An interesting topic,I understood that surgical masks were used to protect the patient from the medic.

Hence are these now being recomended to stop ptential onfection spread from coughs & sneezes?

There is no science behind this. The idea that people might use scarfs as there are not enough surgical masks is even more laughable.  What sort of scarfs, what should they be made of how dense the weave how should they be disinfected and how often?

Finally how will we enforce this: will we go around arresting people who are not wearing masks or the wrong masks?

In the Far East wearing a face mask is just what people do anyway. Half the Chinese students at my local University seem to wear masks all of the time, even before the outbreak. Wearing them did not seem to slow the outbreak in China.

1) All the experts rolled in to the media to discuss masks always state "when correctly worn".

2) Members of this forum regularly debate facial hair with RPE - can you really see government edict demanding we are all clean shaven (still looking for responses to the Matter of Faith post about religious exemptions)?

3) How do you face fit the entire population when test  kit supplies are running low (see request for materials issued on behalf of NE hospitals)?

BTW - WHO are not directly discussing masks but evaluating laboratory based research that indicates droplets from coughs can travel 6m and from sneezes can travel 8m which exceeds current guidance.

Edited by user 03 April 2020 12:13:44(UTC)  | Reason: FFS

Having studied Microbiology some years ago, I've always believed that expecting a cloth mask, even an FFP3 type, to prevent viral infection would be akin to trying to catch a grain of sand with a fishing net.

A sample paper here: https://academic.oup.com/annweh/article/54/7/789/202744

I do, however, realise that some people seek assurance by using such masks, and that was my reasoning behind posting a response to a related debate.

I thought people in China, and elsewhere, routinely wore masks in towns because of the air pollution, not for protection against infections. I've seen them worn in this country in London for the same purpose. Presumably we are talking about different types of mask here.

It would certainly be true that they would be of limited use in the absence of a good face fit, which would exclude anyone with facial hair for whatever reason. You can make your own mask from suitable material, which I suppose would be better than nothing, and certainly better than that idiot Trump's scarf idea.

As has been commented on, if people exercised good hygiene practice when coughing or sneezing, I could see very little reason otherwise for wearing them unless in close contact with others, which of course they shouldn't be.

Just got stopped by the police when I was going for a prescription in town, first time this has happened, and I didn't mind at all. I would rather they were doing this than letting the idiots get away with selfish stupidity.

Those studies are not recent - back when the first repatriation flights to the UK were arriving from Wuhan the transmission distance was being questioned in light of the coach drivers not wearing PPE.

BBC news were reporting this MIT research under a fact or myth back in January 2018!

https://www.bbc.co.uk/news/health-42701590

The latest from GOV.UK on the wearing of masks:

'Use of face masks in the community There is very little evidence of widespread benefit from the use of face masks outside of the clinical or care settings, where they play a very important role. To be effective, face masks must be worn correctly, changed frequently, removed properly, disposed of safely and used in combination with good universal hygiene behaviour. Research shows that compliance with these recommended behaviours reduces over time when wearing face masks for prolonged periods, such as in the community. Therefore, PHE does not advise masks in public places and for those working in supermarkets, waste collection, schools and similar settings. PHE recommends that employers should ensure that:

• spaces in the workplace are optimised to allow social distancing to occur, wherever possible
• signs are visible in the workplace reminding employees not to attend work if they have a fever or cough and to avoid touching their eyes, nose and mouth with unwashed hands
• employees are provided with hand sanitiser for frequent use and regular breaks to allow them to wash their hands for 20 seconds

The UK does not currently advise use of face masks outside of care settings, in line with PPE guidance. PHE will continually review guidance in line with emerging evidence and WHO views, and update our guidance if new evidence suggests that we should do so.'

Perhaps one relevant point to consider. Face masks when the correct ones are worn correctly will only protect nose and mouth. As there is apparently evidence that COVID-19 can be introduced into the body through contact with the eyes should we not also be suggesting visors be worn in addition? Perhaps a motor cycle type crash helmet with the visor down anyone?

WHO guidance remains the same today - and is mirrored by guidance by national authorities.

In broad terms that says:

Presumption that "masks" are not needed by the public OR by those at work who shouldn't be in a situation where they are likely to be in close proximity to someone with symptoms of COVID-19, specifically fever and/or a new and persistent cough.

Avoid diverting disposable protective masks away from where they are most needed at the front line at a time when there are constraints on the global supply.

First line of defence remains social distancing - WHO states one metre or 3 feet. US has gone for 6 feet and the UK for 2m (but is mistranslating that as 6 feet rather than 6 feet 6 inches). This backed up by washing hands etc.

As regards Nathan's point, WHO and others looking at research which suggests that the viral aura emanating from someone coughing could spray out perhaps 2.4m (8 feet), thence considering whether recommended social distancing is sufficient.

However, at this point those in the know need to also consider what the epidemiologists call the dose-response relationship and it appears that insufficient information is yet available to assess how much the viral load impacts the risk.

In simple terms this is about thinking about how much COVID do you need to take in to be at significantly elevated risk. As it can multiply once in the body, only a few droplets could result in illness. But how much is the risk increased with a substantial increase in the original intake of the pathogen. 

