National Journal of Clinical Anatomy

: 2021  |  Volume : 10  |  Issue : 1  |  Page : 1--4

Mask – A Ubiquitous Symbol of COVID-19 Scuffle

NB Pushpa1, Kumar Satish Ravi2,  
1 Assistant Professor, Department of Anatomy, JSS Medical College, JSSAHER, Mysore, Karnataka, India
2 Professor (Additional), Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Correspondence Address:
Kumar Satish Ravi
Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand

How to cite this article:
Pushpa N B, Ravi KS. Mask – A Ubiquitous Symbol of COVID-19 Scuffle.Natl J Clin Anat 2021;10:1-4

How to cite this URL:
Pushpa N B, Ravi KS. Mask – A Ubiquitous Symbol of COVID-19 Scuffle. Natl J Clin Anat [serial online] 2021 [cited 2023 Feb 6 ];10:1-4
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COVID 19 pandemic, the first major global catastrophe of this measure in 100 years, had devastating effects on humanity. The SARS-CoV2 virus of the Coronavirus family responsible for COVID-19 spreads from person to person through small respiratory droplets.[1],[2] The virus colonizes the mouth, nose, and oropharynx of the infected persons gets expelled out when they cough, sneeze, speak, or breathe heavily. These expelled small aerosols are likely to be inhaled and picked up by persons in close contact, especially when <1 m apart. An exposed person can pick up the infection by three possible mechanisms of respiratory pathogen transmission. Transmission can occur through self-inoculation after contact with droplets that settle on surfaces, direct deposition, or inspiration of infectious droplets in the mouth or nose, and deposition on the eyes, as well as through airborne transmission with inhalation of aerosols. Short-range (<2–3 m) aerosol transmission can be difficult to separate from droplet transmission, and long-range transmission for viral respiratory pathogens, including influenza and coronaviruses, remains controversial.[3],[4]

Apart from spreading through aerosols and droplets, COVID 19 is also thought to spread via touching the contaminated surfaces, fomites, etc. However, this is not the common mode of large-scale transmission as in the real-life scenario, the number of viral particles available on contaminated surfaces to transmit infection is much less. This was proved in a study in which the authors tried to mimic actual conditions in which a surface might be contaminated by a patient, no viable SARS-CoV was detected on surfaces.[5]

Since WHO and Centers for Disease Control and Prevention are yet to identify or endorse any specific or definitive treatment regimens, preventive measures such as maintaining physical distance, use of face cover (mask), hand hygiene, and good ventilation play key roles in helping a person to keep himself safe from COVID-19.[6]

Handwashing alone can decrease the risk of viral transmission by 55%. A mask can reduce the risk by 68% and with aforesaid measures combined with wearing gloves, risk can be further reduced by 91%.[7] Eikenberry et al., from their model study, also suggested that wearing masks by the general public can significantly reduce community spread and hence the death toll.[8]

Wearing of masks can bring down the chances of viruses entering the healthy person as droplets while also reducing the risk of expulsion from an infected person.[9],[10] Hence in this article, we concentrate on respiratory transmission by droplets and aerosols and its prevention by appropriate use of masks.

 Types of Masks

It is essential to be aware of the type of mask to be used in a health-care setting, community setting, and at home.

Respirator mask

Respirator masks are designed in such a way that they perfectly fit over the face and there is minimal chance of air escaping from the sides. They were originally designed for people who work in the mining, painting, and construction industries. They provide protection to the wearer against microbes, noxious substances, oil, and gas depending on how tightly the mask is woven and the electrostatic charge incorporated within them. Made of polypropylene material, they are of different kinds based on their ability to resist oil particles. “P” varieties are oilproof and need to be replaced often as pores get clogged by oil particles. They protect all sorts of solid and liquid particles. “R” type is somewhat resistant to oil particles. They also protect against solid and liquid particles. The above said masks are mainly used in industrial settings.

“N” type is not oil resistant. They protect the oil aerosol-free environment. They filter particles that are more than 0.3 μ in size (maximum size of the particle which can pass through the lung). Depending on their efficiency to filter the particulate material, they are called N95, N99, and N100 masks. N95 masks can filter 95% of the particles and N99 and N100 can filter 99% and 99.97% of the particles, respectively. Although coronavirus size ranges from 0.06 to 0.14 μ, they are easily trapped within this mask due to the exhibition of Brownian movement.[11]

Medical mask/surgical mask

Use of surgical masks dates back to the early 1990s. Initially, they were worn by surgeons to prevent contamination of open wounds of patients. Often referred to as a face mask, they do not cover the whole face. Surgical masks are meant to protect against large particle droplets, splatter/splashes. They reduce the risk of exposure to the other person from saliva and respiratory secretions that contain microbes expelled from the wearer to the immediate environment and also remind the wearer not to touch his/her mouth and nose, which, in turn, can transfer microbes from contaminated surfaces. Due to their loose-fitting nature and inability to filter very small particles, they do not provide protection against viruses and bacteria expelled out during coughing and sneezing.[12]

