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Face mask and visor use by the general public
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With a high disease burden in society and where it is difficult to keep a safe distance, face mask use can be a measure to reduce the risk of transmission. Face masks cannot replace other infection control measures, but come in addition. Both local and national advice or orders can be introduced, based on the current infection situation.
From 12.02.2022, there is no national requirement for the use of face masks. Face masks are recommended to reduce the risk of infection in people at increased risk of a severe disease course:
- People with colds or respiratory tract symptoms are advised to use a face mask in close contact with people in risk groups.
- People in risk groups and unvaccinated people are advised to wear face masks among people during periods of widespread transmission if it is difficult to keep their distance from others.
For further information about the recommended use of face masks and other protective gear in the healthcare service, see this article (in Norwegian):
Groups who are not recommended to use a face mask
The following groups are not recommended to use a face mask:
- Children under 2 years should not use face masks as they can interfere with their ability to breathe.
- People who are unconscious or have a reduced state of consciousness, or for other reasons are unable to remove the face mask themselves.
- Children under 12 years are not recommended to use face masks.
Others who for medical or other reasons may be exempt from using face masks include, for example, people who:
- have a chronic heart and / or lung disease
- have an illness or condition that causes impaired cognitive function, or where the use of a face mask would be a major mental strain
- interact with people with impaired hearing
Face masks and hearing impairment
Face masks make interaction difficult for people with impaired hearing.
Face masks can be removed so that people with hearing impairments can more easily understand what is being said. Keep a 1 metre distance if possible.
Medical face masks and cloth face coverings
We distinguish between medical face masks and cloth face coverings:
- Medical face masks are disposable face masks.
- Cloth face coverings are homemade or manufactured and are made of textiles or other washable materials.
Medical face masks
Medical face masks are defined as medical devices. National and European regulations set requirements for such face masks. The requirements include degree of filtration, breathability, splash resistance, testing methods and documentation required.
Cloth face coverings
Cloth face coverings are not medical devices and are not covered by formal regulations. However, the European standardisation organisation (CEN) has prepared a document with guidance on minimum requirements, test methods and how coverings can be used.
There are requirements for filtration ability and breathability, design, size and washability. There are two classes for cloth bandages based on their filtration ability, which must be at least 70 or 90 per cent of particles of around 3 micrometres. By comparison, medical face masks type II and IIR must have a filtration capacity of at least 98 per cent.
For use outside the health service, the Norwegian Institute of Public Health recommends either medical face masks, or cloth face coverings that meet the requirements of CEN. These face masks should not have an inhalation or exhalation valve as this reduces their effect. If there is a shortage of medical face masks, these should be reserved for the health service. The Norwegian Institute of Public Health does not recommend the use of cloth face coverings in the health service.
Face masks are also used in the health sector as protection against COVID-19. In some cases, respiratory protection is recommended instead. These are situations where health personnel is runs a high risk of being exposed by larger quantities of aerosols carrying infectious agents.
Respiratory protection differs from medical face masks by the way it filters the smallest aerosols. When correctly fitted, it sits tighter around the nose, mouth and chin than a face mask. This leads to less leakage around the rims, while a larger share of the air one breathes in and out, will filter through the mask.
There are several reasons why we still recommend medical face masks for protection against COVID-19. While laboratory studies find an increased effect using respiratory protection rather than medical face masks, studies also find that in practice there is no clear difference when it comes to levels of protection against patients with respiratory tract infections such as influensa and coronavirus. One exception is in situations where the exposure is high, for example when performing medical procedures in the patient's respiratory tract.
Experience shows it is difficult to find respiratory protection that fits well, which often leads to leakage around the rims and reduced effect. In addition, respiratory protection is demanding to use over time. Due to the material's density, it is often hard to breathe when it is correctly fitted. For this reasons, the Norwegian Labour Inspection Authority recommends use for a maximun of one hour without a break and a total of three hours per working day. Normal challenges connected to such use over a longer period of time is difficulty breathing, dizziness, headache and skin problems. Some people should not use respiratory protection due to underlying conditions.
There are several different kinds of respiratory protection intended for different kinds of exposure risk. There are masks which protect against particles (including bacteria and viruses), against gases, and those that protect against a combination of the two. It is important to note that respiratory protection intended to protect agains gases does not protect against particles, and vice versa.
