While health authorities in other countries are urging the public to swap their cloth face masks for medical-grade masks or to wear two at a time, Health Canada has not changed its recommendations on mask-wearing, but says it will adapt its guidance if further evidence emerges.
Several European countries, such as France and Germany, have recently called on their citizens to wear medical masks instead of reusable cloth ones, in light of the emergence of more contagious variants of the coronavirus. Meanwhile, U.S. President Joe Biden’s chief medical adviser Anthony Fauci told NBC’s Today that wearing two masks at once, or double-masking, is “likely more effective” for reducing the spread of COVID-19.
As Ontario students prepare to return for in-class learning, is it time to upgrade your – and your children’s – fabric masks? We asked experts to weigh-in.
Covered in this explainer • What are Canada’s official mask recommendations? • Are there enough medical masks to go around? • How do cloth masks compare with medical masks? • What are the qualities of a better mask?
What are Canada’s official mask recommendations?
In an e-mailed statement, Health Canada said it was aware of the recommendations in Germany and other European countries to use medical masks. It noted masks will be part of its discussions when considering additional measures to address emerging variants.
In the meantime, it said, “We continue to reinforce the importance of consistently wearing well-fitting masks (whether medical or non-medical) properly.”
According to the Public Health Agency of Canada (PHAC) website, that means wearing a mask when in public or when you might come in close contact with others, when indoors with people outside your household, and when advised by your local public-health authority. Non-medical masks can be purchased or homemade, but should be made of at least three layers, two of which are tightly woven fabric such as cotton or linen, and a third made of a filter-type fabric, such as non-woven polypropylene, it says. They should completely cover the mouth, nose and chin without gaping, and fit securely and comfortably.
PHAC says medical masks (including surgical masks) and respirators like the N95 must be kept for health care professionals and those providing direct care to COVID-19 patients. But it does also say people at higher risk of exposure or of severe COVID-19 should consider wearing a medical mask if one is available to them.
Are there enough medical masks to go around?
While domestic production of personal protective equipment, including medical masks and respirators, has increased dramatically since last March, it’s not nearly enough to supply medical masks for the entire adult population, said Catherine Clase, an associate professor of medicine at McMaster University and a member of the Centre of Excellence in Protective Equipment and Materials.
If every adult were to need medical-grade masks, that would require roughly 124 million masks per month – and that’s assuming each person needed only one mask each week, she said. Requiring the public to use them “could threaten supply to health care workers,” Dr. Clase said.
In some areas, health care workers are still needing to wear the same mask for long periods of time to stretch the supply, added James Scott, a professor of occupational and environmental health at University of Toronto’s Dalla Lana School of Public Health.
So in terms of making sure hospital and long-term care workers have enough personal protective equipment, “we’re still not completely out of the woods,” he said. And while it’s critical for front-line health care workers to have access to such equipment, the public needs it a lot less because the risk of being exposed to an infected individual is generally much lower than for those who work in hospitals or long-term care homes full of COVID-19 patients, he said.
How do cloth masks compare with medical masks?
Foremost, masks serve as source control, meaning they catch large liquid droplets expelled from the nose and mouth, which carry a high burden of virus, before they have a chance to dry up into tiny, light particles that can move through the air, Dr. Scott said.
“That doesn’t matter whether it’s a medical mask or whether it’s an inexpensive, readily available reusable cloth mask; they both are just about as effective in doing that,” he said.
What medical masks do additionally, he explained, is provide better protection for users from the air they inhale. This is necessary in hospitals or long-term care homes, for example, where patients may be shedding the virus but not able to wear masks for source control. In these settings, medical masks can help protect health care workers from breathing particles in.
Among the general public, however, as long as there is good compliance with people wearing any kind of face covering, Dr. Scott estimated: “We’re probably solving about 90 per cent of the problem just by doing that.”
What are the qualities of a better mask?
As PHAC recommends, Dr. Clase suggests using cloth masks with a middle layer of non-woven polypropylene. Industry-grade, non-woven, spun-bond polypropylene is washable and reusable, which makes it good for masks. It also doesn’t fray, so people can cut a piece to use as an added filter for masks that have a pocket.
Dr. Clase, who is part of a team behind the website Clothmasks.ca, which provides evidence-based guidance on fabric masks, said non-woven materials are desirable because the fibres are arranged randomly, “like spaghetti on a plate,” which means particles are much more likely to be intercepted.
It also helps if one of the multiple layers is cotton with a higher thread count since cotton fibres tend to swell a bit, making them better able to capture droplets and particles, Dr. Scott added.
When it comes to masks for children, Clothmasks.ca says to make sure they don’t have pieces like toggles or buttons that can come loose and pose a choking hazard. Children under age 2, or people who can’t remove their own masks, should not wear them.
What about wearing masks in the playground and during school lunches?
While PHAC recommends changing masks as soon as possible when one gets damp – which in cold winter weather can mean within minutes of stepping outside, Dr. Scott said it’s yet unknown how much moisture affects the ability of cloth masks to catch particles and droplets – but even a wet mask is better than none at all.
When it comes to lunch and snack breaks, when students have to remove their masks to eat, Vinita Dubey, Toronto’s associate medical of health, said in an e-mail statement this week that Toronto Public Health recommends students have “quiet, seated lunches,” and that they be spaced at least six feet apart.
“If there is not enough room to seat students six feet apart, consideration should be made to have a larger room to eat lunch while maintaining distance,” Dr. Dubey said, adding that students and staff are to unmask only while eating lunch and then immediately put their masks back on.
– With files from Caroline Alphonso
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