More than 100 top doctors have backed calls for the public to wear homemade face masks to protect themselves and others from contracting coronavirus when they leave their homes.
They signed a letter saying they were ‘increasingly alarmed at official inaction over the need for the public to wear face masks’.
Ministers could make a decision this week on whether to order the use of protective equipment for millions of Britons in the workplace and on public transport.
The doctors spoke out ahead of a meeting of the Government’s scientific advisers tomorrow to review evidence on whether masks should be made compulsory.
Two people are pictured wearing masks on London’s Clapham Common on Sunday. Ministers could make a decision this week on whether to order the use of protective equipment for millions of Britons in the workplace and on public transport.
THE TRUTH ABOUT FACE MASKS: WHAT STUDIES HAVE SHOWN
Research on how well various types of masks and face coverings varies but, recently, and in light of the pandemic of COVID-19, experts are increasingly leaning toward the notion that something is better than nothing.
A University of Oxford study published on March 30 concluded that surgical masks are just as effective at preventing respiratory infections as N95 masks for doctors, nurses and other health care workers.
It’s too early for their to be reliable data on how well they prevent infection with COVID-19, but the study found the thinner, cheaper masks do work in flu outbreaks.
The difference between surgical or face masks and N95 masks lies in the size of particles that can – and more importantly, can’t – get though the materials.
N95 respirators are made of thick, tightly woven and molded material that fits tightly over the face and can stop 95 percent of all airborne particles, while surgical masks are thinner, fit more loosely, and more porous.
This makes surgical masks much more comfortable to breathe and work in, but less effective at stopping small particles from entering your mouth and nose.
Droplets of saliva and mucous from coughs and sneezes are very small, and viral particles themselves are particularly tiny – in fact, they’re about 20-times smaller than bacteria.
For this reason, a JAMA study published this month still contended that people without symptoms should not wear surgical masks, because there is not proof the gear will protect them from infection – although they may keep people who are coughing and sneezing from infecting others.
But the Oxford analysis of past studies- which has not yet been peer reviewed – found that surgical masks were worth wearing and didn’t provide statistically less protection than N95 for health care workers around flu patients.
However, any face mask is only as good as other health and hygiene practices. Experts universally agree that there’s simply no replacement for thorough, frequent hand-washing for preventing disease transmission.
Some think the masks may also help to ‘train’ people not to touch their faces, while others argue that the unfamiliar garment will just make people do it more, actually raising infection risks.
If the CDC does instruct Americans to wear masks, it could create a second issue: Hospitals already face shortages of masks and other PPE.
Britain is out of step in its guidance, with other European countries including Germany, Italy and Spain now recommending their use.
The doctors are backing the Masks4All campaign which is calling for ‘ordinary homemade masks’ to be worn by the public to help stop those with the disease spreading it to others.
Signatories of the letter include John Ashton, a former president of the Faculty of Public Health, and Martin McKee, a professor of European public health at the London School of Hygiene and Tropical Medicine.
Their missive to The Times said: ‘Official UK policy is illogical… The latest guidance on PPE [personal protective equipment] says that people should wear masks in hospital waiting rooms ‘to reduce both direct transmission and environmental contamination’. Why not elsewhere?
‘The thousands of coronavirus mutual aid groups could make enough homemade masks for everyone, so it would cost next to nothing. Instructions are easily available, for example, at masks4all.org.uk.’
A petition has also been started by Masks4All urging the Government to make masks mandatory in the UK.
The group advises making ‘reusable cotton masks from simple items you can find in your house’, such as scarves or towels.
The campaigners stress that surgical masks and respirators should be reserved for health professionals.
Authorities across Europe, including in Germany, France and Spain, have put their faith in masks as part of their postlockdown plans.
The coverings are already common in China, Japan and South Korea. Sir Patrick Vallance, chief scientific adviser, has warned that the decision is complicated by a lack of evidence that wearing a mask can prevent users from contracting coronavirus.
However, they can prevent any infected wearer from spreading the virus further through coughs and sneezes.
London Mayor Sadiq Khan has urged the Government to change its advice on masks to combat the spread of the virus.
He was supported by former Health Secretary Jeremy Hunt, who said such a move would be ‘sensible’ given how social distancing can be impossible on trains and buses.
Labour leader Sir Keir Starmer said it was ‘inevitable’ the Government would have to change its advice, which at present states that masks are only needed in hospitals.
It comes after US health regulators last week warned parents not to put face masks on babies during the coronavirus pandemic as it may suffocate them.
