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{{short description|Aspect of ongoing COVID-19 viral pandemic}}
{{short description|Aspect of ongoing COVID-19 viral pandemic}}
{{Use dmy dates|date=April 2020}}
{{Use dmy dates|date=April 2020}}
[[File:04.02_總統視察「中央流行疫情指揮中心」_49726568957_66543b616e_o.jpg|thumb|[[Taiwan]] President [[Tsai Ing-wen]] wearing a mask.]]
[[File:Face Mask 140068549.jpg|thumb|A person wearing a mask.]]
The wearing of face masks during the [[2019–20 coronavirus pandemic]] has received varying recommendations from different [[List of national public health agencies|public health agencies]] and [[governments]]. The topic has been a subject of debate, with public health agencies and governments disagreeing on a universal protocol for wearing face masks. Some groups recommend that all members of the public wear masks, while others recommend that only [[COVID-19]] patients and their caretakers should wear masks. Additionally, public health agencies of different countries and territories have changed their recommendations regarding face masks over time.<ref name="mask_not_mask"/> Face masks have been a subject of [[shortage]]s and also been made compulsory in some countries.
The wearing of face masks during the [[2019–20 coronavirus pandemic]] has received varying recommendations from different [[List of national public health agencies|public health agencies]] and [[governments]]. The topic has been a subject of debate, with public health agencies and governments disagreeing on a universal protocol for wearing face masks. Some groups recommend that all members of the public wear masks, while others recommend that only [[COVID-19]] patients and their caretakers should wear masks. Additionally, public health agencies of different countries and territories have changed their recommendations regarding face masks over time.<ref name="mask_not_mask"/> Face masks have been a subject of [[shortage]]s and also been made compulsory in some countries.


Revision as of 17:39, 17 April 2020

File:Face Mask 140068549.jpg
A person wearing a mask.

The wearing of face masks during the 2019–20 coronavirus pandemic has received varying recommendations from different public health agencies and governments. The topic has been a subject of debate, with public health agencies and governments disagreeing on a universal protocol for wearing face masks. Some groups recommend that all members of the public wear masks, while others recommend that only COVID-19 patients and their caretakers should wear masks. Additionally, public health agencies of different countries and territories have changed their recommendations regarding face masks over time.[1] Face masks have been a subject of shortages and also been made compulsory in some countries.

Types of face masks, from least to most protective, include cloth face masks, medical (non-surgical) masks,[2][3] surgical masks, and filtering facepiece respirators such as N95 masks and FFP masks. Face shields and medical goggles are another types of protective equipment often used together with face masks.

Types of masks

Homemade cloth face mask
A surgical mask
An N95 mask

A cloth face mask is a mask made of common textiles, usually cotton, worn over the mouth and nose. Unlike surgical masks and respirators, they are not subject to regulation, and there is currently little research or guidance on their effectiveness as a protective measure against infectious disease transmission or particulate air pollution.[citation needed] They were routinely used by healthcare workers starting from the late 19th century until the mid 20th century. In the 1960s they fell out of use in the developed world in favor of modern surgical masks, but their use has persisted in developing countries.[4][5][6]

A surgical mask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle droplets, splashes, sprays, or splatter that may contain viruses and bacteria, keeping it from reaching the wearer's mouth and nose. Surgical masks may also help reduce exposure of the wearer's saliva and respiratory secretions to others.[7] A surgical mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and the face. Surgical masks may be labeled as surgical, isolation, dental, or medical procedure masks.[7] Surgical masks are made of a nonwoven fabric created using a melt blowing process.[8][9]

An N95 mask is a particulate-filtering facepiece respirator that meets the N95 air filtration rating of the US National Institute for Occupational Safety and Health, meaning that it filters at least 95 percent of airborne particles, while not resistant to oil like the P95. It is the most common particulate-filtering facepiece respirator.[10] It is an example of a mechanical filter respirator, which provides protection against particulates, but not gases or vapors.[11] Like surgical masks, the N95 mask is made of melt-blown nonwoven polypropylene fabric.[12][13] The corresponding face mask used in the European Union is the FFP2 respirator.[14][15]

Recommendations

Health organizations have recommended that people cover their mouth and nose with a bent elbow or a tissue when coughing or sneezing, and dispose of any tissue immediately.[16][17] Surgical masks are recommended for those who may be infected,[18][19][20] as wearing a mask can limit the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and coughing.[21] The World Health Organization (WHO) has issued instructions on when and how to use masks.[22]

