FAQs: Non-Medical Masks and Face Coverings

Health officials recommend that people ≥2 years old wear a non-medical mask when in public or when around people who do not live with them, especially when social distancing is not possible (staying six feet [2 meters] apart).1,2 Masks, ideally with at least two layers of fabric, should be worn primarily to protect others, in case the wearer is infected with COVID-19, but doesn’t have any symptoms.1,5

Question

Answers/Pertinent Information/Talking Points

Which types of face coverings are best to use?

Appropriately sized masks to cover the nose, mouth, and chin, with at least two layers of fabric (e.g., cotton) are preferred.2 For example, children’s masks may need to be smaller than adult masks, depending on the age of the child.

More data are needed before special materials (e.g., silver nanoparticles) can be recommended over other materials or coatings.

Discourage use of face coverings that have a valve for easy exhaling; are made of mesh; or with openings, holes, or vents. These are NOT considered sufficient as they may allow droplets to be released from the mask.16,23

Neck tubes, scarves, bandanas, buffs, or gaiters are not ideal, but these may be better than no coverage at all.22 However, note that when speaking through fleece material larger droplets may be dispersed into smaller droplets. Smaller droplets can remain airborne longer, so it may be best to avoid fleece.24

Face shields may be worn in addition to masks for possible added eye protection to the wearer (since it is thought that SARS-CoV-2 may also be contracted through the eyes). Face shields are NOT recommended as a substitute for masks. Face shields are also not appropriate for newborns or infants.6

  • It is not known if face shields will prevent the spread of respiratory particles from the wearer to others.6,8
  • If face shields are used without a mask, make sure there is NOT a gap between the band and the forehead and that face shields wrap around the sides of the face and extend below the chin.6,8,17
  • Limit disposable face shields to one-time use.6
  • Clean and disinfect reusable face shields after each use (according to product instructions).6
  • Face shields do not absorb droplets if you sneeze or cough, so they should be cleaned frequently.17
  • Encourage patients to clean their face after removing face shields.17

Who may be exempt from wearing a mask?

Masks are not appropriate for everyone. People who are considered exempt from wearing a mask include:1,5

  • infants and children <2 years old.
  • those who have trouble breathing (e.g., uncontrolled asthma or chronic obstructive pulmonary disease [COPD]).
  • those who are unconscious, incapacitated, or unable to remove a mask without help.

Prescribers may decide that other people are also exempt from wearing masks, such as those with:19,25,28

  • post-traumatic stress disorder (PTSD), severe anxiety, or claustrophobia.
  • sensory processing disorders, especially children (e.g., someone with autism who is sensitive to touch and texture).
  • facial deformities that will not allow masks to properly fit.
  • mouth control devices (e.g., sip and puff to operate their wheelchair or assistive technology).

How should masks be put on and taken off?

Wash hands with soap and water or use hand sanitizer BEFORE putting on a mask.1,5

Use ear loops or ties to put on and remove masks.5

Masks should fit under the chin, over the nose and mouth, and snugly against the sides of the face without gaps.1,2,5

Avoid pulling masks down around the neck, up on to the forehead, or leaving masks hanging from one ear. These positions make it easy for people to inadvertently contaminate their hands by touching the outside of the mask. Instead, completely remove masks using the ear loops or ties.

Masks should be removed prior to eating or drinking. Avoid placing masks directly on surfaces like tables, counters, etc. Once off the face, fold the mask in half, placing the outside edges together, keeping the inside layer inside.5 Then place in a clean paper bag or outer-side down on a napkin or paper towel.5 Avoid placing masks in pockets for future use.26

After storing the mask, wash hands with soap and water or use hand sanitizer. Avoid touching your eyes, nose, or mouth until after you have washed your hands.5

How should masks be cleaned?

Use a new mask whenever it becomes damp or dirty.4,5 Disposable masks should be thrown away once soiled or damaged.27 Wash reusable masks, either in the laundry or by hand.4,5

  • If washing in the laundry, use regular, fragrance-free laundry detergent and the warmest water temperature appropriate for the mask fabric.4
  • If washing by hand, use a hot soapy water or a bleach solution (e.g., four teaspoons of bleach per quart of room temperature water).4,5
    • If using a bleach solution, allow masks to soak in the bleach solution for five minutes, then rinse completely with cool or room temperature water.4

Dry masks completely, either in the dryer (highest heat setting) or lay it flat to dry, in direct sunlight if possible.4,5

How can mask tolerability be improved?

Give preference to cotton or linen over synthetic materials (e.g., polyester). Cotton may keep you a little cooler and polyester can trap moisture, making masks become damp more quickly.2,20

Ensure masks are snug, but not too tight.20

Use the type of mask that is most comfortable for you. For example, some people may prefer ear straps and some people may prefer ties around the head. Note that masks that tie may allow for more flexibility in securing a snug fit.21

See our chart, PPE-Related Skin Irritation: Prevention and Treatment, for ways to reduce or treat mask-related skin problems.

