Is Social Distancing Enough to Keep COVID-19 from Spreading without Wearing a Mask?

Is social distancing enough to keep COVID-19 from spreading without wearing a mask?

“We would not have thought that at a distance of several meters it would take so little time for the infectious dose to be absorbed from the breath of a virus carrier” says Eberhard Bodenschatz, Director at the Max Planck Institute for Dynamics and Self-Organization.1

That was the shocking conclusion of a recent investigation made by a team from the Max Planck Institute in Germany on to what extent masks protect under which wearing conditions. Three meters is insufficient to guarantee safety from getting COVID-19. Even at that distance, an uninfected person standing in the breath of a Covid-19 carrier is infected almost 100% of the time in less than five minutes. However, the danger of infection is much reduced if both parties wear well-fitting medical or, better yet, FFP2 masks.2 But why is wearing masks so vital? Let’s take a quick look at the most challenging thing that is facing humanity.

An Interview with COVID-19: who are you?

This investigation, along with other studies and efforts, was done to shed light on a novel coronavirus known as COVID-19 developed in the Chinese city of Wuhan at the end of 2019 and triggered an outbreak of atypical viral pneumonia.2 In fact, COVID-19 has posed an extraordinary hazard to public health around the world.

Timeline of the key events of the COVID-19 outbreak. COVID-19, coronavirus disease 2019; ICTV, International Committee on Taxonomy of Viruses; PHEIC, public health emergency of international concern; SARS- CoV-2, severe acute respiratory syndrome coronavirus 2; WHO, World Health Organization.

COVID-19 has proved his ability to infect all ages of the population to the extent that clinical symptoms can differ with age. On infection, the most common symptoms are fever, fatigue, and dry cough. Below is a summary of COVID-19’s most relevant symptoms.2

Clinical features of COVID-19. ARDS, acute respiratory distress syndrome; ICU, intensive care unit.

Before the clinically approved vaccines being widely available, personal preventative behaviors such as social distance and wearing masks are the best ways to protect us against COVID-19.

What are the different types of masks and respirators?

According to the Centers for Disease Control and Prevention (CDC), Everyone 2 years or older, who is not fully vaccinated, should wear a mask in indoor public places.3

Masks are meant to keep droplets and particles from entering your lungs. They also offer some protection against the particles that are ejected. In this regard, there are different types of masks and respirators you can use to protect yourself and others from getting and spreading COVID-19. Generally, masks do not fit tightly while respirators do. Masks and respirators may be reusable or disposable.4

Respirators (also known as filtering facepiece respirators – FFP) are available at different performance levels such as FFP2, FFP3, N95, N99, N100. They are meant to protect health personnel caring for COVID-19 patients in hospitals and healthcare facilities.5

There are 2 types of masks; cloth masks and disposable masks. Cloth Masks can be constructed from several textiles and come in a range of styles. Disposable masks are widely available. They are sometimes referred to as surgical masks or medical procedure masks.6

Whatever the type you choose, you have to make sure that the mask is worn consistently and appropriately without gaps because it is important that most of the air you breathe in and out flows through the mask rather than around the mask through gaps at the sides, top or bottom. You can find more information regarding how to select a mask in the following link: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html

Initially, researchers and experts were unsure how important it would be for the general public to wear masks. Also, because masks were originally in short supply, it became logical that people can come up with ideas to create masks.

At first, neck gaiters and bandanas were used as masks. However, because neck gaiters are constructed of thin layers and bandanas are open at the bottom, they are not the most efficient way to protect yourself against COVID-19.7

Another type of masks was used at the start of the COVID pandemic, those with exhalation valves. Likewise, they provide a considerably low level of protection as they can allow your droplets to escape into the air. As a matter of fact, people who wear a mask with an exhalation valve can impose others in danger because they are still exposed to his/her aerosols and hence not protected.7

Other alternatives were also used such as face shields. They are designed to protect the eyes from biological fluid splashes (especially respiratory secretions), chemical agents, and debris. In the context of protection from SARS-CoV-2 transmission through respiratory droplets, face shields are used by health workers as personal protective equipment (PPE) for eye protection in combination with a medical mask or a respirator. Because of their limitations, for the public, they are considered to provide a level of eye protection only and should not be considered as an equivalent to masks with respect to respiratory droplet protection and/or source control.8

