Best Face Mask to Protect Against Coronavirus

A man in a chequered shirt with a backpack, wearing a face mask

The UK government have announced that members of the public should cover their face in public to help reduce the spread of coronavirus (COVID-19). There are several masks available from different outlets, but which face mask should you wear?

What is the difference in face masks?

Respirators

3M N95 Face Mask

Respirator masks are secured tightly around the face and have an adjustable clip around the nose so that few particles can enter. They are available in different models, including N95 (FFP2), N99 and N100. The coronavirus particle is thought to be around 125 nano meters in size. This means that respirators provide a high level of protection against COVID-19.

  • N95 masks also known as FFP2 masks, can filter 95% of particles that range in size from 100nm to 300nm
  • N99 masks, also known as FFP3 masks can filter up to 99% of similar particles
  • N100 respirators have the ability to filter up to 99.7% if such particles

Respirator masks are able to provide a higher level of protection against viruses. They are usually marked with an approval rating (N95, KN95, FFP2 etc.).

Respirators can also come valved or unvalved. A valve helps to release air on the exhale, which can reduce sweat build up and reduce stuffiness. Unvalved masks are lighter and less bulky, making them easier to transport.

Surgical Masks

An open box of surgical face masks

Surgical masks are also available in different variations. They are designed to prevent large droplets such as mucous or spit, being expelled from the user. Whilst surgical masks offer an element of protection, they are not effective in filtering small particles in the air. A Type IIR surgical face mask offers more protection against splashes and is considered to be fluid resistant.

Are Face Masks effective in protecting against coronavirus?

Face masks will help prevent contracting and transmitting coronavirus. In fact, any form of covering over your face will be effective. Coronavirus is spread through inhalation or contact with droplets of the virus. Wearing a face mask will prevent a large percentage of droplets from entering the respiratory system. Whilst masks are unable to provide 100% protection, they will most certainly reduce the risk of infection.

Can you reuse a face mask?

You should not reuse a face mask. They are intended for single use as masks may be contaminated with infected droplets. You should not touch the front of a face mask, and it should be taken off from the ear straps. You should wash your hands before and after taking a mask off. The structural integrity of a mask may also be compromised once it has been used, which can make it less effective when using again.

What else can I do to protect myself?

Practising social distancing can reduce the transmission of COVID-19. Regularly washing your hands and avoiding touching your face will also help to reduce transmission of virus droplets. Wearing disposable gloves when going into public places and using hand sanitiser throughout the day is good practise.

A coronavirus biological molecule

Hydroxychloroquine (Plaquenil) and Chloroquine are malaria tablets that have been used for 70 years to treat and prevent malaria. They are also routinely used to treat autoimmune diseases such as rheumatoid arthritis and systemic and discoid lupus erythematosus.

There has been a worldwide surge in demand for these drugs over the past few months. This is a result of mass media attention amidst claims that they can help in the fight against Coronavirus from high profile personalities such as Donald Trump and the Brazilian president Jair Bolsonaro. But can chloroquine and hydroxychloroquine prevent or treat Coronavirus?

What is Hydroxychloroquine and Chloroquine?

Hydroxychloroquine and Chloroquine are two closely related prescription only drugs used to treat autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. These conditions are caused by an overactive immune system. Hydroxychloroquine and chloroquine work by regulating the activity of the immune system to alleviate pain and swelling and can prevent damage to the joints. The two drugs can also be used in the treatment and prevention of malaria.

How does Hydroxychloroquine and Chloroquine work?

Chloroquine works to prevent and treat malaria by interfering with the replication of the malaria parasite. In recent times, studies have shown that chloroquine has lost effectiveness in treating and preventing malaria. This is because the most common strain of malaria has developed resistance to chloroquine, therefore other anti-malaria tablets are preferred.

Hydroxychloroquine and chloroquine work to control autoimmune diseases by regulating the immune system that is usually overactive in these patients. It can do this without causing risk of infection to the patient, as it does not lower the immune system to a level that is dangerous. The full mechanism of action is not completely understood.

What the science says

There have been numerous reports of studies that have shown chloroquine and hydroxychloroquine to be effective in treating Coronavirus.

In February 2020, a Chinese study reported that chloroquine displayed positive results when tested against COVID-19. This study was conducted in vitro, which means that it was only tested in a laboratory setting and not in a randomised trial with humans. Previous in vitro studies that have shown hydroxychloroquine to be effective against other viruses in a lab setting, have not been proven to be effective when tested on humans in a randomised controlled trial.

A French study published in March 2020 showed promising results and created a media hype. The study was conducted on COVID-19 patients and showed that hydroxychloroquine taken together with azithromycin significantly reduced the viral load. However, reports suggest that the results were not entirely accurate as patients who had died during the trial were not included in the viral shedding analysis. The professional organisation attached to The International Journal of Antimicrobial Agents where this study was published, has claimed that the article does not meet the expected standards.

