The Mask Manual
Mask for protection from Covid-19

Health experts and organizations have advised on using mask for protection from Covid-19 infection. There are several types of mask available now ranging from cloth based mask to respirators. With several options and guidelines it is quite difficult to select the types of mask most suitable for our day today purposes. This article will guide the reader to understand the types, specifications, pros and cons of them and serves as a manual on mask.

Types of mask in use in current scenario

Medical/ surgical mask ?

Surgical or procedure masks are flat or pleated (some are shaped like cups)
They are affixed to the head with straps
Tested according to a set of standardized test methods (ASTM F2100, EN 14683, or equivalent)
Balance high filtration, adequate breathability and optionally, fluid penetration resistance
Intended purpose and use

Meant for health- care workers
Fluid resistant and provides the wearer protection against large droplets, splashes, or sprays of bodily or other hazardous fluids.
Protects the patient from the wearer’s respiratory emissions.
Filtration

Does NOT provide the wearer with a reliable level of protection from inhaling smaller airborne particles and is not considered respiratory protection.
Leakage

Leakage occurs around the edge of the mask when user inhales.
Use limitations

Discard after each patient encounter.
N95 mask
An N95 Mask is designed to achieve a very close facial fit and very efficient filtration of airborne particles. Surgical N95 Respirators are commonly used in healthcare settings. A subset of N95 Filtering Facepiece Respirators (FFRs), often referred to as N95s.

Testing and approval

Evaluated, tested, and approved by NIOSH as per the requirements.
Intended use and purpose

Meant for health care workers
Reduces wearer’s exposure to particles including small particle aerosols and large droplets (only non-oil aerosols).
Filtration

Filters out at least 95% of airborne particles including large and small particles.
Leakage

When properly fitted and donned, minimal leakage occurs around edges of the respirator when user inhales.
Use Limitations

Ideally should be discarded after each patient encounter and after aerosol generating procedures.
It should also be discarded when it becomes damaged or deformed; no longer forms an effective seal to the face; becomes wet or visibly dirty; breathing becomes difficult; or if it becomes contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients.
Standards and Quality

US Standards for mask

The US National Institute for Occupational Safety and Health (NIOSH) classifies particulate filtering face piece respirators (FFRs) into nine categories (N95, N99, N100, P95, P99, P100, R95, R99, and R100).
N (not resistant to oil) means that the respirators cannot be used in an oil droplet environment; R (somewhat resistant to oil) and P (strongly resistant to oil) mean that this respirator can be used for protection against non-oily and oily aerosols.
Numerical designations 95, 99, and 100 show the filter’s minimum filtration efficiency with 95%, 99%, and 99.97%, respectively.
The class of filter will be clearly marked on the filter, filter package, or respirator box. For example, a filter marked N95 would mean an N-series filter that is at least 95% efficient.
European Standards for mask

The European Standard (EN 149:2001) classifies FFRs into three classes: FFP1, FFP2, and FFP3 with corresponding minimum filtration efficiencies of 80%, 94%, and 99%.
FFP2 respirators are approximately equivalent to N95 FFRs, making them recommended for use in the prevention of airborne infectious diseases in the US and some other countries.
FFP3 respirators provide the highest level of protection; they are the only FFP class acceptable to the Health and Safety Executive (HSE) for protection against infectious aerosols in healthcare settings in the UK.

Cloth mask
Center of Disease Control, Ministry of Health and Family Welfare and several other health organizations recommend wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain, such as grocery stores, pharmacies, public transports, markets and so on.

Why cloth masks ?

Cloth face coverings may slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.
Cloth face coverings can be made from household items.
To avoid shortage of surgical and N95 masks for frontline health workers.
To provide an extra layer to help prevent the respiratory droplets from traveling in the air and onto other people.
How cloth face masks help ?

Prevent the person wearing the mask from spreading respiratory droplets when talking, sneezing, or coughing.
Face coverings worn by others may protect you from getting the virus from people carrying the virus.
Considerations for use of cloth mask

When using a cloth face covering, make sure:

The mouth and nose are fully covered
The covering fits snugly against the sides of the face so there are no gaps
You do not have any difficulty breathing while wearing the cloth face covering
The cloth face covering can be tied or otherwise secured to prevent slipping
Wash your cloth face covering after each use in the washing machine or by hand using a bleach solution. Allow it to completely dry.
 

 Potential side affects of mask use

False sense of security
Inappropriate use – improper way of wearing, disposal methods, unhygienic way of reuse can lead to infection
For individuals with respiratory health issues, wearing mask can cause breathing difficulty
Moist, humid surfaces provide habitat for the virus. So, wearing wet masks may increase chances of infection
A study has revealed that wearing N95 mask for prolonged time increases nasal resistance causing physiologic changes. However, long term evaluation has to be done.
Final Note

Mask use is inevitable in this Covid-19 era. But one needs to understand the types of mask and their applications, so that we don’t fall short of resources for the one in need. Judicious use of mask is crucial. It is also important to understand the different types of mask and their quality specifications so that one shouldn’t end up buying a fake product. Use the mask rationally and take care of your health and your dear ones. We also need to develop the mask etiquette, use it in the proper way so that it serves the intention.