Surgical masks are made of paper or nonwoven material; hence, they are intended to be used only once and to be properly discarded after usage.[13] They are made of three layers, a melt-blown polymer (usually polypropylene, which acts as a filter and prevents penetration of pathogen in both directions), placed between nonwoven fabric. The outermost layer helps in repelling fluid droplets from the environment, whereas the innermost layer acts as an absorbent and traps the droplets from the wearer. To increase the surface area, to enable the wearer to cover themselves properly from nose to chin, they have been provided with pleats. These masks can be secured via head ties, ear loops, or elastic straps.[14]

Medical/surgical masks, to be called so, should have a minimum of 95% filtration rate with a droplet size of 3 μ and they are tested for American Society of Testing and Materials (ASTMs) five basic criteria, which are flammability, bacteria filtration efficiency (BFE) in vitro, breathing resistance, particle filtration efficiency, and splash resistance.[15]

Nonmedical mask

With the nonavailability of vaccines and proper treatment regimens, it is essential to follow preventive measures in the war against the new pandemic even at the community level. More than 50 countries in the world have made wearing masks compulsory in public spaces. Since every individual cannot avail and afford N95/medical masks, there is a huge requirement of easily available and affordable masks. Fabric/cloth masks meet the aforesaid criteria. Although they are not as effective as N95/medical masks, they help the person wearing it from contracting the infection in crowded places where social distancing is difficult to maintain. Ideally, it should have three layers of cotton/linen fabric. Two layers are tightly woven and the middle layer is a filter type fabric, preferably nonwoven polypropylene fabric. They can be prepared with a wide variety of materials available [Figure 1] and it has been established that a double layer of 100% cotton fabric is 70% effective in seizing minute particles. The best household materials are pillow covers and 100% cotton T-shirts. It is worthy to note that the doubling of masks increases the pressure drop and makes breathing difficult. The main advantage is that they can be washed and reused.[16] A manual has been released by the Ministry of Health and Family Welfare, Government of India, on how to make fabric masks at home using easily available cotton fabric as well as the methods of washing and sanitizing them.{Figure 1}

Vander Sande et al. in their experiments showed that both long-term protection (3 h) and short-term protection were best by filtering facepiece [FFP]-2 against particles, an N95 equivalent compared surgical and homemade mask. Not only the kind of fabric but also the design, fitness to the user's face, type of particle, and the velocity of exposure determine the efficiency of a homemade mask.[17]

Therefore, while homemade masks may not eliminate the disease, they can significantly control the transmission of disease in the light of a shortage of surgical/N95 masks.[7],[18]


The prolonged pandemic has inevitably resulted in a sudden surge in the requirement of masks, compelling the use of masks judiciously. While N95/surgical masks are a must for frontline health workers, reusable masks can protect the general public to some extent from infection. Acute shortage and absolute unpreparedness had compelled many nations to adopt desperate measures to decontaminate and reuse N95 masks. Decontamination measures include the use of hydrogen peroxide, ultraviolet (UV) rays, ethylene oxide, heat, and steam.[19],[20]

A recent study showed that the SARS-CoV-2 virus can remain infectious on the outer layer of the surgical mask even after 6 days.[21] Besides, even accidentally touching a surface for as little as 5 s can result in the transfer of some quantity of the infectious microbes to the hands. Disinfection of masks, especially reusable ones, is therefore crucial. Cloth masks may be disinfected by washing with detergents and bleach, whereas surgical and N95 masks can be best disinfected via hydrogen peroxide followed by UV or heat treatment.[22],[23],[24]

 Children and Mask

It is observed that all masks are less efficient in protecting children when compared to adults.[25] Children under 2 years should not wear masks and those between the age of 2–5 years can wear under proper supervision. According to WHO and UNICEF, older children are expected to wear masks based on the severity of virus transmission in the locality or if they are living with elderly and seriously ill patients. Children over 12 years of age are expected to wear masks like that of adults.[17]

 Safety Considerations

The negative effects of wearing masks in otherwise healthy individuals are negligible. Masks are effective only if worn properly. It does not interfere with tidal volume, oxygen, and carbon dioxide concentration in the blood. Often observed negative impact with prolonged use of masks is an increased frequency of development of headache in individuals with a known history of headache.[26]

Failure to cover the nose and mouth up to the chin will enable the wearer to get exposed to/expel the respiratory droplets. Hanging the mask from the ears, wearing on the chin, and sharing with others should be avoided. Repeated use of soiled masks should be avoided. In the case of single-use masks, they should be disposed of properly after use.[27]

With the emergence of a second wave of the pandemic, identification of new strains of SARS-CoV-2 and proper preventive measures are crucial to help protect people from the virus. Dreading the loss of approximately 80,000 doctors in due course of time after 5 years, the National Medical Commission has recommended the commencement of MBBS (Bachelor of Medicine and Bachelor of Surgery) classes for the current session from February 1, 2021. It is necessary to take all the preventive measures during this pandemic. In this regard, as stated before, along with proper hand hygiene and social distancing, use of face mask can contribute significantly in reducing disease transmission, thus making it a new norm of daily life. It is not only a matter of protection or prevention as, in the era of consumerism and a complicated human psyche, but the social and psychological impact also cannot be ignored.


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