A Cloth Mask or a Plastic Shield – Which, When and How?

Protective barriers are essential for preventing the spread of COVID-19; but there is a choice and room for creativity. Details below!

Looks like we will be dealing with COVID-19 for the foreseeable future and that means that we will have to keep hidden behind face masks. But we’re fed up with masks, and many of us are considering face shields instead. But are plastic face shields as effective as cloth masks in preventing the spread of the coronavirus?

Droplet Protection

We must continue blocking and avoiding infected respiratory droplets especially from asymptomatic people carrying the SARS-CoV-2. Every time we breathe, we send thousands of droplets from our nose and mouth about a meter or so in front of us. Speaking, coughing, sneezing, singing, laughing and hollering sends the droplets twice as far. Not that this is ordinarily a big problem, but each droplet could transport thousands of viable SARS-CoV-2 viruses to uninfected bystanders.

Here are two ways to reduce the spread of COVID-19: One is to stop spraying infectious droplets into the air around us, and two is to prevent them from getting into our eyes, nose, and mouth. Either way, the approach is wearing a protective barrier, like a face mask or shield, but figuring out which is the most comfortable, and effective can be challenging.

Face Masks – Pros

The evidence about the disposable surgical type and layered cotton masks resoundingly show that masks block the number of droplets expelled by a person and they fly a shorter distance in front of us and protects others. Masks also protect the wearer by reducing the number of large droplets we inhale from others (https://www.acpjournals.org/doi/10.7326/M20-2567). That’s why the public health authorities in many countries like the US Centers for Disease Control and Prevention – CDC (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html) recommend the use of cloth masks in public places. 

Face Masks – Cons

Cloth face masks aren’t perfect though. For one thing, they have to fit correctly over the nose and mouth. But droplets can still escape out of gaps near our nose, and the sides of the mask. Other problems with face masks are that they should be put on and off with clean hands and frequently washed, and people often touch their face while adjusting their face masks, which can cause infection. Also, masks can irritate the skin, fog glasses, make it difficult to breathe, and muffle voices, which makes it challenging to communicate. Face masks hide the facial expressions that we take cues from like smiles and frowns and make it difficult for people who are hearing impaired. 

Face Shields – Pros

A clear curved plastic panel face shield is more comfortable, provides a break from wearing masks, and can protect against respiratory droplets from people who are close to you. Also, it stops you from touching your face, there’s less fogging of glasses, and we don’t feel like we have to remove them to talk. It’s easier to put on and take off, easy to clean with soap and water, and they’re reusable. 

Some governments recommend face shields for hairdressers and others in the service industry, and people giving lectures or performing in public. It’s tough to wear  a mask all day.

Face shields protect the eyes, which could be another way to spread COVID-19, as it is for other viruses, like measles and adenoviruses. A study from 2014 showed that face shields block large respiratory droplets and transmission of airborne infections.

Importantly, face shields allow deaf and hard of hearing people to read lips and autistic or demented people to see a person’s face and expressions. 

Face Shields – Cons

The main problem with wearing a plastic face shield that covers your whole face is that the virus can escape above, below and around the sides of the face shield. You can imagine that if someone is standing while you’re sitting, is behind you, or by your side, that you might have droplets entering behind the face shield. Face shields can also get foggy, feel confining, and the elastic around your forehead might be annoying after a long time of wearing.

A relatively new trend is to wear plastic shields used by the food industry that fit under the chin and extend up in front of the nose and mouth, but these are not protective in public places. 

Recent anecdotal evidence of face shields failing to protect against coronavirus spread comes from an outbreak of COVID-19 at a hotel in Switzerland. People wearing masks did not become infected – SARS-CoV-2 only infected those who were wearing face shields.

A major issue is that we don’t know whether face shields protect others from infected people because droplets escape from the sides, bottom and above the plastic panel, depending on the model. 

The Debate Continues

Like so many things in the age of coronavirus, there’s uncertainty because we don’t have all the data to answer the question definitively: Which is better face masks or face shields? We know that face shields block large viral particles and cloth or medical masks protect against small particles. 

Where the experts all agree is that a person wearing a face mask correctly and keeping social distancing doesn’t need to add a face shield. No matter which barrier you choose, a mask or shield, it should always be added to physical distancing, frequent hand washing, keeping your hands off your face, and avoiding crowds. 

For now, public health authorities like the U.S. CDC and Swiss health authorities do not recommend face shields as a substitute for masks. 

But wearing a face mask and a shield like health workers could add extra protection in crowded areas or near infected people, especially for those at high risk of becoming seriously ill.

Tips: 

  • Until there’s more proof, wear a face shield with and not instead of a face mask. 
  • If you’re unsure, wear both, especially in crowded areas, in poorly ventilated public places, on public transportation or when near or caring for a person with COVID-19. 
  • If you really want to wear a face shield, choose one that it extends below your chin in front, to your ears, and has no gap at your forehead.
  • Avoid wearing a lower face nose and mouth plastic shield.
  • For added protection, drape a piece of material along the bottom of the shield.
  • When adding a face shield to your protective gear, be creative and make your own – there are many how-to DIY videos online or find a sexy face shield 
  • Remember that your eyes are windows to the soul, but if you want to show off your smile or your new lipstick or need a hearing impaired-friendly mask, buy a cloth face mask with a clear window or make one of your own
Dr. Michelle Epstein
Michelle Epstein is a medical doctor graduated from the University of Alberta in Canada, who has specialised in Internal Medicine at the University of British Columbia and Allergy and Clinical Immunology at Yale University. Since 2004, she has been a Lab Leader at the Medical University of Vienna’s Division of Immunology.

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