As COVID-19 continues to spread, scientists are developing new ways to resist it. A team at the University of California San Diego has created a method they called a color-changing sticker.9 At the start of 2021, the team made test strips, or stickers, that can be put on any mask (N95, surgical or cloth) to detect the presence of COVID-related molecules that come up from infected people. The user will use those masks and breathe through them with conducting the test bat the end of the day. The test strip comes with a blister pack that the user squeezes to release nanoparticles that change color when the COVID-19 molecules are present. A control line on the test strip will show what a positive result should look like. More information about this $1.3 million project can be found in the university news release from here https://ucsdnews.ucsd.edu/feature/making-masks-smarter-and-safer-against-covid-19?fbclid=IwAR09h3CdCmWeLvmCi0x9vOgKgWztytPno9wmwu8z5i1u3jyp1MnIoM61BNs

Another accessory was added to the mask is the spacer, which creates more room for breathing, reusable and easy to set it up. It can also offer a solution to one of the biggest issues for those who have to wear both masks and glasses by preventing the fogging issue. In addition to makeup protection in ladies by decreasing the friction with the mask.

Speaking of fogged-up eyewear, which results from the escape of your warm breath from the top of your mask and lands on the cooler surface of your lens because the unfitted mask. As annoying as it may be, don’t stop wearing your mask. Instead, American Academy of Ophthalmology (AAO) recommends using a medical or athletic tape to close the gap between the bridge of your nose and the top of your mask.10

Face masks are in trend

Although one can see these additional parts to the masks important in the fighting the COVID-19 pandemic – whether alone or in combination with other like shields, these parts can also be accessories to other people. Face masks have recently become on the forefront of fashion trends as a result of the Covid-19 pandemic. The popularity of this trend has developed at different rates among nations, for example, in Japan. Japanese people are using face masks as part of their culture and civic duty with not much concern over their impact on hindering communication between people, which is for the same reason, face masks are not highly acceptable in western countries.11

Indeed, the type of facemask used by a person can reveal how serious he or she is about the facemask issue. Professor Hermann Gruenwald, University of Oklahoma, supposes that consumer masks came in a number of forms and designs to fit the shape and size of the wearer’s face as well as their aesthetic preferences.12 In addition, celebrity selfies with face masks also became popular, and fashion brands such as Adidas and Chanel quickly entered the market. The face mask became the must-have fashion accessory of the corona crisis.

The truth is that masks are having their moment now. Sequined masks, masks created from recycled vintage textiles, and novelty masks with slogans like “will remove for wine” are all available for purchase online. On the other hand, Lydia Edwards, a fashion historian from Edith Cowan University, believes it’s not the first time for masks to be a fashion trend.

Dr. Edwards has mentioned many of the Western society’s more memorable masks like the vizard, which was worn by upper-class women in Europe to protect their faces during travel. Another example is the domino mask, which appeared in comic books, was worn by the elite to protect their skin against the elements, much like the vizard, and was often worn with a hood. Lastly, the Spanish Flu masks, which worn by people during the 1918 flu pandemic.13

COVID Masks adverse reactions

“Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?”, that was the question raised by Kisielinski and colleagues in their attempt to assess the risks of general mandatory mask use by focusing on the possible adverse medical effects of masks, especially in certain diagnostic, patient and user groups and summarized the undesirable side effects in categories.14

Firstly, a significant increase in the feeling of exhaustion, a feeling of heat, shortness of breath and headaches were classified as internistic side effects. Moreover, confusion, disorientation and even drowsiness and reduced motoric abilities with reduced reactivity and overall impaired performance as a result of mask use as neurological side effects.

Psychological side effects of mask use were headaches, local acne, mask-associated skin irritation, itching, sensations of heat and dampness, impairments and discomfort predominantly affecting the head and face. When wearing masks, confusion, impaired thinking, disorientation and in some cases a decrease in maximum speed and reaction time were observed as psychiatric side effects.

Regarding the dermatological concerns, 96.9% of 876 users of all mask types (community masks, surgical masks, N95 masks) confirmed adverse problems with a significant increase in itching (7.7%), accompanied by fogging-up of glasses (21.3%), flushing (21.3%), slurred speech (12.3%) and difficulty breathing (35.9%). inflammation of the gums, bad breath and inflammation of the lips, especially of the corners of the mouth, are attributed to the excessive and improper use of masks. Increased dry mouth caused by decreased saliva flow and increased ventilation through the open mouth under the mask is the primary cause of the oral disorders described.

