Face masks during the COVID-19 pandemic

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Types of respirator by physical form

The wearing of face masks during the COVID-19 pandemic has received varying recommendations from different public health agencies and governments. The World Health Organisation and other public health organisations agree that masks can limit the spread of respiratory viral diseases such as COVID-19.[1][2][3] However, the topic has been a subject of debate,[4] with some public health agencies and governments disagreeing on a protocol for wearing face masks.

As of early May 2020, 88% of the world's population lives in countries that recommend or mandate the use of masks in public; more than 75 countries have mandated the use of masks.[5] Debates have emerged regarding whether masks should be worn even when social distancing at 2 meters (6 feet),[6][7][8] and whether they should be worn during exercise.[9] Additionally, public health agencies of some countries and territories have changed their recommendations regarding face masks over time.[10] Face masks have been a subject of shortages, and not all have been certified. Moreover, substandard masks were reported on the market with significantly reduced performance.[11]

Types of face masks include:

Face shields, medical goggles, and other types of personal protective equipment are sometimes used together with face masks.

Types of masks

Small particles zigzag due to Brownian motion, and are easily captured. Large particles get strained out, or have too much inertia to turn, and hit a fiber. Mid-size particles follow flowlines and are more likely to get through the filter; the hardest size to filter is 0.3 microns diameter.[14]

Certified medical masks are disposable (except some faceshields). They are made of non-woven material. They are mostly multi-layer. Filter material may be made of microfibers with an electrostatic charge; that is, the fibers are electrets. An electret filter increases the chances that smaller particles will veer and hit a fiber, rather than going straight through (electrostatic capture).[14][15][16][better source needed][medical citation needed] Typically, efficiency of the filtering materials decreases when washed or used multiple times.[17]

Many medical masks are respirators; they are designed to protect the wearer. Surgical masks, on the other hand, are meant to protect others against infection transmission from the wearer (so called "source control").[18] Some respirators and masks have valves,[19] which let exhaled air out unfiltered. This makes them bad for source control.[20][21] It may, however, reduce inwards leakage, thus improving wearer protection.[19]

Face shields

Person wearing a face shield over a green surgical mask. A simple 3D-printed face shield: curved visor, drawstring lanyard, sheet of transparent plastic curved from side to side.
Person wearing a face shield and a surgical mask.

Face shields protect against splash and splatter. Cough simulation experiments show that they protect[19] the wearer[22] against large droplets immediately after the cough, but are less effective against smaller aerosols, which can remain airborne for extended periods and can easily flow around a face shield to be inhaled.

Because they lack a peripheral seal, face shields are used with nose-mouth masks, and to protect nose-mouth masks, but use of face shields alone is not recommended for healthcare workers.[19]

Cloth masks

French cloth face masks certified by AFNOR.
Face masks retain most of the respiratory droplets released from the wearer through talking, coughing, or sneezing, thus reducing the spread of pathogens.[23]

A cloth face mask is a mask made of a common textile, usually cotton, worn over the mouth and nose. Although they are less effective than medical-grade masks, many health authorities recommend that the general public use them because medical-grade masks are in short supply.[24][25]

They were routinely used by healthcare workers starting from the late 19th century until the mid 20th century. In the 1960s they fell out of use in the developed world in favor of modern surgical masks, but their use has persisted in developing countries.[26][27][28]

There were calls for research into the effectiveness of improvised masks even before the emergence of COVID-19, motivated also by past epidemics and modelling of likely mask shortages. However, little research has been done. There are no studies of the use of cloth masks by the general public, one study on the use of cloth masks in hospitals (by healthcare workers, not patients), and many controlled-setting/lab studies of cloth masks' effects on aerosols as of May 2020.[19]

Cloth masks are low-cost and reusable. They vary widely in effectiveness depending on material, fit/seal, and number of layers, among other factors. Unlike disposable masks, there are no legal standards for cloth masks. Fit is important (as with disposable masks). Measures to improve fit, such as an outer layer made from sheer nylon stockings or sheer tights around the head, reduce leakage.[19]

