beard and a respirator mask are mutually exclusive.
Leaf masks for COVID 19
Leaf masks for COVID 19 are the latest in the long line of facial protective gear against COVID 19. Its made of silicone. Its comfortable to wear. Its transparent so you can continue to flaunt your smile. It has inbuilt HEPA filters capable of filtering particles of 0.3 micron size.. It also has an in bulit UV-C light source for cleaning the air that gets in and out. Is also FDA registered.
Copper coated masks for COVID 19.
Copper (Cu) is a naturally occurring metallic element, present in small quantities in many locations including the earth’s crust, soil, oceans, lakes and rivers. It is also a trace element that is necessary in humans, many plants and animals. The antiviral, antibacterial and antifungal properties of copper have been known for centuries. these properties have also been demonstrated by many laboratory studies. New technology allows copper coating of fabrics which are then used in the manufacture of masks. Copper treated materials release copper ions which will deactivate viruses and bacteria. Treated materials have also been tested to kill 100% of Staphylococcus aureus and Klebsiella pneumoniae and deactivate 99.95% of H1N1 virus and 99.9% of Human Coronavirus 229E.
“Variolation”, an unexpected benefit of Masks for COVID 19
Wearing masks for COVID 19 has an indirect beneficial effect on the spread of the virus according to a recent study published in the New England Journal of Medicine. Masks prevent a large “viral load” from entering the human lungs because of their obstructive and filtering functions. They how ever do not prevent a small number of viral particles from entering around the peripheries of the mask especially when the mask is a little loose fitting.
These small numbers of viral particles may be insufficient to cause a full blown COVID 19 illness in the host, but they could trigger an immune response in the host leading to the development of protective antibodies and activated T lymphocyte cells. Antibodies and activated T Lymphocytes could ward off future infections due to larger viral loads and so may prove to be protective for future infections.
This is similar to the process of variolation that was used in olden times to prevent small pox from spreading. A small amount of “scab” from an affected individual was rubbed into the skin of the new host to induce bleeding. This would trigger an immune response to the scab which contained only a very small load of the virus. The immune response so induced was protective against larger viral loads.
Downsides of masks.
Wearing a mask has numerous benefits but some down sides as well. Wearing a mask for a long period of time can lead to “dryness” in the mouth. People who wear masks also tend to breathe through the mouth which causes a decrease in the secretion of saliva. While wearing a mask, people also tend to drink less water. This worsens the dryness further. Reduction in saliva (which has natural antiseptic properties) with dryness also provides a conducive environment for bacterial growth.
The combination of a dry mouth and bacterial overgrowth can cause halitosis (foul smelling breath). Halitosis can be reduced by consciously breathing through the nose, drinking more water, avoiding caffeine, cigarettes, and using alcohol free mouth washes. Its also important to consult a dentist and ensure that you have no periodontal (gum) disease, or cavities.
Maskne (mask induced acne) is an important down side to wearing a protective face mask. It may manifest as pimples, redness or irritation in the area of the face that the mask covers. Wearing a mask for prolonged periods of time results in an environment of humidity and warmth under the mask as a result of warm exhaled air.
Warmth and humidity facilitate bacterial growth. A masked face is also not washed as frequently as a non masked face. this results in clogging of skin pores, accumulation of dead skin cells and oil on the skin surface. These further enhance bacterial overgrowth. If a mask fits too tightly it could result in friction on the skin surface as well. Some masks are chemically treated or have a surface coating of chemicals. These could induce a skin allergy in some people.
Prevention of mask induced complications.
Mask induced acne and other mask related complications could be prevented by the following:
- Wash your face regularly with lukewarm water atleast once in the morning and once at night and once during your work shift. Pat your skin dry. Do not wipe.
- Use a gentle cleanser. Specifically avoid alcohol or perfume containing cleansers.
- Use a non-comedogenic (does no block the pores of the skin) moisturizer.
- Do not use heavy make up while wearing a mask.
- Wash and dry a re-usable fabric mask before using it again.
- Never wear a wet mask. It does not protect against COVID 19 and also promotes bacterial growth under it.
- Do not reuse disposable masks.
- Try and remove your mask for 15 minutes every 4 hours. Wash your hand and ensure you are socially distanced before taking a mask break.
- Choose the right mask depending on your exposure risk, duration of risk, your age, comorbidities etc
- Cotton masks are preferable. Avoid masks made of synthetic fabrics, such as nylon and rayon. These materials can irritate the skin.
What type of mask for COVID 19 is the best?
A lot depends on the level of exposure to the COVID 19 virus. When the exposure risk is low, basic masks may suffice but in high risk settings (ICU healthcare workers looking after proven COVID 19 patients in a hospital), more sophisticated protection is mandatory. The potential for infection is based on the number of viral particles (viral load) and the duration of exposure.
The most lethal combination is prolonged exposure to a high viral load especially in a closed space with a lot of people. Chances of infection are less if the viral load is high but exposure is for a shorter duration or the exposure is prolonged but viral load is small. A useful accessory to any mask is a face shield which ensures an additional layer of protection. A additional layer of protection is welcome especially in areas of possibly “high viral load” such as a closed elevator / lift, a health care facility etc.
Tips from the CDC to make your mask more protective.
The centre for disease control and prevention has recommended a few tips and tricks to maximise the protection your mask gives you.
- Use masks with a nose bridge. The fit is more snug and therefore more protective
- Use a mask with a brace. The brace keeps the edges of the mask more air tight and also prevents the mask from falling off accidentally
- Use a mask with a very snug fit.
- Use multiple masks.
Common mistakes while wearing masks
- Covering only the mouth (and not the nose!)
- Wearing the mask upside down
- Wearing the mask inside out
- Reusing a disposable mask
- Frequently touching the outer surface of the mask
- Using a wet mask
Should I wear a mask even after getting vaccinated?
Yes most certainly, for the following reasons:
- The vaccine is not guarantee of 100% protection. If 100 people receive the vaccine, only 90% are protected. If you belong to the unfortunate 10% you should wear a mask till the COVID virus infection risk exists.
- Even if you belong to the 90% group (described above) vaccine induced protection kicks in only about 2 weeks after the second dose. Till such time you are still susceptible.
- The vaccine protects you by inducing your immune system to produce protective antibodies. If for some reason you are immunocompromised and your immune system is not in “good nick”, you may still develop COVID even after vaccination. People with disseminated cancer and those who have had a transplantation of various organs such as the kidney, heart lungs etc are all known to have weakened immune systems.
- The currently vaccines may not be equally protective against all the currently known variants of the virus
- The virus is known to mutate over time. The current vaccines may not be protective against all of the mutant strains that may appear in the future.
- The vaccine prevents you from developing the disease but does not prevent the virus from lodging itself in your nose and throat. You may be protected but you can still spread the virus to people around you when you speak, cough and sneeze. You have a moral responsibility to those around you! You do not want to be a silent spreader!
A mask will cease to become mandatory only when the pandemic dies down because either herd immunity kicks in or a sufficiently large percentage of the population have been fully vaccinated. Both these possibilities are likely to take a little more time.