KUALA LUMPUR: NON-MEDICAL cloth face masks or face coverings, which are gaining in popularity during the Covid-19 pandemic, may not be all what they are made out to be.
Although some may be fashionable, decorative and aesthetically pleasing, health experts said that the public should ensure the masks meet the Health Ministry's criteria to give maximum protection and were developed based on the latest World Health Organisation (WHO) guidelines to ensure effectiveness.
This came following the government's mandating of masks on public transport and crowded public spaces effective from Aug 1, where social distancing is impossible, to reduce the spread of Covid-19.
According to the ministry's guidelines, fabric masks require a minimum of three layers, where the innermost layer is in contact with the wearer's face and outermost layer exposed to the environment.
The ideal combination of material, it said, should include:
AN INNERMOST layer of hydrophilic material, such as cotton or cotton blends;
AN OUTERMOST layer made of hydrophobic material, like polypropylene, polyester, or their blends, which can limit external contamination from penetrating to the wearer's nose and mouth; and,
A MIDDLE hydrophobic layer of synthetic non-woven material, such as polypropylene or a cotton layer, that may enhance filtration or retain droplets.
Infectious disease consultant Datuk Dr Christopher Lee said reusable masks should not just be for decorative purposes or used as an accessory, but they should also be made according to the stipulated criteria.
Lee, who is the head of the National Covid-19 Mortality Review Committee and former deputy Health director-general (research and technical support), said although wearing any face covering was better than none, a three-layered mask was preferred.
"It doesn't matter if it's decorative or not, as long as the cloth mask is made of the right material. The selection of material is an essential first step as filtration and breathability vary depending on the fabric.
"The mask should cover the nose, mouth and chin, and fit snuggly on the sides of the face. It has to be washed daily when used, hence it is best to have at least two masks.
"A quick check of non-surgical fabric masks may be performed by attempting to breathe, through the mouth, and the multiple layers into your hand. You should not feel much wind."
Dr Lee said fabric masks might not be as efficient as surgical mask, but the focus was not on finding the perfect solution, but to minimise the risk of transmission.
Professor Dr G. Jayakumar of the Community and Occupational Medicine at the Faculty of Medicine in Melaka Manipal Medical College said three-layered fabric masks, if appropriately worn, would provide some protection against Covid-19.
He said improper use, like pulling them below the chin, frequently touching the masks, handling them with unsanitised hands or improper disposal creates a false sense of security to the user and might pose more harm to the user and the public.
"Do-it-yourself (DIY) masks should be of cotton material with multiple layers of fabric that allow users to breathe easily and have to be easily laundered and machine-dried.
"Each layer of the masks has specific relevance in the prevention of transmission of droplets from the user. The respiratory system in a healthy individual can filter minute particles of up to 10 microns.
"Viruses are minute particles of less than one micron in size. Filtering layers within the masks are the most important aspects for filtering the minute particles."
He, however, said the use of a mask was insufficient to provide an adequate level of protection (to the healthy wearer against infection) or source control (preventing the infected wearer from transmitting the virus to others).
He said other precautionary measures should also be adopted, like social distancing and maintaining good hygiene and proper cough etiquette.
"Children under two years, individuals who have respiratory or heart ailments with a history of breathing difficulty must refrain from wearing masks.
"People who are incapacitated, mentally or physically challenged, who cannot remove masks on their own are also advised not to wear masks."
Malaysian Public Health Physicians Association president Datuk Dr Zainal Ariffin Omar said masks could be a trendy tool that reflected people's positive behaviour in understanding the infection, as well as proper cough and sneezing etiquette.
"It is a good sign when it is becoming trendy, but they should follow proper specifications."
Deputy Health Minister Datuk Dr Noor Azmi Ghazali said the government allowed decorated fabric masks as they had become the preferred choice.
He said the ministry would announce details of the specifications and types of face masks that could be worn, and guidelines on how to use and dispose of them.
"It is more important to emphasise the proper use of masks and how to dispose of them."
Fabric masks are recommended for those with no breathing difficulties, workers and people in public areas.
Three-ply surgical masks are recommended for healthcare workers, people with any symptoms suggestive of Covid-19, and vulnerable people, including people aged 60 and above and those with underlying comorbidities.