Fabric masks include a wide range of designs and materials but generally includes any kind of mask that is made from fabric or cloth (including scarves or other fabric that is wrapped around a person’s face covering their mouth and nose) or non-woven material (e.g. polypropylene, polyethylene, or cellulose, materials generally used in surgical masks). These are typically worn by the general population due to concerns around infection or pollution. These masks are not recommended for use by medical personnel as the holes in the fabric are large enough for viruses like SARS-CoV-2 to pass through. Fabric mask design varies widely in material, shape, and number of layers, which can affect performance characteristics. The French Standardization Association has developed a set of standards outlining minimum performance of fabric masks for filtration and breathability (blocks 70% of droplets and solid particles).
Who should wear fabric face masks?
The WHO does not currently provide guidance for or against the use of fabric masks by the general public. Instead, the WHO recommends that decisions regarding public masking (fabric masks or surgical masks if they are not in short supply) be made using a risk-based approach that considers the following factors:
Purpose of the mask: Is the mask intended to provide personal protection against contracting COVID-19 or is the mask used for ‘source control’ purposes (i.e. to prevent infected persons, particularly those who are asymptomatic, from transmitting COVID-19 to others by limiting the spread of potentially infectious respiratory particles from the nose and mouth). Fabric face masks may not provide high-level protection to the wearer against COVID-19 but can help contribute to ‘source control’.
Risk of exposure: This requires considering the prevalence of COVID-19 among the local population and the characteristics of transmission (for example, is the region experiencing small clusters of cases or widespread community transmission). Individual-specific risks based on lifestyles or employment need to be considered. For example, WHO notes that community health workers may have higher risk of exposure, or of exposing others, due to their frequent interaction with the public. Hygiene Promotion staff may be in a similar position. Fabric face masks could be recommended for these high-risk groups or in case of widespread community transmission.
Vulnerability of the local population and the individual to severe disease: Are certain known risk factors for COVID-19 common among certain populations (e.g. diabetes, cardiovascular disease, age).
Setting: In certain areas and circumstances it may be difficult to physically distance. In densely populated areas like slums or camp settings physical distancing may be difficult. Similarly, it may be more difficult to adhere to physical distancing recommendations in enclosed settings such as on public transportation. In the USA, the CDC has recommended that fabric face masks be worn by the general public when outside home, emphasizing the importance of face masks in situations where other public health precautions, such as physical distancing, are difficult (e.g. grocery stores). Other countries have adopted similar guidelines regarding the use of face masks in all or some community and public settings.
Feasibility: Availability and cost of masks should be considered as that may limit access in certain settings. However, the US CDC has described ways to use common household items like t-shirts and bandanas to create fabric face masks. See here. The availability of clean water and soap to wash fabric masks should also be considered.
The WHO provides a table of example scenarios where they apply their risk-based approach and indicate how to decide when surgical or fabric masks should be worn, by whom, and for what purpose. This video also summarizes WHO’s advice regarding the use of surgical and fabric masks. The pro-mask advocacy site MASKS4ALL documents country-level guidelines and recommendations for mask use.
For information on fabric mask use recommendations for children (defined as persons less than 18 years old), please see this section. To learn about safe and hygienic use of fabric face masks, please see this section. For our recommendations on the use of fabric masks for hygiene promoters please see this section. For information on why the WHO doesn’t recommend universal masking in all public spaces, please see this section.
Mask use should be combined with other measures like proper hand hygiene and physical distancing. Masks alone are not sufficient to prevent infection or reduce transmission.
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