Masks have also been recommended for use by those who are taking care of someone who may have the disease.[20] The WHO has recommended the wearing of masks by healthy people only if they are at high risk, such as those who are caring for a person with COVID-19, although they also acknowledge that wearing masks may help people avoid touching their face.[20] Several countries have started to encourage the use of face masks by members of the public.[23]

World Health Organization

World Health Organization advice to the public in the context of COVID-19 endorsed the use of masks only under the following conditions:[24]

  • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
  • Wear a mask if you are coughing or sneezing.
  • Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand sanitizer or soap and water.
  • If you wear a mask, then you must know how to use it and dispose of it properly.

— World Health Organization

US Centers for Disease Control and Prevention

Guidance from the US Centers for Disease Control and Prevention on using and making cloth masks during the 2019–20 coronavirus pandemic[25]

The United States Centers for Disease Control and Prevention (CDC) recommended in April 2020 that the general public wear cloth face coverings in public settings where other social distancing measures are difficult to maintain such as, grocery stores and pharmacies, especially in areas of significant community-based transmission, due to the significance of asymptomatic and pre-symptomatic disease transmission.[26][27]

In March 2020, the CDC recommended that if neither respirators nor surgical masks are available, as a last resort, it may be necessary for healthcare workers to use masks that have never been evaluated or approved by NIOSH or homemade masks, though caution should be exercised when considering this option.[28]

In March and April 2020, the CDC faced backlash over their earlier statements advising that most healthy people did not need to wear a mask. The earlier recommendations had been made to try to conserve supplies for medical professionals, but damaged the agency's credibility.[29][30][31]

China and Asia

China has specifically recommended the use of disposable non-surgical medical masks by healthy members of the public,[2][32] particularly when coming into close contact (1 metre (3 ft) or less) with other people.[33] Hong Kong recommends wearing a surgical mask when taking public transport or staying in crowded places.[34][35] Thailand's health officials are encouraging people to make cloth face masks at home and wash them daily.[36]

Rationale for wearing masks

Queue to buy face masks in Hong Kong, January 30, 2020. Everyone in the line is already wearing a disposable medical mask.

Among the reasons cited by Chinese health officials for wearing masks even by healthy individuals are the following:[37]

  1. Asymptomatic transmission. Many people can be infected without symptoms or only with mild symptoms.
  2. Impossibility of appropriate social distancing in many public places at all times.
  3. Cost-benefit mismatch. If only the infected individuals wear a mask, they would possibly have a negative incentive to do so. An infected individual might get nothing positive, but only bear the costs such as inconvenience, purchasing expenses and even prejudice.
  4. There is no shortage of masks supply in China, which has been producing 100 million masks per day since early March.

Leading microbiologist Yuen Kwok-yung from the University of Hong Kong cites a large viral load in sputum and saliva of an infected person and asymptomatic cases as the reasons why even healthy individuals should wear a mask.[38][39]

According to Stephen Griffin, a virologist at the University of Leeds, "Wearing a mask can reduce the propensity [of] people to touch their faces, which is a major source of infection without proper hand hygiene."[40]

Shortages of face masks

See also: Shortages related to the 2019–20 coronavirus pandemic

Early epidemic in China

People in Wuhan lining up in front of a drug store to buy surgical masks
A notice at a supermarket in Beijing, which says each person can only buy one pack of surgical masks and one bottle of 84 disinfectant liquid a day

As the epidemic accelerated, the mainland market saw a shortage of face masks due to increased public demand.[41] In Shanghai, customers had to queue for nearly an hour to buy a pack of face masks; stocks were sold out in another in half an hour.[42] Hoarding and price gouging drove up prices, so the market regulator said it would crack down on such acts.[43][44] In January 2020, price controls were imposed on all face masks on Taobao and Tmall.[45] Other Chinese e-commerce platforms – JD.com,[46] Suning.com,[47] Pinduoduo[48] – did likewise; third-party vendors would be subject to price caps, with violators subject to sanctions.

