Everyone is talking about these face masks; unfortunately, it isn’t a cool trend about hydration and bright complexion. These face masks are rather uncool but could save you much pain: this is your quick and complete guide to safety and respiratory face masks. A simplified guide to making things clear once and for all!

This ABC covers the following questions: what face masks are; how they work for our health; why to use them, and who MUST use them.

Face masks aren’t an easy subject, and I know I’m walking through a mined path. I DO NOT pretend to be a doctor because I AM NOT, but I’m a rational person who values scientific information and good sense. The reason why I decided to open myself to this delicate topic is that I feel there’s too much misinformation hence the confusion and, sometimes, disinterests. I am fully aware how the guidelines released by your country may widely differ and that you’re acting based on what your Government shows it’s safe and sensible to do. You are free to decide, after all.

The latest health emergency turned global, and everyone has been or is going to be affected at different degree and time. We are living in uncertainty, but these 3 lifestyle components seem lifesaving: accurate hand hygiene, social distancing, and personal protection. This is where face masks come into play.

Face Masks: what they are and what they do
There are many kinds of face masks with different levels of protection, some are specific to particular work environments, hard to produce and expensive. Face masks generally act as a physical barrier between us and harmful substances – such as particles, powders, sprays, etc… – in suspension in the air, while others also work as a proper air filter.

What are all those acronyms?
N95, PPE, FFP3… I bet you feel confused by all those numbers and acronyms. Let me explain before diving into the subject.
PPE and DPI are the same things (the second being the Italian equivalent); they mean ‘Personal Protection Equipment’ and comprise of protective tools and gears, including safety and respiratory face masks. For what concerns those masks used in medical and work scenarios, the EU and the States have mandatory guidelines to ensure the safety and adherence to standards. On the packages and the masks themselves, you’ll find some strings of no-sense text which identify the type of product related to the current regulations. For example, the code ‘EN 149:2001 + A1:2009 FFP2 NR D’ tells you to which law the product complies to (EN… + …), the type of mask (FFP2), its disposable nature (NR) and an optional test being undertaken (D).

N95 is a US code which indicates the percentage of filtration. N95 means that a specific mask filters 95% of the air and isn’t resistant to oils (N); these type of protection are roughly equivalent to the European FFP2 and FFP3. FFP is the acronym for Filtering Face Piece, a filtering mask available in three models with crescent filtration capability, from the lower level offered by FFP1 masks to the higher of an FFP3.

Which kind of masks are available?
No mask is the same. Here are the three major groups:

surgical mask,
FFP with or without valves,
other types.

In this list, surgical masks and FFPs are those regulated by laws. EU and Italian laws state clearly which job and work environment require the usage of a face mask, as well as the specific type depending on the contamination or safety risks involved. The other types group consists of those masks not regulated by the law on their medical performance, such as other disposable protections, anti-pollution and washable masks…

SURGICAL MASKS
We’re very familiar with surgical masks, it’s the one your dentist wears when operates close to your mouth. To be safe, your surgical mask should comply with the UNI EN 14683:2019 regulation. This mask is disposable in nature and offers basic protection.

Your surgical mask has 2 aims:

protecting from splashes, sprays and large droplets;
preventing and reducing the spread of infective agents from surgeons to patients, hence protecting from possible infectious materials.

It’s usually used by doctors and nurses, dentists and assistants, as well as patients with or without viral symptoms. A surgical mask is a one-size product with loose-fit wearability that adapts to every face shape. It’s a rectangular bandage – likely blue in colour – that covers nose, mouth and chin. Its design is rather essential: it has a mouldable metal strip which allows adapting the mask to the bridge of your nose; two elastic loops to keep it steady or strings to secure your mask around your head. The 3-plies type is made of three layers:

the outer layer protects from liquids and splashes, such as blood, watery solutions and other body fluids;
the middle layer filters some pathogen agents;
the inner layer absorbs the moisture created by your breath.

PROS & CONS

Pros: Surgical masks are usually cheap, but, due to the circumstances tied to the COVID-19 emergency, sellers are pumping the price to maximise their profits. They are easy to wear and manageable; fit everyone. Minimal discomfort while breathing.
Cons: Surgical masks don’t block smaller droplets and airborne particles released by sneezes and coughs. They offer only partial protection because their loose-fit leaves gap along the cheeks. The main con is air leakage on the side of the mask. Disposable nature.

FFP MASKS
With the FFP (Filtering Face Protecting) masks, the situation becomes tricky, and people get greedy. FFP masks are a level or more up in protection, and they are usually mandatory in specific work such as heavy-duty industries and hospitals. They are regulated by the UNI EN 149:2009 legislation which defines the minimum requirements for these ‘anti-dust filtering semi-masks used as protective devices for the upper respiratory system’. Their structure is more robust; they are more complex to be produced due to the required material and production techniques. Excluded from this article are the FFP1, which are made of a resistant paper and don’t protect from toxic dust and other harmful materials. An FFP1 is an anti-dust disposable mask, and it represents the more accessible protection for DIY and other repairing works, as well as the easier barrier from mild irritants and pollens.

FFP2 and FFP3 are now at the centre of global attention. These respiratory masks are made of a net of polymeric fibres, a polymeric fabric-no-fabric created with a long process called ‘cracking’. They have a perfect fit that seals the face thoroughly. For this reason, they must be double-checked by the wearer or an assistant. They may include a valve which has the aim of easing breathing and reducing condensation inside the mask, glasses or visors. These valves don’t filter the air and, if not checked, could potentially lead to dangerous leakage. The requests done by several medical and Government authorities to avoid a mass purchase of N95 respirators can be explained with the length of their production, hence the scarcity of this specific product.