Improvised cloth masks seem to be worse than standard commercial disposable masks, but better than nothing. There is, however, little good evidence on them. A single study gives evidence that an improvised mask was better than nothing, but not as good as soft electret-filter surgical mask, for protecting health care workers simulating treating a simulated infected patient, regardless of whether "patient" or carers wore the mask.[19] Another study had volunteers wear masks they made themselves, to a pattern like that of a standard surgical mask, but with ties rather than earloops,[29] from cotton T-shirts, and found that the number of microscopic particles that leaked inside the homemade masks was twice the number that leaked into the commercial masks, and that the homemade mask let three times as many microorganisms expelled by the wearer escape (median averages). There is limited evidence that cloth masks can significantly reduce droplet dispersal.[19]

Cloth masks are commonly made with one layer, two layers, or two layers with a pocket for a removable-filter interlayer[19] (disposable surgical masks also have three layers, with the filter layer midmost[30]). The CDC recommends more than one layer.[31] There is no research on the usefulness of a filter interlayer, as of May 2020. There were until recently no non-disposable materials designed for making masks (see end of paragraph). Common household fabrics which could be used (turned to a new use) as mask materials have been tested.[32][33][34][35] Cloth materials vary widely in filtration efficiency. Some cotton and polyester household fabrics have been found to compare with disposable surgical masks for dry particle filtering. Cotton T-shirt material, pillowcase material, and 70% cotton/30% polyester sweatshirt material are among the common materials that performed well in lab tests, with T-shirts preferred to pillowcases because it was thought that it would probably fit better. Teatowels and vacuum-cleaner bags were effective at filtering, but had a very high air resistance, so were not recommended. Scarves filtered poorly. Surgical sterilisation wrap, a polypropylene non-woven fabric made for wrapping sterilized things to keep them sterile, is designed to filter germs from the air. Using surgical sterilisation wrap to make masks, or as a filter interlayer in cloth masks, has been suggested. There are, however, no tests on using surgical sterilisation wrap for masks, as of May 2020.[19]

Other suggested materials for filter interlayers include air filter materials used in ventilation, heating, and air conditioning, some of which are similar to rigid electret masks in the size ranges of particles they filter. Electrostatic cotton and non-woven, meltblown fabric are the conventional materials used in disposible masks, but are not readily available during the COVID-19 epidemic. A new type of filter, a washable electrostatic cotton filter, has been reported since the start of the pandemic; it is said to withstand repeated washing and folding.[19] It is made of electrospun nanofibers; flanking insulating blocks lay these into quasi-aligned nonwoven sheets, which are layered criss-cross to make a meshlike multilayer mask.[36][37] There is a need for research comparing how well these materials work.[19][38]

Decontamination and re-use

There is no research on decontaminating and reusing cloth masks, as of May 2020.[19] The CDC recommends doffing the mask by handling only the ear loops or ties, placing it directly in a washing machine, and immediately washing one's hands in soap and water for at least 20 seconds. They also recommend handwashing before donning the mask and again immediately after one touches it.[39]

There is no information on reusing a interlayer filter, and disposing of it after a single use may be desirable.[19]

Surgical masks

A surgical mask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle droplets, splashes, sprays, or splatter that may contain viruses and bacteria, keeping it from reaching the wearer's mouth and nose. Surgical masks may also help reduce exposure of the wearer's saliva and respiratory secretions to others.[40] A surgical mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and the face.[40] However, in practice, with respect to some infections like influenza, surgical masks appear as effective as respirators (such as N95 or FFP masks).[41] Surgical masks may be labeled as surgical, isolation, dental, or medical procedure masks.[40] Surgical masks are made of a nonwoven fabric created using a melt blowing process.[42][43]

Surgical masks made to different standards in different parts of the world have different ranges of particles which they filter. For example, the People's Republic of China regulates two types of such masks: single-use medical masks (Chinese standard YY/T 0969) and surgical masks (YY 0469). The latter ones are required to filter bacteria-sized particles (BFE ≥ 95%) and some virus-sized particles (PFE ≥ 30%), while the former ones are required to only filter bacteria-sized particles.[44][45][46]

Disposable filtering respirators

Dust masks can be confused for medical respirators.

