Extra measures for the most vulnerable or extra-cautious
Jo Paton, MKQM Assistant Covid-19 Risk Co-ordinator
Updated 4 August 2021
Most adults, and almost all older adults, in the UK have now been fully vaccinated. But case rates (at least at the beginning of August ’21) remain high. It’s now clear that people who are fully vaccinated can still become infected with covid, although the very great majority of those who do develop comparatively mild symptoms. It’s also clear that those vaccinated people who do develop covid can transmit it to others.
This leaves a small group of people (those who are especially vulnerable to severe covid and/or whose weakened immune systems mean that vaccination protects them less well) still exposed – at least until such time as population immunity becomes a reality and case rates tumble and stay low. Until that time, people who are particularly vulnerable may well choose to take extra precautions for their own protection.
The main precautions that we can take have not changed. They remain:
- Do as much outside as possible
- Open windows when inside
- Reduce the number of people you are in physical contact with
- Wear masks
And it’s this last precaution method that we have some scope for improving. This article is about how to do that.
About Masks: not all are equal
Now all face coverings are better than nothing but some are mainly good at protecting those around the wearer. After all, the main message about masks has always been “My mask protects you; your mask protects me”. But, especially if you are one of the people likely less protected by vaccination and many others are not wearing a mask any more, you might want a mask that protects you as well as others around you. You might, for example, want a more effective mask if you have to go into a higher-risk setting where other people may not be vaccinated such as a hospital appointment, or to do a shift at the food bank or school.
Good news: there are a lot of new studies showing what sort of masks are better at protecting the wearer than others. The efficacy of the different masks, most in common use, varied from 26% to 79% for “consumer-grade” that is ordinary masks. Higher-grade, more professional, masks can filter up to 95% of airborne particles or even higher and these masks are now more available, though still expensive. But it proved possible to increase the filtration efficiency of a not-very-effective ordinary mask from 35% to a high of 80% by making a few adaptations. (Ref 4)
Many of those countries that did particularly well in keeping case numbers very low in the first waves provided their citizens with free, high-grade and quality-controlled masks. Taiwan gave every citizen a fresh supply of high quality masks every week. Hong Kong distributed patented, laboratory-tested, six-layer masks to every citizen. Singapore distributed free, reusable, multi-layer masks with filters to everyone, including children who got child-size ones. In Germany, Bavaria (which at the time had the highest covid rates in Germany) made higher-grade, professional-type masks compulsory in most public settings.
So – what is a “high quality” mask? And what can you do to improve the efficacy of the masks you have?
How to upgrade your mask
If you wear medical procedure masks (rectangles with blue on the outside and white on the inside). These masks were designed to be worn by doctors and nurses carrying out surgery. Their aim is to protect the patient from germs expelled from the mouth of the doctor, that is to protect those around the wearer. You can improve the protection to the wearer if you:
- Make sure you use the nose wire to ensure a good fit at the top of the mask, with no slipping off your nose. If you wear glasses, put them on top of the mask.
- Cross the ear loops over and tuck in the side pleats. This improves the fit at the sides.
- Or tie the mask around the back of your head, using a hair clip to extend and anchor the ear loops. Ties around the back of the head usually mean a better fit than ear loops.
If you wear cloth face coverings. These too were designed to protect those around the wearer. They performed least well in tests of providing protection to the wearer. You can improve protection to the wearer if you:
- Increase the number of layers of fabric making up the mask, using fabric that is either non-woven (such as polypropolene) or a high thread-count cotton. If you can see through the material when you hold it up the light, it is likely too loosely woven. And then add a filter pocket (see next point) so that you end up with 3 layers plus filter.
- Sew a filter pocket into the inside of the mask. This has the advantage of increasing the number of layers and simultaneously increasing filtration. You can cut filters from paper handtowels (like the ones in the Quaker Centre toilets) which have a good balance of filtration efficacy and breathability. Kitchen towels are also possible though not as good. Avoid vacuum bag material as it is too hard to breathe through.
- Sew about 6” of nose wire into the top seam of the mask. This allows you to pinch the wire to fit across the top of your nose. It stops the face covering slipping off your nose and means you don’t keep pulling the face covering up again. Fold the ends inward so it won’t poke through the fabric and scratch your face.
- As with the medical masks above, if the mask is loose at the sides, cross the ear loops to improve the fit at the sides or attach ties that fasten behind your head.
Another option if you have a thin or flimsy face covering, is to wear two masks on top of each other. If you combine multiple layers, you can achieve pretty high efficiencies in blocking particles. You might wear a tighter fitting cloth covering over a looser-fitting surgical mask for example. This is an alternative to a multi-layer cloth mask with a pocket filled with filter material. If you apply all these ideas together, you risk ending up with a mask that’s wonderful at blocking viruses but doesn’t allow you to breathe. Test them out.
If you are buying face-coverings from new, you are looking for ones made of several layers of fabric (non-woven perhaps on the outside and comfortable but tightly woven on the inside), with a pocket for a filter and a nose wire and that comes in different sizes (men, women/teenagers, children). Etsy has several thousand suppliers of non-medical masks and some meet that spec. Suppliers from Japan or Singapore are more likely to do so.
If you are making a face-covering from new, find a pattern that includes a filter pocket and nose wire. One is available from firstname.lastname@example.org.
If you want to buy a higher-grade, professional type mask (such as the Bavarian State Government has now made compulsory for most public settings), you are looking for an FFP2 mask. FFP2 masks are the European standard filtration mask that has a 94% efficiency and typically has no valve. This means that it protects the wearer and those around them.
It is possible to buy even higher grade masks to FFP3 standard (99% efficiency) but these have valves as otherwise it is difficult to breathe through them. The valve means that anyone standing in front of the wearer is exposed to the unfiltered breath coming out of the valve. So if you do have one of the valved masks, you must wear a face covering over it in order to protect other people from your valve. These masks may be familiar to you from seeing them on builders or carpenters to protect against brick dust or sawdust.
If you buy one of these types of mask, you are looking for a reputable supplier who has been in business for longer than a year (the pandemic has led to a proliferation of fake masks), masks to FFP2 filtration standard, that comply with EN149:2001. They are available from Boots. The equivalent mask in the US is an N95 and in China a KN95. The latter are widely available in this country but the HSE (Health & Safety Executive) is not keen on KN95s as the imports are not quality controlled and so their claimed filtration efficacy may or may not be reliable. Almost all of this type of mask are not re-usable
Re-usable, professional-grade masks that meet those standards are available from The Cambridge Mask Company, a long-standing company set up to supply masks to block air pollution. They have valves so a second mask on top is essential to protect others.
Don’t forget the basics
No mask is perfect, and wearing one does not replace the need for other measures like physical distancing, avoiding crowds and hand washing. Hand-washing is especially important after you take your mask off and before you touch your face.