3 July 2020 – latest updates:
- Face coverings to become mandatory in shops in Scotland from 10 July. They are already mandatory on public transport.
- Face covering to become mandatory on public transport in Northern Ireland form 10 July.
- Wearing a face covering is already mandatory in hospitals and on public transport in England.
- Ride-sharing company Uber has made face coverings mandatory for both passengers and drivers across the UK.
- Separately, the World Health Organisation (WHO) has changed its global guidance on face masks, suggesting that in circumstances where social distancing is difficult – such as public transport, shops etc – basic medical masks (not respirator masks) should be worn by the over 60s, and homemade three-layer masks should be worn by the general public.
- Myths about face masks causing oxygen deficiency or carbon monoxide toxicity have been debunked by scientists
Scotland and Northern Ireland make face coverings mandatory in certain situations
From 10 July, face coverings will be mandatory in shops in Scotland, and on public transport in Northern Ireland.
Scotland has already made face coverings mandatory on public transport. In both countries, face coverings are now a condition of travel on buses, trains, ferries and planes.
Certain groups are exempt. In Scotland, this includes children under five, and in Northern Ireland for children under 13. In both countries, people who are unable to put on, wear, or remove a face mask due to a disability do not have to wear a facec covering, nor do transport staff who are behind a protective screen.
In England, face coverings are mandatory on public transport and in hospitals.
Face covering buying and making guide – we explain where you can buy reusable cloth masks, what type to look for, and how to make your own
What’s the current UK advice about face masks and coverings?
- England – as of 15 June 2020 it is be compulsory to wear a face covering on public transport and when visiting hospital or attending as an out-patient. Children under 11, some disabled people and those with breathing difficulties are exempt. Find out more about exemptions to face masks rules on the government website.
- Face coverings are also encouraged in England in certain situations where social distancing is more difficult, such as in small shops – but this isn’t mandatory.
- Scotland – as of 22 June 2020 face coverings are mandatory on public transport, as in England. From 10 July, face coverings are required by law in shops. Exemptions apply for children under five, for some transport workers including drivers separated by a perspex screen, and for people for whom a disability prevents them for wearing a face mask.
- Northern Ireland – from 10 July, face coverings will be mandatory on public transport.
- Wales – has now changed its advice to recommend three-layer face coverings where social distancing is not possible, in line with WHO advice.
Across the UK, ride-sharing company Uber has made it mandatory for both passengers and drivers to wear masks while taking trips.
The UK 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 face masks and medical grade respirators should be left for healthcare and other frontline workers.
Previously, the government had published guidance saying that homemade cloth face coverings could help reduce the risk of transmission in some circumstances, and advising their use in certain situations where maintaining social distancing is more difficult, such as in small shops and on public transport.
It remains to be seen if the UK government will change or update its advice as a result of the chance in stance from the WHO.
Who should not wear a mask?
There are some exemptions to who should wear a face mask, including young children and people with breathing difficulties.
In situations where face masks are mandatory, legitimate reasons not to wear a face mask include:
- if you are not able to put on, wear or remove a face covering because of a physical or mental illness or impairment, or disability, or for whom it would cause severe distress or difficulty
- if you are are travelling with or providing assistance to someone who relies on lip reading to communicate
- if you need to remove the face covering to eat, drink, or take medication
- if a police officer or other official asks you to remove the mask
- if you need to remove a mask or not wear one in an emergency situation to avoid harm or injury
Children under a certain age are also exempt. In Northern Ireland, children under 13 are exempt and school transport is exempt; in England, it’s children under 10 and in Scotland it’s children under five.
Transport workers who are behind a protective screen are specifically exempt in Northern Ireland and Scotland. In England, the mandatory rule on public transport does not apply to staff, though many may choose to wear a face covering where social distancing isn’t possible.
There is a risk that the introduction of mandatory mask rules without equality of access to masks (either to buy or make) could deepen health inequalities related to coronavirus, disproportionately affecting those who must use public transport or visit the hospital.
Research from Disability Rights UK found that 40% of disabled people fear being challenged for not wearing a face covering on public transport, which raises questions around how social stigma surrounding those who are unable to wear masks might be addressed.
More widespread use of masks has also caused concern for those who rely on lip reading to communicate, and there are ongoing campaigns to introduce see-through masks to ameliorate this.
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?
There has been a great deal of debate around face masks.
The World Health Organisation (WHO) originally said that healthy people only needed to wear a mask if they were taking care of a person with COVID-19, and cautioned about the risks of mask-wearing instilling a false sense of security in the wearer and leading to them becoming lax about crucial measures such as social distancing and handwashing.
It also said 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 has now updated its advice on face masks, saying that governments should encourage the general public to wear masks in situations where social distancing isn’t possible, such as on public transport and in shops.
It advises a home-made three-layer mask for most people, and that the over-60’s consider wearing ‘medical’ masks in areas with high rates of community transmission.
The new advice remains cautious, however, advising local policy makers to take into account contextual factors like the risk of infection, vulnerability of the population, availability of masks, and resources required when recommending face masks or making them mandatory.
It also clarifies that ‘medical’ masks means the basic surgical-type disposable ones, not higher-grade respirators such as N95 masks.
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 higher-grade medical respirator masks should be reserved for frontline 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
Myths about masks debunked
Some claims doing the rounds on social media about face masks limiting your intake of oxygen or raising your CO2 to dangerous levels have been debunked by scientists.
While it is important to make sure you can breathe properly while wearing a face covering, when worn correctly they do not cause CO2 intoxication nor oxygen deficiency.’
As for inhaling more CO2, carbon dioxide particles are much too small to be trapped by any mask that is breathable, so you won’t be breathing in the same air you breathe out into the mask.
On both points, medics have highlighted the fact that surgeons and healthcare workers wear much heavier-duty PPE for longer periods of time and do not experience the above issues as a result of wearing a mask.
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 medical / surgical masks aren’t considered to provide protection against coronavirus, as there are gaps where airborne particles can still get in.
- Higher-grade medical respirator 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.
The problem with 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. At around 60p per mask, the cost of using several per day could really add up. They are also non-recyclable.
You should also be wary of high-grade or surgical masks for sale on online marketplaces, 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. The Welsh government has published guidance on how to make a three layer face mask.
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.
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