Question

UPDATED: Why face masks to prevent COVID-19 might now be recommended…

30 April 2020. Related: Access to treatment, All topics, COVID-19, Living with HIV long-term, Other tests.

Hi, I see some people wearing face masks and worry that I can’t get one. How important is this?

Answer

Answer: Simon Collins

Note: This post was updated on 30, 9 and 2 April 2020 from a question first answered on 24 March 2020.

Hi

Thanks for your question.

Information about coronavirus is changing as the pandemic progresses and this includes implications for people who are HIV positive. The trend towards using masks by the general public – HIV positive or not – was supported by a recent editorial in the British Medical Journal. [1]

Another editorial from two prominent US HIV doctors supported the use of masks by everyone. [2]

In the early weeks the answer was definitely no. You only needed to wear a face mask:

1. If you are a health worker, or in a similar high contact job.
2. If you have symptoms and need to travel urgently.

Also:

• Medical masks were (and still are) in limited supply. The current shortage means they should be a priority for health workers.
• Masks are more to protect other people than to reduce personal risk. They should be used by people who currently have symptoms. But having symptoms means you should already be physically distancing or self isolating. Masks do minimise risks to others. If you need to visit a clinic because of serious symptoms tell the clinic when you arrive and ask for a mask. Limited supply might not make this possible.
• Wearing a mask might become a social message about looking after other people (rather than protecting yourself). This is social though and will vary in different cultures and times. Some countries have been used to wearing masks long before the current coronavirus epidemic.
• If you like the solidarity message perhaps make a mask with other material – ie a bandana approach. This will not offer much protection because the material is not fine enough to stop particles. It might show you are aware of protecting others but aren’t using scarce medical supplies.

However, the last couple of weeks has seen much wider discussion that if masks were widely available, this might change the advice for everyone to routinely wear one.

Non-medical masks will still provide some level of protection, even if reduced compared to medical masks. This is now thought to outweigh three main possible harms:

1. That wearing a mask will make people feel more safe when there is little protection.
2. That fitting them wrongly could increase transmission risk – the front of the mask should never be touched.
3. That if infectious particles are caught in the mask, someone will be breathing these in for longer. This means that either changing your mask each day or washing it might be just as important as wearing one.

References:

1. Greenhaulgh T et al. Face masks for the public during the COVID-19 crisis. BMJ 2020; 369:m1435. doi: 10.1136/bmj.m1435 (09 April 2020).
   https://www.bmj.com/content/369/bmj.m1442
2. Gandhi M and Havlir D. The time for universal masking of the public for coronavirus disease 2019 is now. Open Forum Infect Dis. (15 April 2020).
   https://academic.oup.com/ofid/article/7/4/ofaa131/5820544

The links below include other Q&As about COVID-19 – the NYC link is especially good.

HIV and coronavirus (COVID-19): are HIV positive people at higher risk?

Is PrEP affected by coronavirus and COVID-19?

What is difference between self-distancing and self-isolation for HIV and COVID-19

US interim guidelines on COVID-19 and HIV

This information from New York City (online as a PDF file) includes positive information about how to manage a safer approach to sex during the coronavirus health crisis. It covers the safety of sex with yourself and of virtual sex including if your job currently includes sex work.

Sex and COVID-19 (New York City)