So, when someone coughs the viral load is much higher close to the point of emission, ie within the one metre currently recommended as the minimum social distancing by WHO. At 2m that viral load is much reduced, so may well represent a much lower risk. I'm NOT a microbiologist so don't pretend to know the answer to how much the viral load impacts the overall risk! That's the conundrum but for now WHO is holding its ground.

CDC the Centers of Disease Control and Prevention has published new guidance suggesting that the use of cloth face coverings is recommended where social distancing is difficult to maintain e.g. in grocery stores and pharmacies.

However, where I live grocery stores and our local Boots seem to have got the social distancing reasonably well controlled. Thence the CDC advice would not apply.

There is the other problem. Anyone who isn't competent to don, use, remove and dispose of a disposable respirator (or cloth face covering) could be INCREASING the risk of exposure. This is why you see a medic coming out from the sharp end and a colleague in a clean area removing their respirator and disposing it (before then washing their hands). This reduces one important route of exposure for the person who has just exited the high risk zone.

Hi can I ask for advice on what to do if someone wants to wear their own masks at work? I am concerned about letting them because the UK Gov does not advise their use in the community, and use can be linked to relaxed social distancing due to a false sense of security. Also, some other people get panicked by masks.

You will need to expand upon what "work" is.

For example if it is a uniformed position then any "personal" addition could be contrary to contract, however if it is free wear then you need to consider any published dress code.

If someone wants to turn up at a customer facing role in a full "noddy" suit (nuclear, biological and chemical warfare) it is a bit extreme - bad enough the supermarket check out operators are moving behind perspex.

That said our local pharmacist and staff are wearing masks to service prescription dispensing (some staff members wearing their own masks) and I can fully appreciate such a course of action.

I seem to remember that if a mask gets wet (from breath or saliva) it no longer functions, I read on the W.H.O. website that cloth masks should not be used. 

Nobody has mentioned Autoclaves and reusing masks yet.  Will a mask survive the sterilisation process of using an Autoclave (130 degrees C for 15 minutes at negative pressure)?

Originally Posted by: Bigmac1

Did anyone else find it a little disturbing that almost every single person on the BBC News article from within intensive care on last nights news were not wearing their RPE corrctly?

Noone else bothered?

I aslo avoid the news for the very same reason.

Paul, I think you have answered your own question.

If your risk assessment doesn't demonstrate that the use of masks would be on balance beneficial and thence reasonably practicable, then you would be on a hiding to nothing attempting to enforce their use.

Now, depending on your circumstances then it might be possible to make that justification, but you would have to demonstrate other things such as the impracticality of maintaining sufficient social/physical distancing, access to handwashing etc.

Paul911 (and others) Covid-19 has NOT re-written the rules regarding the heirarchy of control which remains UNCHANGED = PPE is the last resort of any sensible employer resting just above discipline.

We are meant to try everything else in response to an assessment deploying PPE as a last desperate measure.

In the supermarket today I heard the checkout operator explain to the supervisor that she was on the till rather than the customer service desk as her colleague has "claustraphobia" issues behind the recently installed screens.

Agree with the last post that PPE should be the 'LAST RESORT' however,in the Domiciliary care service where social distancing is inaplicable .As care may provided one to one,consequently other controls mat may be impossible to apply.Hence what to use? Requires a /change at every visit?,Particularly as if we presume every home we enter is infected?.

1.  How long is Single Use and can a front line NHS worker wear a single use mask all day or does it need to be discarded/replaced after every visit to a different patient?

2.  As the responsibility to issue PPE belongs to the Employer why is the Government being criticised for the shortage.

It now appears Sadiq Khan is a mask expert quoting US CDC guidance as a reason to request everyone in London be required to wear a face covering in public.

Pity he didn't read the detail showing the relative ineffectivness of scarves and bandanas.

This is all biosafety theatre again: the powers that be feel helpless and so they indulge in things like suggesting face masks for all without really thinking what that means: what sort of mask, when do you change it, how do you wear it and who can decide if the face mask you are wearing is appropriate.

The Chinese seem obsessed with the things : see this piece from earlier on in outbreak https://www.independent.co.uk/news/world/asia/coronavirus-china-doctors-zhongshan-hospital-nose-mask-health-workers-a9377856.html before they realised that it was coughing not sneezing that spread the virus.

If the accepted science on masks were to change...and there is some good thinking out there about reduction in viral particle transmission generally having an impact, generally if not specifically... then there are other considerations as to why PHE and Gov advice might not change with it.

If you were advised to wear a mask, where will you get it from? Who will supply it? If everyone were suddenly to start buying them (even if not surgical masks etc. which might reduce supply to keyworkers) then this could be an effective health tax for those whom even a few extra pounds is not available. So, like Asia, supply would surely need to be managed centrally (and potentially through employers within the workplace??). I'm not convinced the current Government has a great track record on getting masks to those that need them in a timely fashion.

I'm also getting a little pedantically frustrated at describing general face masks as PPE. Who does it protect again?

Im sure we agree, not all masks are equal?   The TV was suggesting CV19 is small, about 10 thou of a mm, and for most masks, it will simply pass straight through.  AFAIR, the relevant hazardous particles during welding are about that size, and we know what the air fed filters look like for that.   Apart from medical standard masks, I really can't see the benefits medical masks to prevent inhaling the virus, although they may help prevent the sneeze spreading - lets just make sure we know why they are being worn.... to protect the user or protect others or just a fashion item!