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Face mask and visor use by the general public
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In situations with high infection burden in society and where it is difficult to keep a safe distance, face masks can be recommended as part of the measures to reduce the risk of transmission. Face masks may be used in addition to, but not replacing, other measures.
In the regulations, there is a national requirement for face mask use by people in quarantine who must use public transport, and recommendations for their use in connection with quarantine and isolation. In addition, local recommendations or orders may be issued regarding the use of face masks in municipalities with a high risk of transmission.
General about measures and risk of COVID-19
The most important measures to prevent infection with the SARS-CoV-2 virus are to stay at home in case of illness, to keep at least 1 metre distance from others and to practise good hand hygiene and cough etiquette.
Close face-to-face contact involves the highest risk. Standing back to back, or behind each other as in a queue, gives less risk of infection.
When sitting or standing next to someone, there should be at least 1 metre distance from your shoulder to the other person's shoulder.
People can pass each other without a particular risk of transmission and the recommendations do not apply in these situations.
Medical face masks and cloth face coverings
We distinguish between medical face masks and cloth face coverings:
- Medical face masks are disposable face masks produced for use in the healthcare service that meet current standards.
- Cloth face coverings are homemade or manufactured cloth face coverings made of textiles or other washable materials.
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, how the face mask is to be tested, and documentation required (NS-EN 14683: 2019 + AC: 2019).
Cloth face coverings are not medical devices and are not covered by formal regulations. However, the European standardisation organisation CEN has prepared an agreement document with guidance on minimum requirements, test methods and how coverings can be used (SN-CWA 17553: 2020).
The agreement specifies 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 µm (3 micrometres). In 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 the European agreement document for cloth face coverings (SN-CWA 17553: 2020). 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.
In the healthcare sector, respiratory protection is used in some situations and against microorganisms that are spread by airborne infection. For protection against SARS-CoV-2 it is used mainly in a few procedures (aerosol generating procedures).
Respiratory protection is not recommended for use outside the healthcare service as protection against COVID-19. As COVID-19 is believed to be primarily transmitted by droplet infection, face masks are considered a simpler, less expensive, more accessible and more appropriate measure and provide adequate protection. Respiratory protection requires good adaptation and good training in use to ensure optimal effect. There are also a number of people who, for health reasons, should not use respiratory protection without consulting their own doctor, for example people with heart disease or reduced lung capacity.
Respiratory protection is also, as a result of the COVID-19 pandemic, a scarce commodity in the world. They should therefore be reserved for the health service in situations where it is considered necessary to protect ensure good protection, such as in aerosol-generating procedures.
Use of face masks during quarantine and isolation
People in quarantine after arriving in Norway can use public transport from the point of arrival to the place of quarantine, and the same if they leave Norway during the quarantine period. People in infection quarantine may be allowed to use public transport to reach a suitable quarantine place only after an assessment by the municipal medical officer. Then people over the age of 12 years shall wear a face mask on public transport.
People who are in home isolation because they have COVID-19 (confirmed or probable) should use a medical face mask when they are closer to other household members than 2 metres, if their health condition allows it. Alternatively, household members can wear medical face masks when they are closer to the infected person than 2 metres.
Use of face masks in areas with increased risk of transmission
In municipalities with increased or high infection burden, it may be relevant - in situations where it is not possible to maintain at least 1 metre distance - that the municipality recommends the use of face masks. Some examples of situations where it may be relevant are: on public transport and in taxis, indoors in public places such as shops and shopping centres, in doctors' offices, in businesses with one-on-one contact (hairdressers, etc.).
Each municipality gives recommendations or orders for the use of face masks there. The process is described in the Municipal Medical Handbook Step 5. Measure assessment, and in the Municipal Medical Handbook Appendix 1. Measure packages for each risk level, measures are proposed that may be relevant at different risk levels.
For nursing homes, separate advice is given. The specialist health service provides its own advice for its activities.
It is important to familiarise yourself with the recommendations on the use of face masks that apply to the area in which the individual resides.
Groups that may be exempt
Not everyone can use a face mask, for medical or other reasons, including the following groups:
- Children under 12 years are not recommended to use face masks.
- 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.
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
Correct use of face masks
It is important to have clean hands when you put on and remove the mask. 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.
For many, it can be challenging to get the face mask to fit snugly around the entire edge. If you use a face mask with elastic around the ears, try tying a knot on the elastic so that the loop is smaller and the mask will then sit tighter. It is also important to adjust the face mask well over the bridge of the nose by pressing down on each side of the noseband, and by pulling the face mask well under the chin. Products are available (straps) that can be used to tighten the face mask. Some studies have been published that show it is possible to improve the fit by using a cloth face covering on top of a medical face mask. However, if you use the face mask in the recommended way, it is not necessary to use two. If you choose to use two face masks, make sure that you handle both in the recommended way, and that be aware that breathing resistance may become greater.
Face masks can become contaminated during use. The inside can be contaminated if you are infected. The outside can be contaminated with infectious pathogens from others. Therefore, you should touch used face masks as little as possible, and perform hand hygiene after touching them.
How to put on a face mask:
- Perform hand hygiene.
- 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).
- Perform hand hygiene.
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, but extended use can be considered in a shortage situation.
- 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. Do not use detergents that can be harmful to health.
The following 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 possible to advise how long the face mask must remain unused before it can be safely re-used.
- 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.
Risk of re-using face masks
Re-using a face mask may increase the risk of you becoming infected, but also increases the risk of you infecting others, to a limited extent. If you still choose to re-use a face mask without cleaning it, the following is important:
- Wash or disinfect your hands before and after you put on and take off the face mask.
- Avoid touching the face mask, only touch the elastic / ties and the outer edges, e.g. when pressing down the noseband.
- Store the face mask in a clean, resealable bag. Do not put clean and used face masks in the same bag.
- Use the same side towards the face.
- Do not re-use face masks that may have become contaminated because you or others have touched the part that filters the air with unclean hands, i.e. with hands that have not just been washed or disinfected.
Knowledge base and reports
In June 2020, the Norwegian Institute of Public Health carried out a rapid review about knowledge about the effect of face masks. The review applied to the use of face masks among asymptomatic individuals and where the purpose was to prevent the spread of COVID-19. An Evidence to Decision (EtD)-framework was used to evaluate the knowledge and produce a recommendation. The report was updated in November 2020, see:
- Should individuals in the community without respiratory symptoms wear facemasks to reduce the spread of COVID-19? – Update 1
In August 2020, the Norwegian Institute of Public Health published a report (in Norwegian) with advice on which situations 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.
Visors will be able to prevent large droplets that are thrown out of the mouth and nose of people who speak or shout landing directly on the mucous membranes in the mouth, nose and eyes of people standing nearby. However, the visor does not protect against smaller droplets that can be inhaled by others nearby, or against droplets from the side.
There is insufficient evidence that visors alone provide good protection against respiratory viruses such as the new coronavirus. Therefore, we cannot recommend that the use of a visor alone can replace the use of a face mask to prevent potential transmission.