Another small Chinese study conducted in April 2020 has also shown promising results in patients with mild COVID-19 symptoms. This research was conducted in 62 patients and was randomised unlike the French study. It also compared the treatment and control groups, claiming that patients who were given hydroxychloroquine recovered quicker from cough and fever. The limitation of the study is that it was conducted on a small number of people and it did not include any patients with severe or life-threatening symptoms. The study has not been endorsed by other professionals working in the same field. This is known as a peer-review and is important in verifying and authenticating studies.

In April 2020, a document produced by French scientists concluded that there was no evidence to indicate that hydroxychloroquine was effective in treating Coronavirus. A group of 84 patients receiving hydroxychloroquine were compared with a group of 97 patients who did not. No clear observations were made. However, the limitations to this analysis were that it was not a proper clinical trial and there was no information why certain patients were administered hydroxychloroquine and others not. The paper has not yet been peer-reviewed.

A study was carried out in Brazil with the aim of comparing a high dose of chloroquine against a low dose. The high dose was chosen based upon recommendations from Chinese authorities. This study was drawn to a halt as researchers found increased rates of arrhythmias and a high number of deaths in those taking the higher dose. However, scientists were unable to confirm that the higher dose of chloroquine was the reason for the cardiac side-effects. The efficacy for the lower dose is still being investigated. There was also no control group (a group of patients that receive a placebo).

An observation by US researchers compared the outcomes for 368 COVID-19 patients. One group of patients received hydroxychloroquine, another group received hydroxychloroquine with azithromycin and the third group received neither. The researchers concluded that hydroxychloroquine did not reduce the need for a ventilator, nor did it lower the risk of death. In fact, they found that those taking hydroxychloroquine alone had an increased risk of death. However, this was an analysis and not a randomised controlled trial. It is also important to note that those administered with hydroxychloroquine were in a worse state than the others observed. This study included males only.

Which countries have authorised the use of hydroxychloroquine for COVID-19?

In late March 2020, the US Food and Drugs Administration authorised the ‘emergency use’ of hydroxychloroquine for a limited number of COVID-19 cases. They have not made any categorical claims that it will work but have granted authorisation for hospitals to request the use from government stockpiles. One month later, the FDA issued a warning against the use of hydroxychloroquine and chloroquine outside a clinical trial or hospital setting due to the risk of heart rhythm problems.

France have given approval for doctors to prescribe hydroxychloroquine, however, they have also issued a warning against the side effects.

India recommend that their healthcare workers should use hydroxychloroquine as a preventative treatment and have also authorised doctors to prescribe it to those in close contact with confirmed cases of COVID-19. However, the country’s research body claim that this is ‘experimental’ and should only be used in emergency situations.

The risks of taking Hydroxychloroquine and Chloroquine

Both hydroxychloroquine and chloroquine can cause problems by interfering with the rhythm of the heart. This can be made worse when combined with antibiotics such as azithromycin, which have a similar effect on the heart and can be life threatening. Both drugs are proven to be effective in treating malaria and autoimmune diseases at safe doses, but there has not been any conclusive evidence to prove the safety of hydroxychloroquine or chloroquine in the treatment of Coronavirus. If taken incorrectly, they can cause damage to the liver and kidneys, as well as nerve cells which can cause seizures.

There are many people who rely on hydroxychloroquine to treat autoimmune diseases and research has shown that withdrawal and interruption of treatment can cause a flare up of disease and may be life-threatening. Shortages in the market caused by stock piling and media hype has made it difficult for patients to obtain hydroxychloroquine. Arrangements are in place to allow for an adequate supply for ongoing clinical trials; however, members of the public should refrain from trying to unethically obtain hydroxychloroquine.

So, can Chloroquine and Hydroxychloroquine prevent or treat Coronavirus?

Some studies suggest that chloroquine and hydroxychloroquine have shown promising results, whilst others have not. Currently, there is insufficient evidence to prove that they are effective in preventing or treating COVID-19 and the World Health Organisation has not approved their use. Higher quality and larger randomised controlled trials are required in order to better assess the efficacy of chloroquine and hydroxychloroquine in treating Coronavirus. Those suffering from COVID-19 are likely to be in a vulnerable state and unregulated use of hydroxychloroquine or chloroquine may pose an increased risk to health. These drugs should only be administered under the observation of a qualified healthcare professional.

 

This article contains advice based on research conducted during the time that this article was written. Advice may have changed, and research may have progressed since this article was published and you should consult a doctor if you are in doubt.

