I'm a Doctor and Here's When You Can Safely Keep Your Mask Off

We all want to get rid of the COVID-19 virus, right? So why are so many people reluctant to consistently wear a face mask? There still seems to be a lot of confusion and uncertainty around the issue. According to a July Gallup poll, only 44% of Americans say they "always" wear a face mask, and 28% say they do it "very often," while 14% say they "never" wear one.

Perhaps compliance would be higher if more people knew the answers to some key questions. Like, just how useful is wearing a face mask? When can you take it off? Will wearing a mask stop you or someone you love from becoming infected with COVID-19? How does using a face mask stop the virus from spreading? I'm a doctor and suggest we quickly go through this step-by-step. Read on, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.

As a doctor, I can say it's not just one big rumor. Authorities such as the CDC and WHO—those we trust to review the medical evidence and make rules to help keep us safe—are saying we need to wear masks to beat the virus.

In April, the CDC issued a recommendation that you should wear a mask when not at home, when mixing with people who do not live in your household, or in situations where social distancing is difficult. (This does not apply to children under age 2, or babies.)

In June, WHO recommended that everyone should be encouraged to wear face masks in places where there is increased risk of community transmission.

America's top infectious disease experts for more than 30 years, Dr. Anthony Fauci, never gives an interview (and he gives them a lot) without stressing how crucial wearing face mask is for our health and for stopping the pandemic.

There are three types of face masks:

• Face coverings. Cloth face coverings, often homemade, which loosely cover the nose and mouth. Homemade face coverings should be constructed of nonstretchy cotton or polycotton fabric, with a minimum of three layers in a duck-billed or close-fold' design. It should cover the mouth, nose, cheeks, and chin.
• Medical face masks. These are medical masks usually worn by healthcare professionals as part of their everyday duties. They are a type of PPE and use should be reserved for use in clinical/hospital settings.
• Medical face masks/formal PPE. These are part of Personal Protective Equipment (PPE) worn by medical staff (for example, the N95 respirator mask). These masks are designed to seal tightly around the nose and mouth. The use of these masks is reserved for dealing with patients at high risk of COVID-19 infection, or who are known to be infected, and should only be worn by medical staff.

Face masks do two things.

• Containment. If you're infected with COVID, masks provide a barrier to the viral particles you breathe out, which reduces the chance of you passing the infection to another person.
• Protection. Masks help stop you from breathing in virus particles, reducing the chance of you becoming infected.

Masks are better at containment than protection. Here's the problem: We have no idea who may be infected. Eighty percent of people with COVID-19 have no symptoms and are unaware they're infected. Those who go on to develop symptoms are often most infectious in the early days of their infection while they're still asymptomatic.

This is why wearing masks is a particularly useful tool to stop infected people from unknowingly infecting others.

RELATED: 7 Side Effects of Wearing a Face Mask

New evidence is emerging all the time about the effectiveness of face masks. Did you know you are less likely to become infected with COVID-19 if you wear a mask within one-and-a-half feet of an infected person than if you don't wear a mask and are six feet away?

• A simple washcloth over the mouth prevents respiratory droplets. In a recent (April 2020) study in the New England Journal of Medicine, the number of respiratory droplets produced during normal speech were almost completely obliterated by covering the mouth with a damp washcloth.
• Countries where mask-wearing is mandatory have lower death rates. A recent (June 2020) research study compared the death rate from COVID-19 infection in 194 countries. They found a statistically significant lower death rate in countries where mask-wearing was compulsory. The death rate increased by 8 per week in those countries who had mandated the use of masks, compared to an increase of 54% in those which had not.
• Mask-wearing by a COVID-19 positive passenger on a flight protected other passengers. In one interesting case report, a man who had symptoms and subsequently tested positive to COVID-19 flew from Wuhan, China to Toronto. He wore a mask for the whole flight, and none of the 25 people seated within six feet of him or in the rows around him tested positive after active monitoring and testing at 14 days.
• If 80% of people wore masks, it would help contain the spread of the virus more than going into lockdown, the Population Research Institute says.
• And if 95% of the public wore masks, it would prevent 33,000 deaths by October 1.

You might think you need a medical mask for ultimate effectiveness, but recent research shows a simple cloth mask provides an excellent reduction in the number of exhaled respiratory droplets.

A recent study published in the journal Science Advances compared the ability of 14 different face masks to filter out respiratory droplets during speech.