What can be done to reduce anxiety about wearing a mask?

Here are some tips to decrease anxiety associated with wearing a mask:10

  • See how the fabric feels against your skin before putting it on. Make sure it is comfortable.
  • Breathe calmly and slowly before putting on masks and while wearing masks.
  • Remind yourself that the mask is used to protect you and others.
  • Use short trial periods of wearing the mask at home before going out in public. Start with just a few minutes and gradually work up to longer periods of time.
  • Take breaks from wearing when alone or secluded (e.g., go sit in your car alone for a few minutes, find an empty room).

Set a good example, let kids see you wearing a mask. For kids, a few other tactics may be helpful:11,18

  • Use fun fabrics or patterns. Or, let kids decorate their masks.
  • Have kids take a leader role, put masks on stuffed animals and talk about how masks are used to protect them and others.
  • If mask tolerance/anxiety is an issue, consider using reinforcements (e.g., special snacks, treats, video games).

What can be done to keep glasses from fogging up when wearing a mask?

Be sure masks fit well. Masks that allow warm air to escape can lead to glasses fogging.3

Masks with a nose bridge (moldable around the bridge of the nose) may fit more snugly than masks without this feature.9 Medical or sports tape can also be used to create a better seal between the mask and the nose/cheek bones. If patients have sensitive skin, recommend testing a small piece of tape to make sure it doesn’t irritate the skin.3,9

Push glasses slightly forward on the nose to allow more room for air to circulate or pull masks up higher and allow glasses to rest on top of the mask to block air from escaping out of the top of the mask.3,9

Consider washing the lenses with soap and water or applying antifog products or home remedies (e.g., toothpaste or shaving cream) apply a thin layer to lenses, then rinse with water before wearing them.3 Doing any of these can leave a thin film on the lens that may prevent fogging.9 Before using these strategies, ask patients to check with their optician to make sure it won’t damage any special coatings their glasses may have.9

What can be done to reduce headaches from wearing a mask?

Patients may experience headaches while wearing a mask. Reassure patients that wearing a cloth mask will not lead to hypercapnia (the buildup of carbon dioxide [CO2]in the blood stream).12 Possible reasons for headaches may include:

  • dehydration:13 Give patients tips on how to make sure they drink plenty of water (e.g., scheduling mask water breaks, using alarms as a reminder to drink, drinking more water in the morning before putting on the mask).
  • reduced caffeine intake:13 Patients may be missing their morning caffeine boost because they are wearing a mask. Suggest patients change their routine to drink their coffee while getting ready for the day instead.
  • inhaling unpleasant odors (e.g., fragrances from soaps used to wash masks, bad breath):
    • Encourage good oral hygiene to reduce bad breath (brushing twice a day, flossing, antibacterial mouth rinses).14
    • Suggest limiting intake of foods known to cause bad breath (e.g., onion, garlic).14
    • Suggest that patients use fragrance free soaps when washing their masks.15
  • ear strap irritation:13 See our chart, PPE-Related Skin Irritation: Prevention and Treatment, for ways to reduce irritation from ear straps. For example, masks with ties avoid ear-tugging that may trigger headaches.7

Project Leader in preparation of this clinical resource (360901): Beth Bryant, Pharm.D., BCPS, Assistant Editor

