Update for 11 May 2020: As part of its roadmap to lift lockdown restrictions, the UK government has advised that people should aim to wear a face covering in enclosed spaces, where social distancing is not always possible, such as on public transport or in some shops.
One of the biggest debates around the coronavirus pandemic has been whether everyone should be wearing a face mask to help stop the spread of the disease.
Some countries have made mask-wearing mandatory, or encouraged their use by the public. In Scotland, Nicola Sturgeon had already advised people to consider using a homemade face covering in similar situations.
Now, the UK government has published guidance saying that homemade cloth face coverings can help reduce the risk of transmission in some circumstances, and advising their use in certain situations where maintaining social distancing is more difficult. This is not mandatory though.
Find out more about key issues surrounding face masks, and what you need to know before buying one or making your own.
Face mask buying and making guide – we explain where you can buy masks, what type to look for, and how to make your own
What’s the current UK advice about face masks?
The UK government has advised that, as some people start returning to work in this new phase of lockdown (those who can’t work from home, such as construction workers), people should aim to wear a face-covering in enclosed spaces where social distancing is not always possible, such as on public transport or in smaller shops.
The government has said that wearing a face covering is not intended to help the wearer, but ‘to protect against inadvertent transmission of the disease to others if you have it asymptomatically.’ People with symptoms and members of their household should continue to self-isolate.
It has stressed that surgical masks and medical grade respirators should be left for healthcare and other frontline workers.
The advice is similar for England, Scotland, and Northern Ireland, but differs in Wales where face coverings are not recommended.
Who should not wear a mask?
The government says face-coverings should not be used by children under the age of two, or those who may find it difficult to manage them correctly – for example primary age children, or those with respiratory conditions.
Find out more about how to protect yourself and others from coronavirus
What are the rules on face masks in other countries?
Elsewhere, many countries have encouraged or made mandatory the wearing of face masks by the public.
Some, such as Austria, Slovenia, Bulgaria, Poland, Singapore, and Turkey – have made wearing face masks mandatory in public.
In the US, China, Japan, France, India, Canada, Germany and Brazil, wearing homemade masks in public or in certain situations, such as on public transport, is encouraged but not enforced.
What do the health organisations say?
The World Health Organisation (WHO) currently says that healthy people only need to wear a mask if they are taking care of a person with COVID-19. It says there is currently not enough evidence for or against the use of masks (medical or other) for healthy individuals in the wider community.
It also says those who are coughing and sneezing should wear a mask (though if you are sick you should be isolating at home).
The WHO says countries advising the use of face masks by the public should take a risk-based approach and consider the risks of mask use, including instilling a false sense of security in the wearer, leading to them to becoming more lax about things such as hand hygiene and social distancing.
It also says that ‘non-medical or cloth masks could increase potential for COVID-19 to infect a person if the mask is contaminated by dirty hands and touched often, or kept on other parts of the face or head and then placed back over the mouth and nose.’
But it concedes that there may be some advantages in situations where social distancing is more difficult to achieve – for example on public transport – and in helping curb aysmptomatic spread of the disease by people who don’t know they have it.
The European Centre for Disease Control (ECDC) suggests that homemade masks may be useful to help prevent the spread of coronavirus by asymptomatic people in confined spaces, but acknowledges the evidence for this is currently weak.
All are clear that medical or surgical face masks should be reserved for health workers, where they are needed most.
Face masks: what’s the evidence for them?
A big part of the debate around the efficacy of face masks for general public use stems from what we still don’t really know about this new coronavirus: how far it can travel in the air and how likely it is you would catch the disease from airborne particles alone.
There is also a limited amount of randomised control data available on whether the widespread use of masks prevents the spread of diseases such as the coronavirus.
A meta-analysis of nearly 1,000 studies around influenza transmission by Professor Ben Cowling, Head of Epidemiology and Biostatistics at Hong Kong University, found that the use of face masks, in combination with hand hygiene, was more effective against laboratory-confirmed influenza than hand hygiene alone.
Dr Christopher Hui, Clinical Assistant Professor at Hong Kong University and Honorary Consultant in Respiratory and Critical Care Medicine at the Royal Free Hospital London, says: ‘We believe that face masks help prevent droplet and aerosol spread primarily by capturing the droplets as they exit our airways at velocity when coughing, sneezing or talking at volume.’