While the wider public have been advised to wear a mask or face covering when they go out in order to prevent the infection spreading, pediatricians say it may be harmful for babies.
The Centers for Disease Control (CDC) said infants have such small airways that a mask could do more harm than good and doctors have warned of suffocation.
The good face-mask guide: As UK health officials consider urging everyone to cover their mouths MailOnline reveals the best from top surgical-level respirators costing £20 each or ten mouth covers for £1 each
Face masks could soon be an everyday sight in Britain as health officials admit that they are reconsidering their advice for people not to wear them.
The West, however, is new to the idea and the coronavirus pandemic has triggered widespread use of face coverings in the US, France and Spain.
Britain’s chief scientific adviser, Sir Patrick Vallance, said on Monday that there is an ‘ongoing review’ of official advice on masks.
For weeks the Government has told people not to bother with them and to make sure there are enough available for staff in hospitals and care homes who really need them.
Following a World Health Organization softening on the stance, however, they could soon be recommended to prevent the spread of COVID-19.
Although it is acknowledged that they don’t do much to stop someone catching the virus, there is evidence they can stop already-infected people spreading it.
As officials consider changing guidance on face masks in Britain, here is what you need to know about the types available and their relative effectiveness:
Two types of mask meet high-grade medical standards – FFP3 and FFP2/N95. So what’s the difference?
A man wearing a respirator face mask walks along Weston-super-Mare on Easter Sunday
The two main types of medical-grade face mask on sale in Britain are the FFP3 and FFP2, also known as N95, masks.
These are the types that doctors and nurses must use when treating patients with the coronavirus, and offer the most protection against viruses in the air.
They are particularly vital during ‘aerosolising’ procedures such as putting in a ventilator, which is when medical workers are most at risk of breathing in viruses.
FFP stands for Filtering Face Piece, with FFP3 giving the highest level of protection against virus and bacterial infections, while FFP2 is the level below.
NHS guidance is for medics to use the FFP3 masks, while FFP2 is recommended by the World Health Organization and is the equivalent to the US’s N95 mask.
The N in N95 stands for Not resistant to oil – because the mask is a particle respirator only and doesn’t protect against fluids – while the 95 means it filters out 95 per cent of airborne particles.
Health officials say that when FFP3s are not available, FFP2s can be used. The WHO recommends FFP2 and N95 respirators, which are widely used in other countries.
The N95 does not have the CE mark to show compliance with European safety standards, but has been tested against standards similar to these requirements.
What types of masks can you buy online and how much do they cost?
This pack of two FFP3 masks is the best selling product for the type of respirator on Amazon
High-grade dust masks now used on NHS frontline: FFP3 face masks cost £40 for two
FFP3 masks are the gold standard for preventing the spread of airborne illnesses in hospitals.
They must fit tightly to the face and have all air drawn through a filter that is embedded in the fabric and catches almost every kind of particle as the air flows through.
They are primarily used as dust masks in the construction industry.
The masks are not widely available to members of the public online.
The top listing on Amazon – made by Wrexham-based company Toolpak – has sold out both on the marketplace and the firm’s own website.
Toolpak’s masks appear to be being sold by a third party for £39.99 for a pack of two on Amazon.
The N95 face mask being sold for £6.99 online is the US equivalent of the FFP2 mask in Europe
3M N95 masks are being sold for £25.99 for a six-pack on Amazon
Silver standard masks used by medical workers in US and UK: N95/FFP2 face mask cost £6.99 each
The N95 face mask is the US equivalent of the FFP2 mask in Europe and is backed by the World Health Organisation as suitable for medical use.
Its filter is not as strong as the FFP3 – it weeds out 95 per cent of particles, as the name suggests – but it is still highly rated for NHS staff.
UK health officials say FFP2 masks are second best to FFP3, and should be used if possible because they have a European seal of approval, but N95, which doesn’t have CE approval, can be used if no FFP2 masks are available.
Masks of this grade are more readily available online from sellers in China.
The Amazon bestseller is a N95 mask sold by HJHY, a company based in China. They cost £6.99 but may not be delivered for a month or more. 43 per cent of people who bought the mask rated it just one star out of five.
Another product in Amazon’s bestseller category is a £25.99 six-pack of N95 masks made by 3M and sold by Hpparty, another company based in China. Delivery dates start in mid-May and there are no customer reviews.
These disposable face mask covers offer some protection to users against respiratory diseases
Disposable surgical masks still used in most NHS hospitals: Ten for £9.39
The best known type of medical face mask, known as a surgical mask, is still being widely used by the NHS.
