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  • Face mask and visor use by the general public

Face mask and visor use by the general public

In situations with increased disease burden in society, advice or orders to use face masks may be given to reduce transmission.

In situations with increased disease burden in society, advice or orders to use face masks may be given to reduce transmission.


New national and regional measures

The Norwegian Government has adopted new national measures in effect from 3 December 2021 00:00 a.m. – our pages are being updated.

The Government is also introducing regional measures in several municipalities because of the situation. Please check your municipality's website for more information.

In situations with 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. Close face-to-face contact involves the highest risk. 

As a result of increased transmission, from 1 December 2021 the Government has introduced temporary national recommendations for the use of face masks in contact with the health and care service, as well as a national recommendation on the use of face masks on public transport, taxis, shops and shopping centres where it is impossible to keep a physical distance. The recommendations apply regardless of vaccination status.

For further information about the use of face masks in the healthcare service, see this article (in Norwegian):

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

Face masks and hearing impairment

Face masks make interaction difficult for people with impaired hearing.

If there is an order to use a face mask and it is necessary to remove the mask so that people with hearing impairments can more easily understand what is being said, recommendations or orders to use a face mask should not prevent this. Keep a distance if the face mask is removed to improve communication, 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, produced for use in the healthcare service.
  • Cloth face coverings are homemade or manufactured cloth face coverings 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, how the face mask is to be tested, and documentation required (NS-EN 14683: 2019 + AC: 2019).

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 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.

Respiratory protection

In the healthcare sector, respiratory protection is used in situations where there is a particularly high risk of being exposed to larger amounts of small droplets of infectious pathogens. Respiratory protection requires good adaptation and good training in use to ensure optimal effect. 

Respiratory protection is not recommended for use outside the healthcare service as protection against COVID-19.

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.

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.

After 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:

Posters:

Film:

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. 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.

Other advice:

  • 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 

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 to the face, is important for it to have the intended effect.

The best effect seems to be when contagious people use face masks, known as source control. The mask prevents the spread of large and small droplets from someone who is contagious. However, tiny droplets (aerosols) may 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 becoming infected for someone who wears a face mask because it prevents droplets from entering the mouth and nose and it filters out some of the smaller drops. However, aerosols can leak along the edge of the face mask if you are close to a contagious 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 asymptomatic individuals and where the purpose was to prevent transmission of COVID-19. An Evidence to Decision (EtD) framework was used to review the knowledge and prepare a recommendation. This report was updated in November 2020, see:

After the rapid review was published in November 2020, there have come many new publications, of which we will highlight two. 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.

Recently, Abaluck published the results of a large study from Bangladesh on the effects of face masks in society,

In August 2020, the Norwegian Institute of Public Health published a rapid review 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

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. 

There is insufficient evidence whether 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.

History

01.12.2021: • New national recommendations on the use of face masks in contact with the health and care service, as well as on public transport, in taxis, in shops and in shopping centres where it is not possible to keep distance. • Some linguistic changes and restructuring of the article

24.09.2021: Reference of face masks as infection control measures adapted to a normal daily life with increased preparedness. Removed section about on risk of infection and sections on the use of face masks for quarantine and home isolation.

15.02.2021: Updated section about correct use of face masks.

21.01.2021: New section about respiratory protection, updates to section about Use of face masks in areas with increased risk of transmission.

14.12.2020 Added sentence: These face masks should not have an inhalation or exhalation valve as this reduces their effect. 

27.11.2020 Added section about visors.

20.11.2020 General updates as per Norwegian version.