• The best filtration was seen with use of a medical, fitted, N95 respirator mask (transmission fraction 0.1%). This kind of mask does not contain a valve.
• The worst performing mask was a fleece mask, with a transmission fraction of 110% — a higher rate of transmission than wearing no mask at all!
• Polycotton and cotton masks had a similar reduction in transmission to an N95-valved respirator mask (the valve is fitted to allow inhalation and exhalation). The transmission fraction of these was between 0.2% to 0.4%.
• The most poorly performing mask was a bandana. Wearing a gaiter around the neck and pulling it up and down to cover your nose and mouth, seems to encourage larger respiratory particles to break into smaller ones.

Follow these simple tips to make sure you get the best protection from your mask.

• Have your own mask and do not share it or borrow one from anyone else.
• When you remove your mask, don't touch the front of the mask—lift it off from behind.
• Fold the mask and keep it in a clean bag or container.
• Wash your hands after removing it.
• Wash your mask frequently with hot soapy water.
• Don't forget to continue to wash your hands regularly and practice social distancing. The mask will not protect you unless these other steps are followed.
• Try to avoid touching your face or eyes.
• If you can't wear a cloth mask, you could opt for a face shield instead.

RELATED: 17 Mistakes You're Making With Face Masks

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In general, face masks are for everyone, except for babies or small children younger than 2.

The CDC also says that masks should not be worn by "anyone with trouble breathing," or "anyone who is unconscious, incapacitated, or who would not be able to remove the mask without assistance."

Each state has produced its own guidance about exemptions. For example, the New York City Health Department (NYC) have stated "there is no need to wear a face mask if you have a health issue that makes you unable to tolerate one." (However, they do not stipulate what these health conditions might be.)

There are very few people who cannot wear a mask because of chest or lung conditions. One US respiratory physician, David Kaufman, though not unsympathetic, commented, "If you can wear a headscarf, you can wear a face mask!"

Other respiratory specialists have said that if breathing becomes too difficult when you apply a cloth face covering, it would probably be better for you to stay at home. If your condition is this delicate, you're at exceptionally high risk if you develop COVID-19 infection.

Some people might find it difficult to wear a mask because of mental health issues. If you find wearing a face mask difficult for this reason, here are some tips on how to get used to it. If you can't tolerate a face mask, could you manage a face shield?

RELATED: 9 Side Effects of Wearing Face Masks

While wearing a mask is one of Fauci's fundamentals, there are times when you can take them off safely. "When I see people out on a beach running with nobody around them, good for you, you know, do it. You don't need to be locked down outside," he said. However, if there are a lot of people around, mask up. "If you think you're going to get close to people, you know, flip a mask on. But if you're walking with your dog or your wife or husband or somebody that you're in the house with anyway, and you're not going to stay separated from them and then just do it." He also explained that there is no need to go to extremes. "You could see your friends," he points out. "I mean, what I do myself right now, I'm very careful about wearing a mask, but every evening, and it's now late at night, because when I go home, my wife and I, we go out for a four mile jog, power walk, whatever you want to call it. And I do this," he explained, pulling his mask down around his chin. "It's like this. And I'm chatting with her. If I see 50 yards ahead, someone coming, I go like that," he continued, pulling his mask back over his face. "We pass them. 'Hello. How are you?' And then I'm outside. You can do that. You can do that."

Using a face shield made of clear plastic may seem to be an attractive alternative to a mask, but these don't seem to be as protective.

Face shields do have some advantages: They cover your eyes, can be re-used indefinitely, are easy to keep clean, and communication is easier than with a mask.

However, research suggests that in certain situations—for example, if someone coughs directly in your face, if you're wearing the shield at work, or if you're moving around a lot—respiratory droplets can more easily pass around the sides of the shield. In fact, face shields are only 45% effective at reducing the transmission of respiratory droplets.

The CDC does not recommend the use of a face shield instead of a mask. However, if you can't wear a face mask, a face shield is better than nothing at all.

Wearing a mask is only one part of the recommendations to keep us safe. We also need to continue to do the other things we've been advised, including regular handwashing and social distancing. If you have symptoms, stay at home and seek medical advice. For more information, check out how you can request a free face mask, and to get through this pandemic at your healthiest, don't miss these 37 Places You're Most Likely to Catch Coronavirus.