An N95 mask is a particulate-filtering facepiece respirator that meets the N95 air filtration rating of the US National Institute for Occupational Safety and Health, meaning that it filters at least 95 percent of airborne particles, while not resistant to oil like the P95. It is the most common particulate-filtering facepiece respirator.[47] It is an example of a mechanical filter respirator, which provides protection against particulates, but not gases or vapors.[48] Like the middle layer of[30] surgical masks, the N95 mask is made of four layers[19] of melt-blown nonwoven polypropylene fabric.[49][50][unreliable medical source?] The corresponding face mask used in the European Union is the FFP2 respirator.[51][52]

Hard electret-filter masks like N95 and FFP masks must fit the face to provide full protection. Untrained users often get a reasonable fit, but fewer than one in four gets a perfect fit. Fit testing is thus standard. A line of vaseline on the edge of the mask[53] has been shown to reduce edge leakage[19] in lab tests using manikins that simulate breathing.[53]

Disinfecting and re-use

Hard electret-filter masks are designed to be disposable, for 8 hours of continuous or intermittent use. One laboratory found that there was a decrease in fit quality after five consecutive donnings.[19]

Hard electret-filter masks are often reused,[citation needed] especially during pandemics when there are shortages. Infectious particles could survive on the masks for up to 24 hours after the end of use, according to studies using models of SARS-CoV-2;[19] In the COVID-19 epidemic, the US CDC recommended that if masks run short, each health care worker should be issued with five masks, one to be used per day, such that each mask spends at least five days stored in a paper bag between each use. If there are not enough masks to do this, they recommend sterilizing the masks between uses.[54] Some hospitals have been stockpiling used masks as a precaution.[55] The US CDC issued guidelines on stretching N95 supplies, recommending extended use over re-use. They highlighted the risk of infection from touching the contaminated outer surface of the mask, which even professionals frequently unintentionally do, and recommended washing hands every time before touching the mask. To reduce mask surface contamination, they recommended face shields, and asking patients to wear masks too ("source masking").[56]

Apart from time, other methods of disinfection have been tested. Physical damage to the masks has been observed when microwaving them, microwaving them in a steam bag, letting them sit in moist heat, and hitting them with excessively high doses of ultraviolet germicidal irradiation (UVGI). Chlorine-based methods, such as chlorine bleach, may cause residual smell, offgassing of chlorine when the mask becomes moist, and in one study, physical breakdown of the nosepads, causing increased leakage.[19] Fit and comfort do not seem to be harmed by UVGI, moist heat incubation, and microwave-generated steam.[19]

Some methods may not visibly damage the mask, but they ruin the mask's ability to filter. This has been seen in attempts to sterilize by soaking in soap and water, heating dry to 160 °C, and treating with 70% isopropyl alcohol, and hydrogen peroxide gas plasma[19] (made under a vacuum with radio waves[57]). The static electrical charge on the microfibers (which attracts or repels particles passing through the mask, making them more likely to move sideways and hit and stick to a fiber[citation needed]) is destroyed by some cleaning methods. UVGI (ultraviolet light), boiling water vapour, and dry oven heating do not seem to reduce the filter efficiency, and these methods successfully decontaminate masks.[19]

UVGI (an ultraviolet method), ethylene oxide, dry oven heating and (highly toxic[citation needed]) vaporized hydrogen peroxide are currently the most-favoured methods in use in hospitals, but none have been properly tested.[19] Where enough masks are available, cycling them and reusing a mask only after letting it sit unused for 5 days is preferred.[54]

Elastomeric respirators

Elastomeric full-face masks

Elastomeric respirators are reusable devices with exchangeable cartridge filters that offer comparable protection to N95 masks.[58] They were used as a substitute for N95 masks among shortages during the COVID-19 pandemic.[21]

