Guidelines on use of masks by public

Ministry of Health and Family Welfare Directorate General of Health Services [Emergency Medical Relief] 
Novel Corornavirus Disease (COVID-19)
 Guidelines on use of masks by public
 1. Introduction A new disease named novel coronavirus (COVID-19) emerged in early December 2019 in China and has now spread to over 90 countries. 
        As on 9 th March 2020, India has reported 42 cases mostly among those who had travelled from affected countries. It causes a minor illness in majority of patients with symptoms of fever and or cough. 
               A small proportion of such persons may progress to severe disease with difficulty in breathing. It is spread by an infected person with COVID coughing and the droplets from his cough infecting others in close vicinity (less than 1 metre). 
                      Any such new disease invariably related to cough leads to suggestions from various quarters, especially in social media, to use mask by general public to prevent the disease. 
2. Purpose of this document The purpose of this document is to give correct evidence based information to general public on use of mask. 
3. Medical masks Medical masks of different size and shapes are available in the market. The common ones are flat pleated masks of woven fabric which covers the nose and mouth and affixed behind the head with straps/ elastic fasteners. There are also conical or duck bill shaped masks with valves (or without valves) that fit in the contour of face over the nose and mouth, but are costlier. 4. Use of masks by general public 
4.1. 
                   Persons having no symptoms are not to use mask Medical masks should not be used by healthy persons who are not having any symptoms because it create a false sense of security that can lead to neglecting other essential measures such as washing of hands. 
                  Further, there is no scientific evidence to show health benefit of using masks for non-sick persons in the community. In fact erroneous use of masks or continuous use of a disposable mask for longer than 6 hours or repeated use of same mask may actually increase risk of getting an infection. 
                    It also incurs unnecessary cost. In such situation, more effective steps are: 
i. Wash hands frequently with soap and water for 40 seconds. An alcohol based hand sanitizer with 70% alcohol must be used for 20 seconds. If hands are dirty or soiled, do not use alcohol based hand sanitizer, but wash hands preferably with soap and water. 
ii. While coughing or sneezing cover nose and mouth with handkerchief, paper tissue. If handkerchief or tissue paper is not available cough into the flexed elbow. Dispose of tissue immediately after use and wash hands. 
iii. Refrain from touching face, mouth, nose and eyes. 
iv. Stay at least a metre away from those coughing or sneezing. 
v. Monitor your body temperature. 
4.2. When and who should use medical masks (apart from health care worker). 
4.2.1. When a person develops cough or fever. Use of medical three layer masks when ill, will prevent your infection from spreading to others. However you also need to wash your hands frequently to avoid spreading infection to others. 
4.2.2. While visiting a healthcare facility. 
4.2.3. When you are caring for an ill person. 
 4.2.4. Close family contacts of such suspect/confirmed cases undergoing home care should also use Triple layer medical mask. 
4.3. Duration for which a medical mask will remain effective A medical mask, if properly worn, will be effective for 8 hours. If it gets wet in between, it needs to be changed immediately.
 4.4. Correct procedure of wearing triple layer mask While wearing a medical mask, the steps given below needs to be followed. If you do not follow them, you may get infected from the mask itself. These steps are: 
 Unfold the pleats; make sure that they are facing down. 
 Place over nose, mouth and chin. 
 Fit flexible nose piece (a metallic strip that can easily be located) over nosebridge. 
 Secure with tie strings (upper string to be tied on top of head above the ears – lower string at the back of the neck.) 
 Ensure there are no gaps on either side of the mask, adjust to fit. 
 While in use, avoid touching the mask. 
 Do not let the mask hanging from the neck. 
 Change the mask after six hours or as soon as they become wet. 
 Disposable masks are never to be reused and should be disposed off. 
 While removing the mask great care must be taken not to touch the potentially contaminated outer surface of the mask 
 To remove mask first untie the string below and then the string above and handle the mask using the upper strings. 
4.5. Disposal of used masks Used mask should be considered as potentially infected. Masks used by patients / care givers/ close contacts during home care should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then disposed of either by burning or deep burial.