Call for widespread use of face coverings to reduce COVID-19 community infections.

Today we outline our position in support of widespread use of face coverings by everyone in the community during the coronavirus COVID-19 pandemic. Professor Ewan Macdonald OBE from the University of Glasgow is cosignatory to this position.

The use of face coverings - a complementary control measure

Wearing face coverings in public, particularly in well-frequented locations such as shops and public transport is recommended in addition to current social distancing and hand-washing instructions. Face coverings can help reduce transmission of the virus in public, because people may unknowingly be infected and be spreading the virus in the air.

The wider public use of facemasks is currently a highly contentious issue where the science is being conflated with supply issues for respirators and masks used in healthcare. Health and social care, workers, are at higher risk from inhaling fine particles containing the virus and the public are at risk if an infected person coughs or sneezes directly at them within a 2m range.

IOM believes that everyone outside their homes should wear non-medical face coverings such as bicycle masks, snoods and similar coverings. This will reduce the chance of infection from coughs and sneezes, both directly between people, and indirectly from droplet contamination of surfaces. This advice is particularly important in busy public spaces such as supermarkets, shopping centres and on public transport, including taxis.

Our guidance

• The use of face masks or coverings in public can reduce the spread of the infection in the community by minimising the spread of respiratory droplets from infected individuals who have not yet developed symptoms or who remain asymptomatic.
  
  
• The use of face coverings in the community should be considered only as a complementary measure and not as a replacement for established preventive measures, for example, physical distancing, respiratory etiquette, meticulous hand hygiene and avoiding touching the face, nose, eyes and mouth. 

Key points for the public

• The public must understand the different terms used when discussing facemasks because the functionality can vary between mask types.
  
  
• The term “facemask” includes respirators (e.g. FFP3 respirators tested to the standard EN149), surgical masks (e.g. tested to the standard EN 14683:2014) and informal masks or face coverings (i.e. non-medical masks or coverings such as scarves or snoods).
  
  
• Respirators are designed to prevent exposure of workers to infective and other hazardous agents present as fine particles in the air.  Also, these masks will have some efficacy in preventing emissions of infectious agents from infected individuals. In the present pandemic, respirators should only be used by health and social care workers. Users need to be fit trained to correctly use these for optimal protection.
  
  
• Surgical masks are designed to prevent the emission of respiratory droplets by infected individuals.  Also, they will have some limited efficacy in preventing exposure of individuals to fine particles containing infective and other agents present in the air, although less than respirators. In the present pandemic, surgical masks should only be used by health and social care workers.
  
  
• The use of respirators and surgical face masks by healthcare workers must be given priority over the use in the community. The general public should only seek to use non-medical facemasks or coverings.
  
  
• Appropriate non-medical face coverings should be made of closely woven textiles and should completely cover the nose and mouth.
  
  
• Appropriate widespread use of face coverings is key for the effectiveness of the measure amongst the general public and can be improved through education campaigns.

Our work aims to improve the understanding of the factors affecting human health in the workplace and in the wider environment and promotes practices which lead to improvements in the health of workers and the wider population. We are updating our blog regularly with information to help people navigate COVID-19, our latest blog post 'Will a mask protect me during the Covid-19 pandemic?' is particularly pertinent. 

Dr Robert Aitken
CEO of The Institute of Occupational Medicine (IOM)

Publications

European Centre for Disease Prevention and Control
Using face masks in the community - Reducing COVID-19 transmission from potentially asymptomatic or pre-symptomatic people through the use of face masks

IOM
Effectiveness of face masks used to protect Beijing residents against particulate air pollution