The filters must be replaced when soiled, contaminated, or clogged. These components may be hard to find amidst shortages; the filters may thus be sterilized, in a way that does not harm the filter, and re-used. In medical use, they must be cleaned and disinfected, as some germs can survive on them for weeks.[21]

Full-face versions of elastomeric respirators seal better and protect the eyes. If they have exhalation valves, then they are counterrecommended in settings where the unfiltered exhaled air might infect others (for instance, surgery). Fitting and inspection is essential to effectiveness.[21]

Powered air-purifying respirators (PAPRs)

A PAPR in a level-3 biosafety lab. Note waist pack and hose to blow air into headpiece.

PAPRs are expensive masks with a battery-powered blower that blows air through a filter to the wearer. Because they create positive pressure, they need not be tightly-fitted.[59] PAPRs typically do not filter exhaust from the wearer.[60] They are not generally designed for healthcare use, as of 2017.[18]

Novel face masks (research and development)

On 15 April 2020 scientists claimed to have developed a biodegradable material for face masks which is effective at removing particles smaller than 100 nanometres including viruses and has a high breathability.[61][62] Two Israeli companies reportedly have developed antiviral face masks – one of which is infused with antiviral copper oxide and zinc oxide nanoparticles, the other is made out of cotton embedded with accelerated copper oxide particles and a nanofiber textile.[63][64][65] Other Israeli researchers have developed a 3D-printed nanoscale fiber sticker coated with antiseptics which can be attached to a traditional mask for extra protection.[65] Other reseachers report that laser-induced graphene may be used to add self-cleaning and photothermal properties to face masks.[65] In March 2020, Huang Jiaxing became the first scientist to receive a $200,000 grant by the United States' National Science Foundation to develop a chemical which can be safely built into common face masks to make them protect against SARS-CoV-2 and self-sanitize passing droplets.[65][66]


The landmark Egyptian Theater in Boise, Idaho presents a wry "Now Playing" public health message

Health organizations have recommended that people cover their mouth and nose with a bent elbow or a tissue when coughing or sneezing, and dispose of any tissue immediately.[67][68] Surgical masks are recommended for those who may be infected,[69][70][71] as wearing a mask can limit the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and coughing.[72] Masks have also been recommended for use by those who are taking care of someone who may have the disease.[71] The WHO has recommended the wearing of masks by healthy people only if they are at high risk, such as those who are caring for a person with COVID-19, though they also acknowledge that wearing masks may help people avoid touching their face.[71] Several countries have started to encourage the use of face masks by members of the public.[73]

As of May 2020, 88% of the world's population lived in countries where their government and leading disease experts recommended or mandated the use of masks in public places to limit the spread of COVID-19.[5]

World Health Organization

The World Health Organization (WHO), in its updated advice dated 5 June 2020, recommends that the general public should wear non-medical fabric masks where there is known or suspected widespread transmission and where physical distancing is not possible, and that vulnerable people (aged over 60 or with underlying health risks) and people with any symptoms suggestive of COVID-19 should wear medical masks.[74] The stated purpose of mask usage is to prevent the wearer transmitting the virus to others (source control) or to offer protection to healthy wearers against infection (prevention).[74]

Previously, early in the outbreak, the WHO had only recommended medical masks for people who had respiratory symptoms and those sharing living space, caregivers, and healthcare workers.[75][76] In a 6 April advice, the WHO recognized that wearing a medical mask can limit the spread of certain respiratory viral diseases including COVID-19, but believed that the use of a mask alone is not sufficient to provide an adequate level of protection and that other measures (such as hand hygiene) should be adopted.[77] In the scope of the community setting, the WHO stated that masks should be reserved for healthcare workers, except for people with symptoms, claiming that medical masks would create a false sense of security and neglect of other measures.[77] The WHO advice was criticized, as experts and researchers have pointed out the asymptomatic transmission of the virus.[78][79] The WHO revised its mask guidance in June, with its officials acknowledging that studies have indicated asymptomatic or pre-symptomatic spread but that not much is known.[80]

Regarding cloth masks and their recommendation by countries as a means of source control in the general population, the WHO has stated that their protective effectiveness to the wearer is still unknown, however they may protect others if the wearer is a pre-symptomatic or asymptomatic carrier.[1] The WHO recommends that decision-makers adopt a risk-based approach when deciding in which settings and circumstances non-medical masks should be used in the community.[1]

WHO's advice to the public in the context of COVID-19 endorsed the use of medical masks under the following conditions:[81][when?]

