advertisement

Infectious Diseases

Updated 11 June 2020

Masks and Covid-19: How, when and why – the latest guidelines

Still unclear on whether you should be wearing a mask? We unpack the latest guidelines from the WHO.

  • As Covid-19 progresses, more research means changes in guidelines
  • This applies to masks as well
  • The WHO adapts guidelines as we discover more about Covid-19


At the beginning of the Covid-19 outbreak, the use of a mask in public spaces was still frowned upon in countries where this has never been done before. Masks were mostly recommended for those who were already coughing and sneezing, and it was recommended that surgical masks be reserved for healthcare workers who regularly come into contact with infected people.

As the pandemic swept across the world, many nations adopted regulations that made the use of a fabric mask mandatory when outdoors. In South Africa, a mask should be worn at all times when venturing outdoors for work, shopping or exercise.

The case for masks – why did it change?

When Covid-19 first made headlines, scientists and healthcare professionals identified it as a mostly respiratory disease, which spreads through respiratory droplets when an infected person sneezes or coughs. It, therefore, seemed logical to suggest that a mask only be worn if you yourself were ill and sneezing or coughing – and as long as you stayed away from someone who was ill, a mask was unnecessary.

But as scientists unpacked more about Covid-19 over the last couple of months, there were more grey areas. It was suggested that infected people could spread viral particles long before they even showed symptoms, as the incubation period could be up to 14 days. Research even investigated the possibility of the virus being airborne, especially in healthcare settings and indoor spaces with little ventilation, which made health authorities, including the WHO question their stance on masks.

Distinction between medical masks and non-medical masks

As panic began to spread, people who do not regularly work in medical settings started to stock up on surgical masks and respiratory N95 masks, causing a shortage of stock for medical workers.

The World Health Organization (WHO) now distinguishes between medical and non-medical masks as follows:

  • Medical masks should be certified according to national or international standards to ensure proper performance in a healthcare setting. They are designed for single use only.
  • Non-medical masks are not standardised and can be made from a variety of fabrics and in different shapes. These have not been fully evaluated and there is no set rule for a single type of fabric or layering technique.
  • WHO provides recommendations for fabrics and layering in their updated document on masks.

Why should a healthy person wear a mask?

An earlier review published by Health24 took the current evidence for mask usage into account, and while a mask alone is not enough to protect a person in a public space, current literature shows that it reduces infection risk.

As the WHO adapted its guidelines, it listed several advantages of using fabric masks in public:

  • They reduce the potential exposure risk from people who could already be sick but are not yet showing symptoms.
  • They remind people to implement other measures such as hand washing and not touching their faces.
  • Not only do they lower your risk, but they lower the risk of potentially infecting others (if you have Covid-19 and not know it yet).
  • The creation of fabric masks could create an additional source of income for those who manufacture and distribute masks in their communities.

When and where should we wear a mask?

The WHO states that masks should be worn in medical settings and in places where physical distancing can’t always be fully practised, such as supermarkets, enclosed spaces and even urban outdoor exercise areas.  

In South Africa, it is mandatory to wear a mask when running errands and going to work – your specific place of employment should guide you on this if you are not able to work from home.

When exercising outdoors, it is also mandatory to wear a mask, and here are tips on running with a mask if you are struggling to get used to it.

Managing a mask – best practices

The WHO also listed guidelines on correct mask usage to avoid accidental contamination and to implement best hygiene practices. Although their newly-updated guide lists a comprehensive update on masks in a medical setting, we will focus on guidelines for most of us outside a medical setting:

  • Always wash your hands before putting on your mask and after removing it. 
  • Don’t fiddle with the mask and touch your face while wearing it. Ensure a comfortable fit to avoid this.
  • Always untie the masks at the back or unhook the ear loops without touching the front of the mask near your mouth or nose.
  • Do not share masks among family members. Ensure that each person in the household has at least two masks.
  • Never reuse surgical masks. These are meant to be discarded after one use. Rather invest in a fabric mask, which is more sustainable.
  • Always wash fabric masks after use.
  • Don’t rely on the mask alone. You should still keep your distance and practise good hand hygiene when going out in public.

READ | Running with a mask: what you should know and choosing the right one

READ | Masks and your skin: what you should know

READ | Should face shields replace masks to ward off coronavirus?

Image credit: Retha Ferguson from Pexels