The FFP2 mask can filter up to 94% of the air and particles up to 0.6 μm. It protects from chemical products in powder, fungi, moulds, dust, smokes, aerosol and other liquids which can be hazardous also in the long run. These masks are widely used in manufacture plans (textile, glass, mining, iron and steel industries; foodstuff and agricultural production), as well as in medical environments (hospitals, clinics, and labs), where the staff is exposed to low-to-moderate risk.

The FFP3 mask can filter from 99.85% to 99% of the air and particles up to 0.6 μm in dimension. This type offers the highest level of protection and is a specialised gear. They protect from dangerous dust, smokes, solid and liquid aerosol; toxic, carcinogenic or radioactive materials (nickel, platinum, lead, asbestos, etc..), as well as pathogens microorganisms like virus, fungi and bacteria. They are mandatory in textile, pharmaceutic, mining, iron and steel industries; building and construction sites, waste treatment plans; hospitals and labs where the staff is exposed to high risk.

PROS & CONS:

Pros: FFP2 and FFP3 are the most effective PPEs, if worn correctly; they are professional protective tools.
Cons: These masks are expensive, hard to find and uncomfortable to breathe with. A wrong usage or storage is potentially harmful.

OTHER TYPES of FACE MASKS
This simplified title groups those protective aids available on sale which don’t fit into the previous categories, hence CANNOT be considered medical PPEs. They aren’t appropriate in hospital, laboratories, clinics and similar environments nor for the frontline staff. In Italy, these masks can be produced by respecting law n° 16, 2, DL (decree) 18/2020 with which the manufacturer must assure the safety of its products. These masks don’t comply with the official health requirements, but the public may wear them while applying other safety steps, such as social distancing and strict hygiene at all times.
Anti-pollution and washable face masks are part of this category. DIY surgical masks may be considered so but at your own risk.

Why using a face mask
To wear or not to wear a face mask? This is the crucial question you are allowed to ask. Every country is adapting her own guidelines on the usage of face mask for the public. The usage of respirators in critical environments isn’t questionable. While the WHO and the CDC (the American Centre for Diseases Control and Prevention) discourage a wide use of surgical masks by restricting them to patients and those with viral symptoms and medical equipes; the situation may differently evolve as the research goes on.
This is what the WHO suggests still today: ‘If you are healthy, you only need to wear a mask if you are taking care of a person with the suspected 2019-nCoV infection. Wear a mask if you are coughing or sneezing.’ [1]
The US situation is a good example of how things can quickly change at the top of the State organisation…
While the CDC was quite stubborn and did ‘not recommend that people who are well wear a facemask to protect themselves from respiratory illnesses, including COVID-19. You should only wear a mask if a healthcare professional recommends it. A facemask should be used by people who have COVID-19 and are showing symptoms.’ On last Thursday interview, Trump opened to some possibilities: ‘I don’t think they’ll be mandatory because some people don’t want to do that,” […] If people wanted to wear them, they can. If people wanted to use scarves they can.’ [2]
Health is an unquantifiable treasure; everyone should take care and protect themselves in the most reasonable, responsible and rational way. If a respiratory disease spreads through the air where infective substances – containing viruses and bacteria – are released via droplets and micro aerosols, then the most logical way for self-protection is a physical barrier whether or not we are infected. Here good sense must always be applied. For the peace of our mind and respect for our loved ones’ health, a simple surgical mask would be an easy act of respect towards ourselves and our community. You never know at the end…

Face masks and respirators: who MUST wear them?

This is probably the trickiest part of this discussion, and I take full responsibility for my actions and words. I cannot stress enough how every country is adapting and adjusting to this global emergency. The guidelines I support and follow are those released by the ISS, the Italian High Institute for Health.

Who Wears What

The following information is extrapolated from the ‘Vademecum mask usage’… draught up by the Association ASSO.FORMA and divulgated by Ministry of the Intern.

FFP2 MASKS
with VALVE: To be used in hospitals, intensive therapy units and infective diseases units. By doctors, GPs, rescuers, red cross members and similar positions. Doctors can place a surgical mask over an FFP2 with valve.
without VALVE: to be used by doctors, GPs, red cross rescuers and similar positions. Used by armed forces exclusively when working in emergency scenarios in support of medical staff. The mask must be paired with protective glasses and disposable gloves.

FFP3 MASKS
with VALVE: to be used in hospitals, intensive therapy units and infective diseases units. To be used by doctors, GPs, red cross rescuers and similar positions because more likely to be in contact with infected people.
without VALVE: to be used by armed forces exclusively when working in emergency scenarios in support of medical staff. The mask must be paired with protective glasses and disposable gloves.

SURGICAL MASKS
All civilians without exclusion, working people, armed forces, employees in public offices, foodstuff salespersons. As well as medical staff when not in their units to avoid the spread of infections.
In addition to these, people can wear homemade surgical masks made of heavy fabric to block droplets and liquids.

In the early days of the pandemic in Europe, we experienced the illogical reply to possible danger with people running to stock and stockpile on first necessity items. Among with loo rolls and UHT milk, soap and any kind of antibacterial products were the first to disappear from the shelves. The same happened online with PPEs, particularly, with surgical face masks with a massive increase in prices.

The use of surgical masks in daily life. Complete health guide to face masks — – My pandemic-style outfit for grocery shopping the safe way (ph. JP) –

‘Shu’ – Tiny Temple Project by Aakheperure (all rights belong to)

Not to be boring and repetitive: since this situation regards everyone, we must act accordingly. You’re free to decide but, if you don’t care about others’ health, and you’re instead moved by a selfish instinct for survival, then simply cover your mouth. Leave the technical masks to those in real need and wear a surgical mask (which is also cheaper)! If you can’t buy any, craft something with some equally cheap DIY. Every little step helps and talking about steps… stay at least 1 meter away from me, please!