Sources

https://www.medicinenet.com/hydroxychloroquine/article.htm

https://www.ema.europa.eu/en/news/covid-19-reminder-risk-serious-side-effects-chloroquine-hydroxychloroquine

https://annals.org/aim/fullarticle/2764199/use-hydroxychloroquine-chloroquine-during-covid-19-pandemic-what-every-clinician

Coronavirus (COVID-19) – Asthma Update

A woman with asthma wearing an orange jumper and beige jacket wearing a face mask

Asthma is a chronic condition that causes inflammation in the lungs. This leads to symptoms such as wheezing, breathlessness and coughing. There is no evidence to suggest that those who have asthma are at an increased risk of contracting coronavirus. However, individuals with poorly controlled asthma, or asthma that requires steroid treatment are at a higher risk of developing complications if they contract COVID-19.

Why are asthmatics “high risk”?

Viral infections are a major cause of asthma attacks. COVID-19 causes inflammation of lung tissue, making it difficult to breathe. This can trigger an asthma attack or cause further complications such as pneumonia. Because asthmatics already have a compromised lung function, there is a higher chance that they will develop serious complications if they contract the virus. They are likely to struggle more than someone who has full lung capacity.

Will using a steroid inhaler make Coronavirus worse?

Steroid inhalers, also known as “preventer inhalers”, help to control lung inflammation and prevent acute symptoms. High levels of steroids can have a negative affect on your immune system, but the level of steroids in a preventer inhaler is very small in comparison to tablets. There is a much greater risk to your health if you contract coronavirus and you have poorly controlled asthma. Steroid inhalers keep asthma under control and will reduce the chances of complications when used correctly. Preventer inhalers that contain corticosteroids control the level of inflammation in the lungs. Asthma UK advise that you should use your preventer inhaler as prescribed to reduce your risk from coronavirus.

What else can I do to reduce the risk from COVID-19?

If you have asthma, you should follow these steps:

Stay at home

Only leave the house if you need to get essentials such as food and medication. You should only go to work if you are unable to work from home.

Keep using your preventer inhaler

This will help to keep inflammation in your lungs under control, reducing the risk of complications such as an asthma attack. You should follow your asthma plan and stick to your prescribed asthma treatment.

Keep your reliever inhaler with you

The most common type of reliever inhaler is a salbutamol inhaler, also known as Ventolin. You should only use this inhaler if you are experiencing symptoms such as wheeze, shortness of breath or cough. If you feel that your symptoms are worse than usual, you should consult your GP or call 111 for advice.

Minimise contact with asthma triggers

These include:

  • Dust
  • Pollen
  • Pollution
  • Pets
  • Mould
  • Strong smells such as fragrances
  • Extreme weather conditions (heat, wind, cold)

Follow the usual protocol

  • Frequently wash your hands with warm water and soap
  • Do not touch your face, especially your eyes, nose and mouth
  • Avoid close contact with people and follow the social distancing rules
  • Disinfect surfaces and other areas you encounter frequently

Look after your general health and well-being

You should try and maintain a regular sleeping pattern, even if you are not working. Adequate rest will ensure your body is functioning at an optimal rate. Try to reduce stress and keep your mind occupied. Eat well and maintain a healthy diet, whilst incorporating exercise a few times a week. Use this opportunity to loose weight and stop smoking, as this will be beneficial to your health.

What if I get Coronavirus and have asthma?

The main COVID-19 symptoms are a high temperature and a persistent cough. If you develop these symptoms, you should:

  • Stay home and isolate. You should not go to any public place including your doctor’s surgery, pharmacy or a hospital.
  • You should call 111 to seek advice. Make sure to let them know that you have asthma.
  • Stick to your asthma plan and continue to use your medication as prescribed. You should take paracetamol to bring your body temperature down.
  • If you have an asthma attack or difficulty breathing, you should call 999 for emergency assistance.

Should I wear a mask for Coronavirus?

Currently, the Centre for Disease Control in America have recommended the use of face coverings to slow the spread of COVID-19. This has been echoed by Germany who have adopted a similar approach. The UK have not issued any guidance in relation to the use of face masks yet, as they are waiting on guidance from scientists. Masks can act as a visual reminder, helping to change behavioural habits, such as touching the face or avoiding close contact with someone else. It is not possible to say that masks are ineffective, as they are being used by front line healthcare workers. The issue is to do with masks that are of poor quality, ineffective technique when wearing a mask, and the unhygienic re-use of masks.

Update

On 11th May 2020, the UK government advised that people should wear face masks to prevent Coronavirus. This should be done in conjunction with practising social distancing. You can protect your face with a piece of cloth, a surgical face mask or an N95 mask.

This article contains advice based on research conducted during the time that this article was written. Advice may have changed since this article was published and you should consult a doctor if you are in doubt.