By March, China quadrupled its production capacity and has been producing 100 million masks per day.[37]

National stocks and shortages

In 2006, 156 million masks were added to the US Strategic National Stockpile in anticipation of a flu pandemic.[49] After they were used against the 2009 flu pandemic, neither the Obama administration nor the Trump administration renewed the stocks.[49] By 1 April, the US's Strategic National Stockpile was nearly emptied.[50][clarification needed]

In France, 2009 H1N1-related spending rose to €382 million, mainly on supplies and vaccines, which was later criticised.[51][52] It was decided in 2011 to not replete its stocks and rely more on supply from China and just-in-time logistics.[51] In 2010, its stock included 1 billion surgical masks and 600 million FFP2 masks; in early 2020 it was 150 millions and zero, respectively.[51] While stocks were progressively reduced, a 2013 rationale stated the aim to reduce costs of acquisition and storage, now distributing this effort to all private enterprises as an optional best practice to ensure their workers' protection.[51] This was especially relevant to FFP2 masks, more costly to acquire and store.[51][53] As the 2020 coronavirus pandemic in France took an increasing toll on medical supplies, masks and PPE supplies ran low and caused national outrage. France needs 40 millions masks per week, according to French president Emmanuel Macron.[54] France instructed its few remaining mask-producing factories to work 24/7 shifts, and to ramp up national production to 40 millions masks per month.[54] French lawmakers have opened an inquiry on the past management of these strategic stocks.[55] The mask shortage has been called a "scandal d'État" (State scandal).[56]

In late-March/early-April 2020, as Western countries were in turn dependent on China for supplies of masks and other equipment, China was seen as making soft-power play to influence world opinion.[57][3] However, a batch of masks purchased by Netherlands was reportedly rejected as being sub-standard. The Dutch health ministry issued a recall of 600,000 face masks from a Chinese supplier on 21 March which did not fit properly and whose filters did not work as intended despite them having a quality certificate.[57][3] The Chinese Ministry of Foreign Affairs responded that the customer should "double-check the instructions to make sure that you ordered, paid for and distributed the right ones. Do not use non-surgical masks for surgical purposes".[3]

N95 and FFP masks

A woman in Ukraine wearing an FFP mask after masking in public places was made mandatory.

N95 and FFP masks were in short supply and high demand during the 2019–20 coronavirus pandemic.[58][51] Production of N95 masks was limited due to constraints on the supply of nonwoven polypropylene fabric (which is used as the primary filter) as well as the cessation of exports from China.[12][59] China controls 50 percent of global production of masks, and facing its own coronavirus epidemic, dedicated all its production for domestic use, only allowing exports through government-allocated humanitarian assistance.[12]

In March 2020, President Donald Trump applied the Defense Production Act against the American company 3M which allows the Federal Emergency Management Agency to obtain N95 respirators from 3M.[60][61] White House trade adviser Peter Navarro stated that there were concerns that 3M products were not making their way to the US.[60] 3M replied that it has not changed the prices it charges and is unable to control the prices its dealers or retailers charge.[60]

In early April 2020, Berlin politician Andreas Geisel alleged that a shipment of 200,000 N95 masks that it had ordered from American producer 3M's China facility were intercepted in Bangkok and diverted to the United States. Berlin police president Barbara Slowik stated that she believed "this is related to the US government's export ban."[62] 3M said they had no knowledge of the shipment, stating "We know nothing of an order from the Berlin police for 3M masks that come from China" and the U.S. government denied that any confiscation had happened and that they use appropriate channels for all its purchases.[63][64] Berlin police later confirmed that the shipment was not seized by U.S. authorities, but was said to have simply been bought at a better price, widely believed to be from a German dealer or China. This revelation outraged the Berlin opposition, whose CDU parliamentary group leader Burkard Dregger accused Geisel of "deliberately misleading Berliners" in order "to cover up its own inability to obtain protective equipment". FDP interior expert Marcel Luthe said "Big names in international politics like Berlin's senator Geisel are blaming others and telling US piracy to serve anti-American clichés."[65] Politico Europe reported that "the Berliners are taking a page straight out of the Trump playbook and not letting facts get in the way of a good story."[66] The Guardian also reported that "There is no solid proof Trump [nor any other American official] approved the [German] heist".[67]

