Countries have responded differently to the coronavirus pandemic, and while face masks are considered essential for healthcare workers, there is no global consensus on whether they should be worn by the general public.

In Germany, not wearing a face mask in public attracts a hefty fine, while in the United States the public have been asked to make their own cloth masks.

So should we be wearing face masks en masse in Australia?

Earlier this month, deputy chief medical officer Paul Kelly said that while face masks were crucial for health workers, they are “not recommended for the Australian public”. 

Professor Kelly said even if supplies of masks were unlimited he would not advise that everyone wear them.

“Using a mask incorrectly can actually make it more dangerous,” Professor Kelly said.

Epidemiologist Abrar Chughtai, a lecturer in international health at UNSW, told The New Daily that unlike many other countries, Australia has so successfully contained COVID-19 via measures including widespread testing and social distancing that there is no need for healthy people to wear face masks in public.

As of Wednesday, Australia had 6738 confirmed cases of COVID-19, including 5649 recovered cases, and 88 deaths.

Worldwide, there were 3.12 million confirmed cases including 929,000 recovered cases, and 217,000 deaths.

There is no “confirmatory evidence” that the general public wearing face masks stops the spread COVID-19, despite “observational data” showing that widespread face mask wearing has worked in countries such as Japan, South Korea, Singapore, Taiwan and Vietnam, Dr Chughtai said.

“In a pandemic we have a mix of interventions such as social isolation and early detection, and face masks are just one factor, so it’s very difficult to separate what is and isn’t working well,” he said.

“In Australia, we actually did very well in testing, contact tracing and social isolation. We’re lucky we don’t have a high number of cases.

So what we’re doing right now is working and we don’t really need to add another thing into the mix.’’

Former Queensland chief health officer and professor of public health at QUT Gerry FitzGerald described the debate around face masks as a “vexed question” that has been handled differently by various jurisdictions around the world.

“I think the best position to take on the topic is to say [to the general public], look, wear them if you like, but don’t rely on them,” Professor FitzGerald said.

You’ve got to continue to enhance personal hygiene, social distancing, all of those sort of things, because [face masks] will not protect you.

“And the second thing is, don’t take away from the people who need them.”

However, there is some evidence that face mask use in the community could be beneficial in some settings, explained Raina MacIntyre, head of biosecurity research at the Kirby Institute and professor of global biosecurity at UNSW.

In a city with high disease incidence universal face mask use in the community may help flatten the curve,’’ Professor MacIntyre said.

“This is because COVID-19 can be transmitted from people without symptoms or in the two days before they develop symptoms. So if mask use is high in the community, it may prevent onward transmission from infected people and also protect well people.”

Face masks “may be especially beneficial” when worn in crowded settings such as on buses, trains or in crowded public venues, she said.

One study on face mask use in households showed that, when someone in the household is sick, face masks can protect well members of the household against infection if properly used.

“Other studies have also shown that masks protect in community settings such as households and college dorms. So, there is evidence that masks work in community settings,” Professor MacIntyre said.

“In fact there is more evidence for use by well people than by sick people – we have done a trial of masks in sick people too, and it probably protects, but there are larger and more trials on masks for well people.”

Types of face masks

Three main types of face masks have been used during the coronavirus pandemic.

N95 masks 

• N95 or P2 face masks filter fine particles and were in short supply during the recent bushfires crisis
• Ongoing supply issues mean these should be reserved for frontline healthcare workers who need them most.

Surgical masks 

• There have been some supply concerns around surgical masks
• In Australia, they are mostly used in a medical setting, by healthcare workers and patients.

DIY cloth masks

Earlier this month, the US Centres for Disease Control and Prevention (CDC) advised the general public to wear home-made cloth masks to help slow the spread of COVID-19.

The nation is among the world’s worst hit by the virus, this week recording more than one million cases of coronavirus.

The US now accounts for almost a third of the more than three million cases worldwide.

Despite health authorities currently not advising Australians to wear masks, some people may still wish to make and wear a cloth mask.

“The use of cloth masks was recommended for the community in the US,” Professor MacIntyre said.

“This is a compromise position that does not impact on health worker supplies.”

Professor MacIntyre authored the world’s only published trial of cloth masks in 2015, and the study cautioned against the use of cloth masks, finding that surgical masks were superior.

It also found that cloth mask wearers had higher rates of infection than the standard practice control group of health workers, many of whom wore no mask.

However, Professor MacIntyre said the study used “a locally manufactured cotton mask with two layers”, and that it is possible “a well-designed cloth mask could still provide good protection”.

“People can be educated on wearing masks, and a pattern or template can be provided for making a well-designed DIY mask,” she said.

Professor MacIntyre advised people making and wearing DIY face masks to:

• Use water-resistant material
• Use material with a fine weave and high thread count
• Make a mask with two or more layers of material
• Make sure it is a good fit around the face
• Have at least two masks so you can change them during the day
• Wash all masks used during a day in the laundry at the end of every day
• Try a nylon stocking over the top, as one study showed this improved filtration for all kinds of masks.