As the COVID-19 coronavirus outbreak continues to worsen, for weeks the official line from the Australian government and the World Health Organization (WHO) has been that healthy members of the public don't need to wear face masks.
Some experts agree that essential personal protective equipment (PPE) such as surgical masks and N95 respirators should be reserved primarily for healthcare workers.
But recently there's been a growing debate about the benefits of encouraging everyone to wear face masks, whether they're bought or homemade. Even the US government recently changed its stance and now recommends wearing cloth masks in public.
So should you wear a face mask or not? Here's what you need to know.
According to the Department of Health, you should wear a face mask if:
- you have or suspect you may have COVID-19
- you're caring for someone who has or may have COVID-19
- you work in a 'high-risk' occupation such as health care.
The department's surgical mask fact sheet adds, "There is little evidence supporting the widespread use of surgical masks in healthy people to prevent transmission in public."
For the rest of us, whether or not to wear a mask is a harder question to answer and even health experts are divided.
Some experts argue that one of the main reasons public health bodies and governments aren't recommending that the general public wear face masks is to stop panic buying. Surgical masks and N95 respirators are essential for health workers to protect themselves and are currently in short supply across the globe.
There aren't enough masks to go aroundPhysician Dr Norman Swan
On the ABC's Coronacast podcast, physician Dr Norman Swan says the decision to wear a face mask must balance benefit with supply.
"If everybody were to wear an effective mask in public, we would reduce the rate of spread of asymptomatic disease... [but] there aren't enough masks to go around at the moment," he says.
"Even emergency doctors are being told to go easy on the masks, and therefore it's really hard to justify using masks for the general public because we would not be protecting the people who need to be protected.
"It would be a 'nice to have' but we can't afford it at the moment."
The official line from the Department of Health is that healthy members of the public don't need to wear face masks.
Even experts don't agree
Some say there's simply little benefit in the average person wearing a mask.
Sydney-based epidemiologist Gideon Meyerowitz Katz says that while there's some evidence wearing a mask may help reduce the spread of droplets if you cough or sneeze, this may not be the primary way diseases make their way around the community.
In a post on medium.com he says, "What's likely much more common – and, by most indications, the main way that COVID-19 is spread – is someone coughing into their hand and then touching surfaces, or coughing directly onto those surfaces, where the virus can live for a long time.
"Someone else then touches the surface, doesn't wash their hands, and goes on to touch their face, which causes an infection."
By most indications, the main way that COVID-19 is spread is someone coughing onto surfaces... Someone else then touches the surface, and goes on to touch their faceEpidemiologist Gideon Meyerowitz Katz
But the fierce debate about the benefits of face masks rages on, particularly because of the incubation period of COVID-19 – people may be infected but aren't yet experiencing symptoms.
As Tom Frieden, a former director of the US Centers for Disease Control and Prevention (CDC) tells our US sister organisation Consumer Reports, "If you put a mask on someone who is ill, they are less likely to spread the virus to others."
"That includes people who don't have symptoms. We know people who don't have symptoms can spread the virus."
The CDC is now recommending that people wear cloth face coverings when out in public. (For more, see Growing number of countries make masks compulsory.)
If we all wear masks, people unknowingly infected with the coronavirus would be less likely to spread itResearch scientist Jeremy Howard
Research scientist Jeremy Howard is also calling for everyone to wear face masks to suppress the spread of the virus (also known as 'flattening the curve'). In an op-ed for The Washington Post, he says, "Many authorities still advise only people with symptoms to wear masks. But this doesn't help with a disease like COVID-19, since a person who does not yet show symptoms can still be contagious."
"Basic masks can be effective in reducing virus transmission in public… If we all wear masks, people unknowingly infected with the coronavirus would be less likely to spread it."
Wearing a face mask can also work as a physical barrier to limit hand-to-face contact and may even work as a behavioural 'nudge', reminding you and others around you of the dangers of the virus, which in turn could help social distancing.
Can wearing a face mask increase the risk of COVID-19?
It's possible that masks can leave wearers at a higher risk of infection. The coronavirus pathogen can live on the surface of masks, as it can on any other surface, and most people who aren't used to wearing a face mask are likely to touch or adjust it, then touch their face without washing their hands.
If you do choose to wear a mask, consider this advice from WHO: "Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water … if you wear a mask, then you must know how to use it and dispose of it properly".
Most people are likely to touch or adjust their face mask, then touch their face without washing their hands.
Authorities in China and South Korea have encouraged the use of face masks among the general public, and some European countries have followed suit. Austria, Slovakia, the Czech Republic and Bosnia-Herzegovina have made it compulsory to wear face masks when outside the home.
In the US, the CDC recently changed its advice, and while not mandatory, it now recommends "wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g. grocery stores and pharmacies) especially in areas of significant community-based transmission."