This is important because even these small droplets can carry a significant viral load that has been demonstrated to survive for periods of hours or even days.
The change in UK government advice has come after ‘careful consideration of the latest scientific evidence from the Scientific Advisory Group for Emergencies (SAGE).’
Previously, Deputy Chief Medical Officer Jenny Harries said the fact that the issue has been debated at length by the UK government’s scientific advisors suggests that the evidence isn’t quite so clear, whereas the evidence for measures such as hand hygiene and social distancing is more solid.
Hand washing and social distancing remain the most important actions to take to protect yourself and others from coronavirus.
Find out more about hand hygiene, soap and sanitiser gel
Does wearing a face mask protect you from catching coronavirus?
There has been confusion about who a face mask is intended to protect: the wearer, or those around them.
There are two basic types of mask:
- Standard surgical masks aren’t considered to provide protection against coronavirus, as there are gaps where airborne particles can still get in.
- Higher-grade medical masks (such as the N95 or FFP2 or FFP3 types) provide a higher level of protection, but they aren’t appropriate for use by the general public as they require specialist fitting to be effective, and are only considered necessary for health workers in high-risk frontline settings such as treating coronavirus patients in hospital.
Those in favour of face masks argue that wearing a face covering similar to a surgical mask is about protecting others and preventing the spread of the disease, rather than protecting yourself.
Some doctors believe that this is particularly important to prevent asymptomatic people – who may be unaware that they have COVID-19 – from spreading the virus. This is echoed in the UK government guidance.
Dr Hui says that ‘much of the effectiveness with wearing a face mask is to stop the outward spread of droplets from the airways. This protects others from a sneeze or cough when we are out in the community’.
This is particularly important in places where it’s difficult to maintain social distancing, such as on public transport.
In this way, face masks are hoped to serve as an additional measure to try and limit the spread of COVID-19, in the same way that supermarkets and pharmacies have introduced measures such as social distancing and limiting the number of people in a shop at one time.
Why you shouldn’t buy disposable face masks
One of the big concerns around advocating the use of face masks is that it could significantly worsen shortages of protective equipment for NHS and other frontline workers, whose need is far greater.
Health Secretary Matt Hancock has already said that it would be nearly impossible for the government to supply face masks, and the medical-grade masks that do exist should be kept for health workers on the frontline.
Surgical masks are single-use products that should be replaced as soon as they are damp or after one use – another reason why they are unlikely to be a practical solution for sustained daily use. They are also non-recyclable.
You should also be wary of high-grade or surgical masks for sale online, as they are likely to be sold at inflated prices, and could even be fake.
Dust masks and anti-pollution masks
Dust masks for DIY and building work, and commuter-style anti-pollution masks, are another option some people have turned to, but they may not be suitable if they feature an exhalation valve.
This is because the valve, which is designed to make it easier to breathe, lets you exhale unfiltered air out, so this type of mask isn’t suitable for protecting others in the community.
How to make a face mask and use it safely
If you do decide to use a face covering, it’s vitally important to follow the guidance on how to do this properly, otherwise you could end up increasing your risk of infection.
The WHO has helpful instructions on how to use a face mask properly, these include:
- Wash your hands before putting on the mask
- Make sure the mask covers your mouth and nose, and fits snugly without gaps
- Avoid touching the mask while using it
- To remove the mask, remove it from behind (don’t touch the front), dispose of it immediately (if it’s a single use mask) and wash your hands afterwards
Homemade cloth masks can be reused, but should be washed thoroughly after every use in a soap solution.
How to make your own face covering
There are numerous tutorials online for making your own face mask.
If you have the materials and wish to sew one, there are patterns to follow – watch our video above for an example. If you don’t, it’s also possible to fashion a mask without having to sew anything.
The UK government has instructions for different ways to make a mask at home, including one that doesn’t require any sewing (see below for a similar pattern from the CDC):
Some people have recommended adding a fresh paper towel or coffee filter between the mask layers each time that you wear it, for added filtration.
Bear in mind the evidence for homemade masks is thin on the ground, and they are not recommended for use in clinical settings.
You shouldn’t consider them a protective measure for yourself – maintaining strict social distancing and other hygiene precautions are still your best personal protective measures against coronavirus.
For more advice on buying or making a face covering, see our full face mask guide.