Despite the aforementioned side effects, for the general public, mask wearing is very safe. Most mask related problems can usually be improved with prevention measures, such as moisturizers if you are prone to skin problems. Another crucial step is to make sure your mask fits comfortably and that the straps are not too tight. Changing your mask on a regular basis, while keeping your skin dry, may also benefit your skin.15

Introducing the COVID-19 fighting package

Handwashing, physical separation, actions to decrease indoor exposures, immediately identifying infected people and their contacts, implementing rapid and supportive isolation and quarantine services, and delivering COVID-19 vaccinations, where available, should all be part of a package of measures to stand against the spread of COVID-19.16

Although wearing masks is the simplest method among them, there is no single technique that will ensure universal mask use. Therefore, numerous government and public health agencies have promoted campaigns to embrace mask use, such as the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC), the Africa Centers for Disease Control (Africa CDC). Minnesota’s mask-wearing policy is a good example to explain how policymakers can issue an appropriate policy and make the public view its rules as evidence-based, not politically motivated. Alongside, developing a communication channel with those who experience multiple, overlapping barriers that hinder them from wearing masks.16

Another campaign was “Be The One” focused on the value of protecting one’s neighbors and community, motivated focus groups to take action—especially for Black and Latinx audiences. During Africa Mask Week, a multiorganizational outreach effort, leaders and communities across Africa rallied on social and traditional media to promote mask-wearing. The campaign reached 229 million people and resulted in an 18% increase social posting activity related to mask-wearing.16

The global population has been forced to adapt new ways of life as a result of the COVID-19 pandemic, including the wearing of masks as a new norm. As a result, wearing masks becomes critical for preventing airborne sickness that cannot be simply replaced.

References:

1. Bagheri G, Thiede B, Hejazi B, et al. An upper bound on one-to-one exposure to infectious human respiratory particles. Proceedings of the National Academy of Sciences. 2021;118(49):e2110117118.
2. Hu B, Guo H, Zhou P, Shi Z. Characteristics of SARS-CoV-2 and COVID-19. Nature Reviews Microbiology. 2020;19(3):141-154.
3. Coronavirus disease (COVID-19): Masks [Internet]. Who.int. 2021 [cited 30 December 2021]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19-masks
4. Chua M, Cheng W, Goh S, et al. Face Masks in the New COVID-19 Normal: Materials, Testing, and Perspectives. Research. 2020; 2020:1-40.
5. Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19) outbreak [Internet]. Who.int. 2020 [cited 30 December 2021]. Available from: https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak
6. COVID-19 and Your Health [Internet]. Centers for Disease Control and Prevention. 2021 [cited 30 December 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html
7. Coronavirus Face Masks & Protection FAQs [Internet]. Hopkinsmedicine.org. 2021 [cited 30 December 2021]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-face-masks-what-you-need-to-know
8. Coronavirus (COVID-19) face shields – a quick guide [Internet]. Australian Government- Department of Health. 2020 [cited 30 December 2021]. Available from: https://www.health.gov.au/sites/default/files/documents/2020/07/coronavirus-covid-19-face-shields-a-quick-guide.pdf
9. Making Masks Smarter and Safer Against COVID-19 [Internet]. Ucsdnews.ucsd.edu. 2021 [cited 30 December 2021]. Available from: https://ucsdnews.ucsd.edu/feature/making-masks-smarter-and-safer-against-covid-19?fbclid=IwAR09h3CdCmWeLvmCi0x9vOgKgWztytPno9wmwu8%E2%80%A6
10. How to Wear a Face Mask Without Fogging Your Glasses [Internet]. American Academy of Ophthalmology. 2021 [cited 30 December 2021]. Available from: https://www.aao.org/eye-health/tips-prevention/face-mask-foggy-glasses-coronavirus-covid
11. How is the mask trend behaving on social media around the world? [Internet]. Heuritech. 2020 [cited 30 December 2021]. Available from: https://www.heuritech.com/blog/articles/masks-trend-social-media/
12. Gruenwald, Hermann. (2020). Corona Face Mask Fashion. 10.13140/RG.2.2.27388.77446.
13. Why the plague doctor mask had such a long beak (and other facts about masks of the past) [Internet]. Abc.net.au. 2020 [cited 30 December 2021]. Available from: https://www.abc.net.au/news/2020-09-10/covid-face-masks-fashion-history-protect-from-sun-dust-disease/12644446
14. Kisielinski K, Giboni P, Prescher A, et al. Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?. International Journal of Environmental Research and Public Health. 2021;18(8):1-44.
15. COVID-19 Scientific Advisory Group Rapid Evidence Report [Internet]. Alberta Health services; 2021 [cited 30 December 2021]. Available from: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-evidence-of-harm-from-mask-use-for-specific-populations.pdf
16. Promoting mask-wearing during the COVID-19 pandemic: A POLICYMAKER’S GUIDE [Internet]. Prevent Epidemics.org; 2021 [cited 30 December 2021]. Available from: https://preventepidemics.org/wp-content/uploads/2020/08/Promoting-Mask-Wearing-During-COVID-19.pdf