  • If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
  • Wear a mask if you are coughing or sneezing.
  • Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand sanitizer or soap and water.
  • If you wear a mask, then you must know how to use it and dispose of it properly.

US Centers for Disease Control and Prevention

Guidance from the US Centers for Disease Control and Prevention on using and making cloth masks during the COVID-19 pandemic[82]

The United States Centers for Disease Control and Prevention (CDC) recommended in April 2020 that the general public wear cloth face coverings in public settings where other social distancing measures are difficult to maintain, such as grocery stores and pharmacies, especially in areas of significant community-based transmission, due to the significance of asymptomatic and pre-symptomatic disease transmission.[82][2]

In March 2020, the CDC recommended that if neither respirators nor surgical masks are available, as a last resort, it may be necessary for healthcare workers to use masks that have never been evaluated or approved by NIOSH or homemade masks, though caution should be exercised when considering this option.[83]

The CDC faced backlash over earlier advice that most healthy people did not need to wear a mask. When asked by National Public Radio about the 3 April reversal, the CDC cited studies from February and March showing presymptomatic and asymptomatic transmission.[84] Professor of public health Larry Gostin said that the CDC could have revised its recommendation sooner; by maintaining its initial recommendation throughout March, it had given the public the impression that widespread mask usage was ineffective even though scientific evidence to the contrary was already available.[84] The earlier recommendation damaged the agency's credibility,[79][85][86] and in June 2020 Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, admitted that the delay in recommending general mask use was motivated by a desire to conserve dwindling supplies for medical professionals.[87]

China and Asia

China has specifically recommended the use of disposable medical masks by the public, including its healthy members,[12][88] particularly when coming into close contact (1 metre (3 ft) or less) with other people.[89] Hong Kong recommends wearing a surgical mask when taking public transport or in crowded places.[90][91] Thailand's health officials are encouraging people to make cloth face masks at home and wash them daily.[92] The Republic of China (Taiwan), South Korean, and Japanese governments have also recommended the use of face masks in public.

In March 2020, when asked about the mistakes that other countries were making in the pandemic, the Chinese Center for Disease Control and Prevention director-general George Fu Gao said:

"The big mistake in the U.S. and Europe, in my opinion, is that people aren't wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role − you've got to wear a mask, because when you speak, there are always droplets coming out of your mouth. Many people have asymptomatic or presymptomatic infections. If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others."[93]

Rationale for wearing masks

Queue to buy face masks in Hong Kong, 30 January 2020. Everyone in the line is already wearing a disposable medical mask.
Shadowgraphs. Left, videos of the outer airflow during a sneeze, comparing different methods of covering one's mouth and nose (and none).[94] Right, conversation. Convection also shown.

The National Health Commission of China cited the following reasons for the wearing of masks by the public, including healthy individuals:

  1. Asymptomatic transmission. Many people can be infected without symptoms or only with mild symptoms.[95]
  2. Impossibility of appropriate social distancing in many public places at all times.[95]
  3. Cost-benefit mismatch. If only the infected individuals wear a mask, they would possibly have a negative incentive to do so. An infected individual might get nothing positive, but only bear the costs such as inconvenience, purchasing expenses, and even prejudice.[95]
  4. There is no shortage of masks in China, which has been producing 100 million masks per day since early March.[95]

Leading microbiologist Yuen Kwok-yung from the University of Hong Kong cites a large viral load in sputum and saliva of an infected person and asymptomatic cases as the reasons why even healthy individuals should wear a mask.[96][97]