Correct use of face masks
For the face mask to have a good effect, it is important that it fits snugly around the edges and covers the mouth and nose well. In this way, you ensure that as much of the air you breathe in and out is filtered through the face mask, and does not leak out the sides.
The inside of the face mask can be contaminated during use if you are infected. The outside can be contaminated with infectious pathogens from others. Therefore, you should touch face masks as little as possible.
How to put on a face mask:
- Wash hands or use hand disinfection.
- Put on the face mask with the lighter coloured side nearest the face.
- Fasten the face mask with the elastic around the ears, or around the head if it has a tie.
- Press the noseband down on each side of the bridge of the nose and pull the face mask firmly down under the chin.
- If you wear glasses, wear these on top of the face mask.
- Touch the face mask as little as possible during use.
- Remove the face mask, preferably only touching the elastic / ties
- Dispose of the face mask as normal waste (keep the cloth face covering in a bag until it is washed).
- Wash hands or use hand disinfection.
See the film or download the posters:
- Correct use of medical face masks and cloth face coverings - posters with illustrations for download
- How to use a face mask - poster with text and illustrations
- Information about the use of face masks in other languages - posters and information letters in many languages
Re-use of face masks
- Medical face masks should not be re-used.
- Cloth face coverings can be re-used after washing, and should be able to withstand repeated washes at minimum 60 degrees. Use regular washing detergents, but not softeners.
- Clean cloth face coverings must be stored separately from used ones.
- In situations where a face mask must be used several times in a short time, it is recommended to use a new or clean face mask each time. If you touch the part of the face mask that filters the air with unclean hands, infectious pathogens can be transferred to / settle on the face mask and the risk of infection increases. It is especially important not to reuse face masks that have become damp or soiled.
Cleaning of face masks
Some cleaning methods are not recommended, either because there is insufficient documentation on virus inactivation or because they can reduce the textile's filtering ability:
- Freezing. The virus can survive at very low temperatures.
- Boiling. May affect the filtering ability of the textile.
- Dry cleaning. The process can leave harmful substances in the textile.
- Unused. If time passes between each time the face mask is used, viruses may be inactivated. However, laboratory studies have shown that the virus can survive from hours to days, depending on temperature, humidity in the room and material in the face mask. It is therefore not known how long the face mask must remain unused before it can be safely re-used.
Knowledge base and reports
There are limited studies on the preventive effect against COVID-19 when using face masks in society. Overall, the research indicates that it has some effect. Correct use, such as ensuring that the face mask covers the mouth and nose and sits tightly, is important for it to have an effect.
The best effect is when contagious people use face masks. The mask prevents the spread of large and small droplets from someone who is contagious. Some of the tiny droplets (aerosols) will leak out from the sides of the face mask, and you can become infected if you are close to a contagious person.
The face mask also provides protection against being infected for the person using it, because it prevents droplets from entering the mouth and nose. However, aerosols can leak in around the edges of the face mask if you are close to an infected person.
Face masks also have a signal effect, and can act as a reminder of the risk of transmission in society.
In June 2020, the Norwegian Institute of Public Health prepared a rapid review of the knowledge about the effect of face masks. The review concerned the use of face masks among people without symptoms and where the purpose was to prevent transmission of COVID-19. This report was updated in November 2020:
- Should individuals in the community without respiratory symptoms wear facemasks to reduce the spread of COVID-19?
In August 2020, the Norwegian Institute of Public Health published a rapid review with advice on the use of face masks in public. The report describes situations where it may be relevant to recommend face masks to the general public, and the advantages and disadvantages of recommending the use of face masks in such situations:
- Bruk av munnbind i befolkningen blant personer uten kjent eller mistenkt smitte med covid-19 [in Norwegian]
In June 2021, the Norwegian Defence Research Establishment conducted a large literature study on the effect of medical and non-medical face masks used both as source control and respiratory protection.
- Efficacy of face masks as source control and respiratory protection against transmission of SARS-CoV-2
In September 2021, the results from a large study from Bangladesh on the effects of face masks in society were published:
Visors can prevent large droplets that are thrown out of the mouth and nose of people who speak or shout enter the mouth, nose and eyes of people standing nearby.
There is insufficient evidence whether visors alone provide good protection against respiratory viruses such as the new coronavirus. Therefore, we cannot recommend that visors can replace the use of a face mask.