Importantly, the CDC is recommending only homemade cloth masks – not the surgical masks or N95 respirators so vital to health workers.
The CDC also stresses that masks should be used in addition to all the other measures currently recommended for COVID-19 prevention. (See Practise good hygiene for more.)
The situation in Australia
Meanwhile, Australia's deputy chief medical officer Paul Kelly says that authorities are "actively looking" into whether to advise the general public to wear face masks while outdoors, but that so far they haven't changed their current recommendation.
A homemade cloth face mask.
There's no shortage of online tutorials for making your own face mask using supplies you might already have around the house – from handkerchiefs and old T-shirts to paper towels and even bras and men's briefs.
But it's not just bloggers, crafters and YouTubers who are offering 'how to' guides. In the US, Harvard Medical School Teaching Hospital and the Boston Children's Hospital recently shared a joint video about making a homemade reusable respirator mask in response to the current shortage (although it's not approved for use and should not be used as a replacement for conventional and approved PPE).
In France, standards institute Association Française de Normalisation (AFNOR) has also developed a detailed standard for a DIY protective mask, including instructions on how to make a 'duckbill' or flat-fold mask. It also instructs people how to put on and remove DIY masks, how to wash and dry them, and how to dispose of them safely.
AFNOR stresses that the DIY barrier mask "in no way exonerates the user from routine application of the protective measures, which are essential, and of the social distancing rules" and that "this device is not intended to be used by health workers in contact with patients".
The CDC has issued simple instructions for making your own cloth face mask (both sew and non-sew options).
Once made, you should ensure it:
- fits snugly but comfortably against the sides of the face
- is secured with ties or ear loops
- includes multiple layers of fabric
- allows for breathing without restriction
- can be laundered and machine dried without damage or changes to its shape (cloth masks should be routinely washed in a washing machine).
But before you go down the DIY route, remember that surgical masks and N95 respirators need to meet certain regulatory standards. There's no guarantee a homemade mask actually will protect you from the coronavirus.
"They are probably reasonably effective at stopping large droplets getting out, but nobody knows whether or not cloth masks actually make a difference to reducing community spread, and you wouldn't want to bet on it," says Dr Norman Swan.
Some evidence cotton is best non-surgical material
Studies in the UK and the Netherlands found that while DIY masks made from cotton clothing, pillowcases or tea towels didn't perform as well as surgical face masks and respirators, they did remove about 50–60% of 0.2 micron particles (which are similar in size to coronavirus particles).
But the studies also reached slightly different conclusions. The researchers in the Netherlands write, "Any type of general mask use is likely to decrease viral exposure and infection risk on a population level, in spite of imperfect fit and imperfect adherence." The UK study concludes that "a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection".
A fitted N95 respirator mask.
'Better than nothing'
It's difficult to get a DIY face mask to seal tightly around the face, but this doesn't necessarily mean it's ineffective.
In 2013, University of Cambridge researchers tested the fit of DIY masks by measuring the number of virus particles inside a DIY mask versus its outside while it's being worn. They found that, depending on the material, the DIY option blocked half the number of microorganisms expelled by volunteers. They concluded that while less effective than surgical masks (which were three times more effective), homemade masks are "better than nothing".
A 'last resort' for healthcare workers
As for the efficacy of cloth masks vs medical masks for healthcare workers, a 2015 Australian-led randomised clinical trial found that "moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection". (The trial didn't look at the results of non-mask wearers because the control group wore masks as they usually would in hospital.)
In light of the COVID-19 crisis, the authors updated their conclusion, saying that for healthcare workers "the physical barrier provided by a cloth mask may afford some protection" but that they should only be used as a "last resort".
While the debate around face masks will probably continue, one thing most experts do agree on is that face masks alone aren't enough to stop the spread of the COVID-19 coronavirus.
"Staying at home with the kids and keeping away from other people, that's the one thing that's really going to make a big difference," says Swan.
To protect both yourself and others, the Australian Department of Health says it's essential to:
- practise good hygiene such as washing your hands often with soap and water, using alcohol-based hand sanitisers, and avoiding touching your eyes, nose and mouth
- practise social distancing by staying at home. If you have to go out, make sure you you keep at least 2m away from others
- follow the limits for public gatherings
- understand how to self-isolate if you need to.
We're in this together
For over 60 years, we've been working to make Australia fairer and safer for all consumers.
Today, we're all tackling one of the biggest challenges we've ever faced, and we're stronger when we work together.
Throughout the coronavirus crisis, CHOICE experts will be here to help. We'll be working with you to stand up for consumer rights, highlighting bad business practice via our investigative journalism, and providing regular expert advice and resources.
As a nonprofit organisation, we depend on your support. If you can, please consider making a donation so we can do even more in future.