Doctors, nurses and healthcare workers are now instructed to wear these types of mask as a minimum at all times when working near confirmed or suspected coronavirus patients.
They are considered effective enough for most staff outside of intensive care or who are not inserting or removing breathing equipment.
Although they don’t have built-in air filters, the masks can stop droplets of liquid, which are how the majority of the COVID-19 viruses are spread.
The best-selling product of this type under ‘masks and respirators’ on Amazon today is a ten-piece set of disposable face covers which costs £9.39.
The mask – with an average review rating of 3.5 stars – has an inner layer of cotton fabric, a middle layer of medical filter paper and an outer layer of waterproof fabric. It is sold by a company in London and delivers in early May.
Another top seller is a pack of 20 costing £7.97 and shipping from a company called T-Shell in Guangdong, China.
These types of masks are typically not reusable and should only be used for one day at a time.
Cycling masks can also provide people with a layer of protection from airborne particles
This mask is for sale for £11.99 on Amazon
Cycling masks designed to filter out pollution but with potential to stop viruses: £7.57 for six
While cycling masks remain untested regarding coronavirus, they are intended to provide a layer of protection from airborne particles.
They are designed to stop cyclists breathing in pollution when they ride through areas with heavy traffic.
They contain an air filter for this purpose, but are not regulated to the same standard as medical face masks so provide varying levels of protection.
High quality cycling masks, such as those made by the well-known UK brand Cambridge Mask Co. cost upwards of £20 and are reusable. The company has now sold out of all stock but is taking pre-orders.
Other cycling masks are available on Amazon, with the site’s bestseller a £7.57 pack of six from a company called Diyii in China. The firm says the masks are good for those with sensitive skin allergies and can be washed repeatedly, and are also suitable for camping, running, travel and climbing.
Another top seller on the marketplace is a reusable mask sold by the Chinese firm KZKR-EU which costs £11.99 per mask and claims it will deliver within two weeks.
This valved gas mask is claimed to match up to the highest filtration standard
This rubber-sealed, military-looking mask is for sale for £29.87 on Amazon
The dramatic option: Respirator gas mask costing £34.86 for one
Perhaps the most dramatic-looking option of all masks is the gas mask respirator.
These are generally used by people spraying paint or other chemicals which it would be dangerous to inhale, or working in hazardous environments.
The masks have built-in valves fitted with filters which may be able to keep out droplets carrying the coronavirus.
The top listing on Amazon is a mask costing £34.86 and sold by SafeYear, a company based in Shanghai, China. The mask is rated FFP3, meaning it would be suitable for even the riskiest medical procedures.
Another top listed option on the site is a full-face rubber-sealed black mask which costs £29.87.
It is sold by the company Maikoler, based in China, and says it would be delivered by the end of May. The military-looking contraption has no customer ratings.
A woman in New York is pictured wearing a makeshift cloth facemask
A man in Fife, Scotland, shocked shoppers when he turned up at Asda wearing a mask made from a sanitary towel
T-shirts, bandanas and even sanitary towels: Homemade face masks may offer protection, too
Many people are opting to make masks at home using cloth or other materials – some have even been pictured using sanitary towels.
The Centers for Disease Control and Prevention (CDC) in the US recommends people use cloth face coverings when they go out in public and even has a how-to guide for people to make their own out of t-shirts or bandanas.
The intention of these is not specifically to protect people from catching the virus but to prevent the spread of it by encouraging such widespread use that people who are infected but don’t know about it wear something that blocks the viruses being expelled on their breath.
However, European researchers have suggested these may not be effective and up to 90 per cent of particles can make their way through the fabric.
The European Centre for Disease Prevention and Control said rates of illness were much higher among healthcare staff using masks made out of cloth instead of surgical masks.
It said: ‘Altogether, common fabric cloth masks are not considered protective against respiratory viruses and their use should not be encouraged.
‘In the context of severe personal protective equipment (PPE) shortages, and only if surgical masks or respirators are not available, homemade cloth masks (e.g. scarves) are proposed as a last-resort interim solution by the US CDC until availability of standard PPE is restored.’
FASHION FIRM TURNS TIGHTS INTO MASKS FOR NHS STAFF
A Cheshire-headquartered, family-run hosiery business has switched from producing tights to washable face masks, to ease the demand on medical equivalents for frontline NHS staff.
The company, ELLE, joins the likes Prada, Gucci, LVMH, YSL and Burberry who are all using their production facilities to make PPE and hand sanitiser.
ELLE can produce 350,000 masks per week that are designed to be comfortable to wear, and are washable, so eco-friendly.
