During the ongoing COVID-19 pandemic, many hospitals and healthcare workers are facing
inadequate supplies of masks. In response, strategies to produce, allocate, comply, conserve, reuse,
and repurpose different types of masks are being explored in healthcare and non-healthcare settings.
This note provides a summary of the existing research evidence and jurisdictional experience on these
*The full briefing can note including the complete Summary of Evidence, Appendix, and References can be accessed in the PDF file at the top of the page*
- Strategies to optimize the use of masks in healthcare settings during supply shortages include:
- Produce: Some jurisdictions have redeployed capacity towards producing masks and fast-tracking regulatory processes, but limited efforts were found to support innovation in developing new technological solutions.
- Allocate: Jurisdictions have particularly focused on establishing guidance on prioritizing the allocation of masks for health care workers, and using centralized processes for storage, management, and distribution of masks.
- Use/Comply: Research and jurisdictions have particularly focused on ensuring correct use and re-use of medical and non-medical masks in different settings and by different populations.
- Conserve: Research and jurisdictions suggest using the same N95 respirator without removing it during repeated close contact or using a N95 respirator beyond its recommended shelf-life, as long as it retains its fit and function.
- Reuse: Research and jurisdictions have suggested using the same N95 respirator multiple times, after decontamination in between uses, as long as it retains its fit and function. Many reprocessing methods exist, but ultraviolet germicidal irradiation and hydrogen peroxide vaporization are the most promising. Other innovations are being considered by Health Canada.
- Repurpose: Health Canada has recommended repurposing equivalent models to N95 respirators if they meet certain specifications. There is insufficient evidence to determine efficacy differences between surgical masks and N95 respirators for protection against COVID-19. Some jurisdictions have guidance on when to use homemade face masks.
- In non-healthcare settings, medical and/or non-medical masks are recommended to be worn by those working in densely populated areas or in close proximity to others (e.g., cashiers, police, staff at points of entry such as public transit hubs and airports).
Analysis for Ontario:
- In Ontario, there are directives or supports related to producing, allocating, using, reusing, and repurposing different types of masks during COVID-19. These recommendations generally align with those provided in the scientific evidence and international/Canadian jurisdictions.
Use of Masks in Health Care Settings:
* The entirety of the Supporting Svidence for Use of Masks in Health Care Settings is accessible in the PDF file at the top of the page*
Based on research evidence and jurisdictional scans, where available, strategies for supporting the use of masks under supply shortage conditions to prevent COVID-19 transmission can be related to one or more of the following:
- Production: Refers to home-based production, rapid technological innovations, and fast-tracking
- Allocation: Refers to efficient allocation and stocking practices.
- Use/Compliance: Refers to supports and monitoring for correct use.
- Conservation: Refers to use beyond the recommended duration or shelf-life.
- Reuse: Refers to the “donning” (putting on) and “doffing” (taking off) by the same person without
decontaminating, decontaminating and reusing by the same person, and decontaminating and
reusing by others.
- Repurpose: Refers to medical masks and alternative materials.
Supporting Evidence for Use of Masks in Non-Healthcare Settings:
- There is insufficient evidence to recommend universal wearing of non-medical face masks as a protective measure against COVID-19, but it may be useful for high-risk individuals in transient situations.
- Medical masks are recommended to be worn by police, military, professions that have close proximity to other people (e.g., cashiers), staff working in points of entry (e.g., cleaners, screeners, and interviewers in airports or ports), and workers developing respiratory symptoms.
- For non-medical masks, China, France, Germany, Italy, South Korea, U.K., and U.S. recommend some degree of face covering in limited circumstances, including when using public transit or in smaller retail stores where maintaining social distance may be difficult.
- China and South Korea are the only two countries among the jurisdictions examined that have recommended wearing a mask more broadly in public.
- A few jurisdictions (France, Germany, and Italy) were found to have changed their recommendations since mid-March, however it remains unclear the extent to which these decisions were informed by changing evidence.
- For medical masks, the commonality in guidance from China, New Zealand, and South Korea appears to be to provide medical masks to essential workers who are working in densely populated workplaces (e.g., transit hubs) or are in frequently contact with many people (e.g., policing).
- Almost all provinces have recommended that citizens consider using a face covering to reduce the risk of transmission of COVID-19 in areas where physical distancing may be challenging or impossible, while ensuring proper use, cleaning, and disposal of face coverings.
- In Saskatchewan, as part of the Re-Open Saskatchewan plan, as personal services (e.g., hairstylists, registered massage therapists, acupuncturists) re-open, clients will be screened and asked to wear gloves and face masks.
- Provincial recommendations on mask use for workers in non-healthcare settings are to consider using medical or non-medical masks to provide some source control in areas where physical distancing may be challenging or not possible. However, good hand hygiene practices are essential to avoid self-inoculation from face touching.
- In the current context of PPE shortages associated with COVID-19, medical masks should be conserved for use in healthcare settings. Non-medical masks (e.g., cloth masks) are recommended as the preferred choice in most situations where masking is for source control.
- A COVID-19 exposure risk assessment for workers may aid employers considering a policy on masking for source control (e.g., see considerations recommended by US Occupational Safety and Health Administration and WHO).
The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following members of the Network provided evidence synthesis products that were used to develop this Evidence-To-Policy Briefing Note:
- Canadian Agency for Drugs and Technologies in Health. April 27, 2020. Optimization of N95 Respirator Masks during Supply Shortages – Round Up (CADTH Horizon Scan). Ottawa.
- Ontario Agency for Health Protection and Promotion (Public health Ontario). April 4, 2020. COVID-19 – What We Know So Far About…Reuse of Personal Protective Equipment.
- Ontario Health (Quality). April 11, 2020. Recommendations on Optimizing the Supply of Personal Protective Equipment During the COVID-19 Pandemic.
- Ontario Hospitals Association. May 1, 2020. PPE Decontamination Meeting Notes. Personal Communication.
- Trillium Health Partners and Institute for Better Health. April 6, 2020. IBH Evidence Summary on N95 Reprocessing – Draft. Personal Communication.
- Waddell K, Gauvin FP, Wilson MG, Moat KA, Mansilla C, Wang Q, Lavis JN. 29 April 2020. COVID-19 rapid evidence profile #5: What is known about the use of medical masks by essential non-medical workers to prevent community transmission of COVID-19? Hamilton: McMaster Health Forum.
- Waddell K, Wilson MG, Gauvin FP, Mansilla, C, Moat KA, Wang Q, Lavis JN. 30 April 2020. COVID-19 rapid evidence profile #6: What is known about strategies for supporting the use of masks under shortage conditions to prevent COVID-19? Hamilton: McMaster Health Forum.
- Wilson MG, Gauvin FP, Moat KA, Waddell K, Mansilla C, Wang Q, Lavis JN. 29 April 2020. COVID-19 rapid evidence profile #4: What are the most effective non-medical masks for preventing community transmission of COVID-19, and should they be required for all of society? Hamilton: McMaster Health Forum.