Jared Moskowitz, head of the Florida Division of Emergency Management, accused 3M of selling N95 masks directly to foreign countries for cash instead of the US. Moskowitz stated that 3M agreed to authorized distributors and brokers to represent they were selling the masks to Florida, but instead his team for the last several weeks "get to warehouses that are completely empty." He then said the 3M authorized US distributors later told him the masks Florida contracted for never showed up because the company instead prioritized orders that came in later, for higher prices, from foreign countries (including Germany, Russia, and France). As a result, Moskowitz highlighted the issue on Twitter, saying he decided to “troll” 3M.[68][69][70] Forbes reported that "roughly 280 million masks from warehouses around the US had been purchased by foreign buyers [on March 30, 2020] and were earmarked to leave the country, according to the broker — and that was in one day", causing massive critical shortages of masks in the US.[71][72]

As more and more countries restricted the export of N95 masks, Novo Textiles in British Columbia had plans to become the number-one manufacturer in Canada.[73] AMD Medicom in Quebec also plans to become the second Canadian manufacturer of N95 masks, with a contract to supply the Government of Canada.[74]

Mask use and policies by country and territory

See also: 2019–20 coronavirus pandemic by country and territory and National responses to the 2019–20 coronavirus pandemic
The government of Taiwan instituted a mask rationing system. With population of 23.8 million, Taiwan has been producing more than 10 million masks per day since March.
  • Austria Austria: Everyone entering a supermarket, a grocery store or a drug store must wear a face mask.[75][76]
  • Bosnia and Herzegovina Bosnia and Herzegovina: Wearing a face mask is compulsory.[77]
  • China China: Healthy individuals are advised to wear disposable medical masks in public places.[2][33] Some local governments require wearing masks when going outside.
  • Czech Republic Czech Republic: Forbidden to go out in public without wearing a mask or covering one's nose and mouth.[78]
  • France France: On March 3, the government issued a degree announcing requisition of stocks of FFP2 and anti-splash masks until May 31, 2020.[79]
  • Germany Germany: On March 31, Jena was the first bigger German city to introduce an obligation to wear masks, or makeshift masks including scarves, in supermarkets, public transport, and buildings with public traffic.[80] On April 2, the Robert Koch Institute, the federal epidemic authority, changed its previous recommendation that only people with symptoms should wear masks to also include people without symptoms.[81]
  • Hong Kong Hong Kong: Members of the public are recommended to wear a surgical mask when taking public transport or staying in crowded places.[34]
  • Indonesia Indonesia: Citizens were ordered to wear face masks when they leave the house.[82]
  • Israel Israel: All residents are asked to wear face masks when in public.[83]
  • Japan Japan: Masks have been widely used by healthy individuals despite absence of official advice to do so.[84] On March 1, prime minister Shinzo Abe enacted a policy in Hokkaido instructing manufactures to sell facial masks directly to the government, which would then deliver it to residents.[85]
  • Malaysia Malaysia: Masks have been widely used by healthy individuals despite absence of official advice to do so.[86] On March 17, Malaysia banned exports of medical and surgical masks to meet local demand.[87] In April, the government was set to distribute 24.62 million masks, four for each household, while advising people to only use them if they have symptoms.[82]
  • Morocco Morocco: Wearing a face mask is compulsory.[88]
  • Panama Panama: Panama has made it obligatory to wear a face mask whenever going outside, while also recommending the manufacture of a homemade cloth face mask for those who cannot purchase face masks.[89]
  • Singapore Singapore: Masks have been widely used by healthy individuals despite absence of official advice to do so.[90]
  • Slovakia Slovakia: Forbidden to go out in public without wearing a mask or covering one's nose and mouth.[78][77]
  • South Korea South Korea: Masks have been widely used by healthy individuals despite absence of official advice to do so.[91] The government implemented a policy of centralized procurement and rationing of face masks, purchasing 80% of national production since early March.[92]
  • Taiwan Taiwan: On January 21, the government announced a temporary ban on the export of face masks.[93] On 6 February, the government instituted a mask rationing system.[94] Taiwan has been producing ten million masks per day since mid-March.[95] On April 1, passengers on trains and intercity buses were required to wear face masks,[96] unmasked riders facing a fine.[97]
  • Vietnam Vietnam: On March 16, Vietnam requested everyone to wear a face mask when going to public areas in order to protect themselves and others.[98]
  • Ukraine Ukraine: Since April 6, wearing a face mask is required by the government in public places. In Kyiv, public places were clarified to include parks and streets.[99]
  • United States United States: On April 6, the CDC recommended the wearing of non-medical cloth face coverings when in public places.[100][101]

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