References

  1. CDC. Coronavirus Disease 2019. (COVID-19). How to wear masks. August 7, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-to-wear-cloth-face-coverings.html. (Accessed August 20, 2020).
  2. Government of Canada. Coronavirus disease (COVID-19). Non-medical masks and face coverings. July 24, 2020. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/about-non-medical-masks-face-coverings.html. (Accessed August 5, 2020).
  3. Hazanchuk V. How to wear a face mask without fogging your glasses. May 21, 2020. https://www.aao.org/eye-health/tips-prevention/face-mask-foggy-glasses-coronavirus-covid. (Accessed August 5, 2020).
  4. CDC. Coronavirus Disease 2019. (COVID-19). How to wash masks. May 22, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-to-wash-cloth-face-coverings.html. (Accessed August 5, 2020).
  5. Government of Canada. Coronavirus disease (COVID-19). COVID-19: how to safely use a non-medical mask or face covering. July 20, 2020. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/covid-19-safely-use-non-medical-mask-face-covering.html. (Accessed August 5, 2020).
  6. CDC. Coronavirus Disease 2019. (COVID-19). Considerations for wearing masks. August 7, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html. (Accessed August 20, 2020).
  7. Ong JJ, Bharatendu C, Goh Y, et al. Headaches associated with personal protective equipment – a cross-sectional study among frontline healthcare workers during COVID-19. Headache 2020;60:864-77.
  8. World Health Organization. Advice on the use of masks in the context of COVID-19. June 5, 2020. 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. (Accessed August 5, 2020).
  9. Cleveland Clinic. Health essentials: how to keep your glasses from fogging up while wearing a mask. May 12, 2020. https://health.clevelandclinic.org/how-to-keep-your-glasses-fog-free-while-wearing-a-mask/. (Accessed August 6, 2020).
  10. Anxiety and Depression Association of America. Getting comfortable with PPE. April 2020. https://adaa.org/sites/default/files/Tips%20for%20Getting%20Comfortable%20in%20Your%20Mask%20and%20with%20PPE_UChicago%20Medicine%2C%20NYU%2C%20Emory%20.pdf. (Accessed August 6, 2020).
  11. Demarco C. Kids and masks during the COVID-19 pandemic: 7 questions answered. June 1, 2020. https://www.mdanderson.org/cancerwise/how-to-get-kids-to-wear-masks-during-the-coronavirus-covid-19-pandemic.h00-159382734.html. (Accessed August 6, 2020).
  12. Hartford Healthcare. Killer COVID-19 masks? The truth about trapped carbon dioxide. June 22, 2020. https://hartfordhealthcare.org/about-us/news-press/news-detail?articleid=26712&publicId=395. (Accessed August 6, 2020).
  13. Cove. How to avoid migraine triggers while wearing your mask. https://www.withcove.com/learn/migraine-triggers-mask. (Accessed August 6, 2020).
  14. Premier Health. A face mask surprise: your bad breath. May 26, 2020. https://www.premierhealth.com/your-health/articles/healthnow/a-face-mask-surprise-your-bad-breath. (Accessed August 6, 2020).
  15. American Academy of Dermatology. 9 ways to prevent face-mask skin problems. https://www.aad.org/public/everyday-care/skin-care-secrets/face/prevent-face-mask-skin-problems. (Accessed August 6, 2020).
  16. Minnesota Department of Health. Frequently asked questions about the requirement to wear face coverings. Updated August 19, 2020. https://www.health.state.mn.us/diseases/coronavirus/facecoverfaq.html. (Accessed August 21, 2020).
  17. Cleveland Clinic. Will a face shield protect you from the coronavirus? July 28, 2020. https://health.clevelandclinic.org/will-a-face-shield-protect-you-from-the-coronavirus/. (Accessed August 7, 2020).
  18. The Summit Center. Teaching your child to tolerate wearing a mask: tips and guidelines. https://www.thesummitcenter.org/app/uploads/2020/04/Desensitizing-to-Wearing-Face-Mask-Parent-Resource.pdf. (Accessed August 11, 2020).
  19. Dorfman D, Raz M. Mask exemptions during the COVID pandemic – a new frontier for clinicians. July 10, 2020. https://jamanetwork.com/channels/health-forum/fullarticle/2768376. (Accessed August 11, 2020).
  20. Rossen J. How to make wearing a face mask more comfortable during the warm, sweaty, summer months. June 4, 2020. https://www.mentalfloss.com/article/625141/how-make-face-masks-comfortable-warm-summer-months. (Accessed August 11, 2020).
  21. Conner K. Face mask feeling uncomfortable? Here’s what you can do for ear and head relief. August 9, 2020. https://www.cnet.com/health/face-mask-feeling-uncomfortable-heres-what-you-can-do-for-ear-and-head-relief/. (Accessed August 11, 2020).
  22. Callaghan A. Neck tubes and scarves are not ideal face masks. Updated August 7, 2020. https://www.outsideonline.com/2411426/buff-bandana-face-mask-effectiveness. (Accessed August 11, 2020).
  23. CDC. Coronavirus Disease 2019 (COVID-19): about masks. Updated August 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html. (Accessed August 11, 2020).
  24. Fischer EP, Fischer MC, Grass D, et al. Low-cost measurement of facemask efficacy for filtering expelled droplets during speech. August 7, 2020. https://advances.sciencemag.org/content/early/2020/08/07/sciadv.abd3083. (Accessed August 11, 2020).
  25. Southeast American Disabilities Act Center. The ADA and face mask policies. Updated August 10, 2020. https://www.adasoutheast.org/ada/publications/legal/ada-and-face-mask-policies.php. (Accessed August 17, 2020).
  26. Balzer D. Tips on how to wear and care for your cloth mask. May 8, 2020. https://newsnetwork.mayoclinic.org/discussion/tips-on-how-to-wear-and-care-for-your-cloth-mask/. (Accessed August 17, 2020).
  27. Johns Hopkins Medicine. Coronavirus: how to care for your face mask. Updated July 2, 2020. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-how-to-care-for-your-face-mask. (Accessed August 17, 2020).
  28. Cardinal Innovations Healthcare. Anxiety coping strategies when wearing a face mask. July 1, 2020. https://www.cardinalinnovations.org/Resources/Blog/Anxiety-Coping-Strategies-When-Wearing-a-Face-Mask. (Accessed August 17, 2020).

Cite this document as follows: Clinical Resource, FAQs: Non-Medical Masks and Face Coverings. Pharmacist’s Letter/Prescriber’s Letter. September 2020.

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