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Does a fabric mask provide enough protection against COVID-19? Experts weigh in

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As the weather cools and COVID-19 restrictions continue to ease in some areas of the country, Canada's chief public health officer has advised Canadians to opt for a mask that offers the best quality and fit.

"The same as vaccination provides us with an essential base layer of immune readiness protection, masks are an essential top layer against virus inhalation and spread between people," Dr. Theresa Tam said during a press conference on Friday.

"Heading into the winter, there are many reasons to ensure that our top or outer barrier layer of protection is of the best quality and fit possible. With the highly contagious Delta variant continuing to predominate, the risk for surges and disease activity is likely to increase with more time spent indoors, particularly where there are pockets of low vaccine coverage."

Tam warned of slight "turbulence" amid rising new COVID-19 cases. Approximately 2,500 new cases were reported each day on average over the previous week, representing an 11 per cent increase.

Tam pointed to evolving evidence on how SARS-CoV-2 — the virus that causes COVID-19 — acts, namely that it can remain suspended in air in poorly ventilated areas, similar to second-hand smoke.

Although severe illness remains stable, Tam advised that infections need to be kept down in order to prevent increases, along with other protectionary measures such as proper hand hygiene and avoiding crowds.

Asked about mask-wearing on CTV News Channel in recent days, several experts agree that Canadians should opt for a medical or surgical mask as opposed to a cloth one, and make sure to wear them properly.

GETTING THE BEST POSSIBLE MASK

Dr. Ronald St. John, former director-general of the Public Health Agency of Canada's Centre for Emergency Preparedness and Response, told CTV News Channel on Friday that while vaccination rates remain high — about 85 per cent of those 12 years of age and older are fully vaccinated in the country — that alone is not sufficient to stop all transmission.

John said masks range in effectiveness, from the common light-blue medical masks to those used in operating rooms.

"It's just not practical for ordinary citizens to be walking around in operating room masks, so the idea is to get the best possible mask even if it's the light-blue one, but wear it correctly," St. John said.

"Make sure the little metal band is pressed around your nose and it's tucked under your chin, including covering your facial hair and so forth. That's going to be a major deterrent for transmission. If you can get an N95 mask, even better, but it's harder to breathe through an N95 mask, so it's balancing out risk."

Dr. Dale Kalina, an infectious disease specialist at Joseph Brant Hospital in Burlington, Ont., told CTV News Channel on Friday that he uses disposable hospital-grade masks at work, but also wears disposable masks at home. He says they filter out the vast majority of pathogens, fit well and are easier to breathe through than most fabric-based ones.

He said many countries, particularly in western Europe, are recommending the disposable KN95 masks, different from the N95 that needs to be fitted.

"As many have said before, including Dr. Tam, it is important to get a mask that fits really well around your face and doesn't have large gaps," he said.

THE EVOLUTION OF MASK MESSAGING

The use and mandating of masks, along with their effectiveness, have remained controversial for some dating back to the early days of the COVID-19 pandemic.

The Centers for Disease Control and Prevention in the United States at one point did not recommend mask-wearing for those who are well, advice that was echoed, as well, by the Public Health Agency of Canada (PHAC).

Tam herself at one point talked about the potential negative aspects of mask-wearing, such as a false sense of confidence.

"But also, it increases the touching of your face. If you think about it, if you've got a mask around your face sometimes you can't help it," she said during a press conference on March 30, 2020.

People's understanding of the virus and of masks has since changed, with evidence showing that the virus can be transmitted by people who are infected whether they show symptoms or not, with most transmission occurring indoors. Many jurisdictions also have mandated mask-wearing in certain areas to try and limit the spread of COVID-19.

Health officials also have stated that fully-vaccinated individuals can still be infected and transmit COVID-19, although this is much less likely, as is the chance of serious infection, compared to those who are unvaccinated or partially vaccinated. There also is evidence that vaccine protection may wane in some instances.

However, PHAC now notes that "when layered with other recommended public health measures, a well-constructed, well-fitting and properly worn mask can help prevent the spread of COVID-19."

Specifically, the agency says masks can help contain an individual's own respiratory particles and prevent or reduce the amount of infectious particles a person inhales, especially if a mask is well-made and fits properly.

On CTV News Channel on Friday, Dr. Kashif Pirzada, an emergency room physician based in Toronto, described wearing the right mask as akin to a "superpower," providing "ultimate" protection in an indoor space where the virus may be floating around.

On masks, Dr. Kwadwo Kyeremanteng, an intensive care unit and palliative care doctor based in Ottawa, told CTV News Channel on Saturday that people who may still be worried about getting COVID-19, such as those who are older or have comorbidities, may want to think about the quality of their face coverings or situations where the risk of transmission may be higher.

Commenting on mask-wearing Friday, Cynthia Carr of Epi Research Inc. in Winnipeg cautioned people to not let down their guard and just "slap" on a mask and let it come loose.

"It needs to be a well-fitted mask, it needs to be clean and you need to wear it consistently and not kind of pull it down below your nose every now and then. That is a risk and we should not be doing it," she said.

Dr. Christopher Labos, a cardiologist and epidemiologist based in Montreal, also said Friday that because supply is no longer much of an issue, he said the best quality mask most people need is a surgical one, while a well-manufactured cloth mask with a filter in between might also be a reasonable alternative.

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