It’s Time To Revise Mask Guidelines In View Of COVID-19 Variants

New Delhi: Face masks have become more of a fashion statement than a safeguard against COVID-19. In the absence of any updated guidelines with regard to masks since April 2020 when N95 masks were in short supply, any piece of cloth that is an excuse for a mask is acceptable.

It is common to see people matching their outfits with flimsy masks and escape the COVID guidelines. With COVID-19 variants like the Delta that spread faster, it is time to consider more heavy-duty masks than cotton masks.

During the second wave, double masking or using N95 masks, especially in cities where infection rates had gone up to as high as 50% was recommended.

“Cotton masks may not be an effective solution to prevent the aerosol-mediated transmission in high-risk areas like hospitals, markets and other crowded places where one cannot follow social distancing rules,” Dr Merlin Moni, associate professor at infectious disease division at Amrita Hospitals, Kochi told Quartz. This also applies to spaces that are air-conditioned and not properly effective.

Moni said studies have shown that cotton masks protect the wearer by only around 50%, and a surgical mask is close to 60%. For this reason, N95-level masks – also known as FFP2 according to European testing standards are recommended by doctors, especially in cities with high infection rates. These can prevent the transmission of airborne particles by 95%.

The downside of N95 masks

Whichever mask you wear, the key is that it should snugly fit the face, and cover your mouth and nose. A general rule is that if you are wearing glasses, a well-fitted mask, especially around the nose, will not make them fog up.

However, N95 masks are generally single-use and most of them cannot be washed or disinfected. While there is no consensus on how many times N95 masks can be used, doctors ideally say these should not be used more than two or three times at the most.

For this, doctors use a common hack, which was developed when there was a shortage of medical-grade masks. You buy five masks and wear one each day. The ones not in use can be kept in a paper bag. This way, five masks can be used for up to three weeks in rotation.

But for those using these masks regularly in crowded places, such as offices or shopping malls, doctors recommend reusing N95s only if they can be decontaminated, the report added.

“Ideally, an N95 can be reused up to three times after disinfecting effectively using either a hydrogen peroxide vapor spray, treating it with heat at 70 degrees Celsius, or by using UV light,” Dr Sharad Joshi, principal consultant of pulmonology at Max Super Speciality Hospital in Vaishali was quoted as saying. He does not recommend reusing these masks in hospital settings. Joshi added that a surgical mask can be worn over an N95 to prolong its use.

Dr Moni also suggests that UV chambers for disinfecting such masks could be a viable and sustainable solution for large workplaces to consider reopening. However, disposable N95s may not be an affordable solution for many people.

What about cotton masks?

“These are also more comfortable to wear than surgical or N95s, and can be effectively used for the elderly while they are in reverse quarantine,” Dr Moni was quoted as saying. (Reverse quarantine is a public health strategy used in Kerala where vulnerable populations like the elderly are kept away from the general population during an infectious outbreak).

  • Cloth masks can augment the efficacy of the surgical mask. While separately a surgical or a cotton mask may not be as protective, a cotton mask worn over a surgical mask can offer up to 80% protection against the virus. The cotton mask also helps make the surgical mask fit more snugly.
  • Being able to wash and reuse makes them both sustainable and resourceful in low-income settings. And while N95s are most effective in infection-friendly settings, it is equally prudent to have a large population wear face coverings correctly to halt the community spread.
  • This guidance is also useful in outdoor spaces and well-ventilated public transport, where a cotton mask could be a safety net against a mass cluster outbreak.

What to do when working out

An N95 mask may be challenging to use while running, cycling or strenuous workout. A triple-layered cotton mask may be enough for cycling or running outdoors, though.

For indoor gyms, Dr Moni said a visor has been found effective at stopping transmission in simulation studies. But this will still not be effective if it is a closed space and crowded.

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