The unisex masks can be washed up to 25 times and are constructed from a double-layered material, which has antimicrobial properties.
The masks are also given additional antimicrobial and water-repellent treatments, meaning if someone coughs or sneezes nearby there is protection from the droplets in the air.
The factory usually makes over 12 million pairs of tights a year. ‘It’s important that all businesses do their bit to support all efforts to fight Covid 19, and we are no different,’ said Anja Khan, chief executive at ELLE.
‘With such a huge demand on surgical masks for frontline health care professionals, we wanted to ease this strain and supply an “every day” option as part of social distancing guidelines.
‘So instead of making tights, we are now making masks. This isn’t a commercial decision but the right thing to do. From a cost perspective, we are making just enough money to cover our costs, keep our colleagues in jobs and in turn support their families.’
In addition, ELLE’s ‘factory to face’ traceability through its Made in Green accreditation means that every mask is tested for harmful substances and produced in environmentally friendly factory facilities with socially responsible working conditions linked to fully transparent production.
Heartbreak as all IVF treatment is cancelled
Couples trying for a baby face heartbreak after being told they will no longer be able to have IVF.
All private clinics and NHS hospitals were told to stop fertility treatment last Wednesday due to the coronavirus outbreak.
There is no date for when IVF will restart, according to the fertility regulator Human Fertilisation and Embryology Authority (HFEA).
Fertility treatment is still going ahead in New York, which has also been hit hard by the virus, as it is deemed an ‘essential’ health service.
But in the UK, the regulator has stopped IVF based on Government advice.
It follows concerns that women who have IVF may later need medical treatment from an overstretched NHS and that fertility treatment may not be compatible with social distancing.
But as conceiving through IVF becomes more difficult with time, the shutdown will leave some older women fearing that they may run out of time to have a baby.
More than 54,000 people a year have fertility treatment in the UK, according to the latest figures.
Sally Cheshire, chairman of the regulator, said to patients that she hopes they can ‘understand that this is the only responsible course of action for the fertility sector at this tough time’.
Stuart Lavery, a reproductive medicine expert at the Wolfson Fertility Centre at Hammersmith Hospital, said: ‘Our IVF nurses have all had to be redeployed to help with coronavirus, with our lab staff helping at the new Nightingale Hospital for Covid patients.
‘I think that’s the right call because the challenge the NHS is facing is the priority.’
But there are concerns that for women having IVF through the NHS, they may be older than the upper age limit by the time the treatment can go ahead.
Whether the age limit will be extended after the lockdown will be up to individual clinical commissioning groups in local areas who fund the treatment.
JOHN ILLMAN: Why I’m sure making face masks compulsory is a common sense step we must take
I welcome the news that London mayor Sadiq Khan is campaigning to make face mask wearing compulsory for people travelling in the capital during the coronavirus crisis. I hope other mayors and local councils will follow suit.
I hope that Government proposals, now being discussed, to make mask wearing a plank of lifting lockdown will prevail. This revolutionary – but common sense proposal – may be ridiculed by those who would insist that there was insufficient medical evidence for such action.
But these are not normal times. We do not have time to carry out a mass of scientific studies. We need to act now. The number of deaths due to Covid-19 each day continues to shock and the NHS, while coping, is under pressure.
So I endorse the idea put forward this week in the British Medical Journal (BMJ) that we should adopt what is known as the ‘Precautionary Principle’.
London mayor Sadiq Khan is campaigning to make face mask wearing compulsory for people travelling in the capital during the COVID-19 crisis
This states that we should sometimes act without conclusive evidence if this is likely to do good – and, having made a study of the evidence for and against, I believe that is exactly what face masks could do.
Written by a team led by Professor Trisha Greenhalgh, of Oxford University, the BMJ article warns: ‘In the face of a pandemic the search for perfect evidence may be the enemy of good policy.’
In more than 40 years as a medical journalist – much of it working for this paper – I understand absolutely the value of evidence-based medicine.
The Index Medicus, the bible of medical research, lists more than 9,000 articles and studies about the potential benefits and hazards of surgical masks I have always believed there was logic behind the idea that face masks might protect us against infection, but my experience of wearing one last month in Vietnam was revelatory.
When we arrived in the country – before the widespread international lockdown – my wife and I weren’t wearing masks. Indeed, we were surprised when booking into our hotel in Saigon to see all the reception staff in masks.
This had a powerful symbolic impact in addition to any protective effect. If everyone around you is wearing masks, you become increasingly hygiene conscious and cautious about what you do.