European Countries Start Recommending High-Filtration Masks – Over ‘Artisanal’ Cloth Variants 
Doctors putting on N95 respirator masks, face shields, gloves and gowns before entering a COVID-19-positive patient’s room in August in San Diego, US.

In the midst of the spread of new SARS-CoV2 virus variants, several European countries have updated their guidance and regulations on masks, to recommend the use of high-filtration medical-grade masks over fabric ones in confined settings. 

France’s health advisory council (Haute Conseil de la Santé Publique) issued new recommendations last week, warning against the wearing of certain homemade masks due to the insufficient protection provided from the more highly transmissible COVID-19 variants. 

“Artisan masks that you make at home, with the best intentions in the world [and] respecting the official advice, do not necessarily offer all the necessary guarantees,” said French Health Minister, Olivier Véran, in an interview with France Inter

Joining Germany and Austria, France appears set to recommend Category 1” masks, which filter over 90% of particles, for use people are in close contact with others. Category 1 masks includes FFP2 filter masks, or their N95 or KN95 equivalents, as well as single-use surgical masks, and certain fabric masks with high filtration levels, France said.

Fabric masks, included under Category 2, only capture approximately 50% to 60% of all respiratory aerosols. 

A study published in The Lancet in June found that N95 masks and masks with similar levels of filtration are associated with a larger degree of protection from viral infection in comparison to reusable cotton masks. These results were supported by a study conducted by Duke University. 

Surgical masks are three times more effective in preventing droplet transmission than homemade fabric masks, found a 2013 study conducted by Public Health England, a UK governmental health agency. The study advised against the use of homemade masks if a supply of commercial surgical masks is available. 

In light of the data on the degree of mask protection and the more highly contagious variants, “the high council for public health recommends, as do I, that the French do not wear masks they have made at home,” Véran said. 

The recommendation has yet to be enforced and officials are expecting some issues with its implementation. 

German and Austria Have Already Tightened Mask Regulations

Germany and Austria have already tightened mask regulations, mandating the use of medical-grade masks – N95, KN95, FFP2, or surgical masks – on public transportation and in supermarkets. 

“If the virus becomes more dangerous, the mask has to get better,” said Markus Söder, the Minister President of Bavaria, Germany’s largest state and the first to begin implementing the new mandate. 

Production of FFP2 masks is scaling up in Germany, but some experts worry that prices could rise if suppliers are unable to meet the new demand. The government has aimed to provide 15 FFP2 masks to 34.1 million citizens over the age of 60 or with a history of illness by the end of January. 

Health officials in Europe are approaching the new mask guidelines differently. While Germany is requiring FFP2 equivalent masks, French health authorities have discouraged the public from using FFP2 masks, which are high grade fitted masks, because they are difficult to wear correctly.

“In most cases FFP2 masks will be ineffective if they aren’t professionally fitted: people will end up breathing through the gap between the mask and face rather than through the designated filter,” said Jonas Schmidt-Chanasit, a Professor of Arbovirology at the University of Hamburg, in an interview with the Guardian

United States Experts Begin Touting “Hi-Fi” Mask Alternatives – But US CDC Yet To Update Guidance 

In parallel to European counterparts, a group of Harvard University experts have also proposed a United States “Hi-Fi” initiative to promote public use of higher quality N-95 or KN-95 masks that can protect more effectively against COVID-19 variants.

As a cheaper alternative, some experts, including US President Joe Biden’s Chief Scientific Advisor Anthony Fauci, are recommending wearing a double mask combination- a surgical mask and a cloth mask, if N95 or FFP2 masks are not available. The combination of two masks, if they fit well, could provide a filtration efficacy rate over 90%. 

Fauci, Director of the National Institute of Allergy and Infectious Diseases, could be seen sporting such a combination at the US President’s Inauguration last week.  He later said that wearing a double mask “likely does” provide more protection. 

“If you have a physical covering with one layer [and] you put another layer on it, it just makes common sense that it likely would be more effective. That’s the reason why you see people either double masking or doing a version of an N95,” Fauci told NBC News on Monday. 

Dr. Anthony Fauci, Director of the National Insitute of Allergy and Infectious Diseases, speaking on COVID-19 virus variants and mask wearing.

Despite increasing moves towards medical-grade masks, the US Centers for Disease Control and Prevention (CDC) has so far stuck to its existing guidelines. The CDC continues to recommend the use of masks made with tightly woven fabrics with two or three layers and discourages the public from using medical masks and N95 respirators in order to reserve them for healthcare personnel. 

WHO Also Sticks to Fabric Masks For General Public

The guidance provided by WHO also continues to recommend only fabric masks for the general public under the age of 60 and without underlying health conditions. It advises the restriction of medical masks to people over age 60, those with certain health conditions, including chronic respiratory disease, cardiovascular disease, cancer, diabetes, and immunocompromised patients, and health care workers.

Image Credits: Flickr – County of San Mateo, Flickr – Navy Medicine, NBC.

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