According to Stephen Griffin, a virologist at the University of Leeds, "Wearing a mask can reduce the propensity [of] people to touch their faces, which is a major source of infection without proper hand hygiene."[98] The precautionary principle has also been cited by the British Medical Journal as a reason some may encourage universal face mask wearing.[99]

Asian health officials and experts have been promoting universal masking. For instance, Wang Linfa (a leading infectious disease expert who heads a joint Duke University and National University of Singapore research team) stated that masking is about "preventing the spread of disease rather than preventing getting the disease", remarking that the point is to cover the faces of people who are infected but do not know it, so it is imperative for everyone to wear one in public.[100]

Studies beginning in the 2000s suggested that the required six feet of social distancing is insufficient and based on debunked studies from the 1930s or error.[4][101][102]

Efficiency studies for COVID-19

A WHO-funded systematic review by Chu et al. (June 2020) published in The Lancet found that the usage of face mask could result in a large risk reduction of infection with epidemic-causative betacoronaviruses, in which N95 or similar respirators accounted for a larger risk reduction than disposable surgical or other similar masks.[103] Masks were found to be protective for both healthcare workers and people in communities exposed to infection; evidence supports masking in both healthcare and non-healthcare settings, with no striking differences detected in the effectiveness of masks between the settings.[103] Eye protection (e.g., goggles and face shields) was also associated with a lower risk of infection.[103]

One study concluded that SARS-CoV-2 can be transmitted by respiratory droplets or airborne droplet nuclei in a Syrian hamster model for COVID-19 and that such transmission could be reduced by usage of surgical masks, especially when worn by infected individuals.[104]

A study in mainland China found that the wearing of face masks by infected individuals at home before symptom onset was effective in reducing the risk of spreading the disease to family members. It also found that the use of a face mask after the illness onset provided little protection.[105]

Shortages of face masks

Early epidemic in mainland China

People in Wuhan lining up in front of a drug store to buy surgical masks.
A notice at a supermarket in Beijing, which says each person can only buy one pack of surgical masks and one bottle of 84% disinfectant liquid a day.
Chinese electronics manufacturers, such as BYD Electronic, began to produce surgical masks after the outbreak.

As the epidemic accelerated, the mainland market in China saw a shortage of face masks due to increased public demand.[106] In Shanghai, customers had to queue for nearly an hour to buy a pack of face masks; stocks were sold out in another in half an hour.[107] Hoarding and price gouging drove up prices, so the market regulator said it would crack down on such acts.[108][109] In January 2020, price controls were imposed on all face masks on Taobao and Tmall.[110] Other Chinese e-commerce platforms –,[111],[112] Pinduoduo[113] – did likewise; third-party vendors would be subject to price caps, with violators subject to sanctions.

By March, the PRC had quadrupled its production capacity to 100 million masks per day.[95]

National stocks and shortages

At the beginning of the COVID-19 outbreak in the United States, the U.S.'s Strategic National Stockpile contained just 12 million N95 respirators, far fewer than estimates of the amount required.[114] Millions of N95s and other supplies were purchased from 2005 to 2007 using congressional supplemental funding, but 85 million N95s were distributed to combat the 2009 swine flu pandemic, and Congress did not make the necessary appropriations to replenish stocks.[114] The Stockpile's primary focus has also primarily been on biodefense (defense against a terrorist or weapon of mass destruction attack) and response to natural disaster, with infectious disease a secondary focus.[114] By 1 April 2020, the Stockpile was nearly emptied of protective gear.[115] In January and February 2020, U.S. manufacturers, with the encouragement of the Trump administration, shipped millions of face masks and other personal protective equipment to the PRC, a decision that subsequently prompted criticism given the mask shortage that the U.S. faced during the pandemic.[116]

In France, 2009 H1N1-related spending rose to €382 million, mainly on supplies and vaccines, which was later criticized.[117][118] It was decided in 2011 to not replenish its stocks and rely more on supply from China and just-in-time logistics.[117] In 2010, its stock included 1 billion surgical masks and 600 million FFP2 masks; in early 2020, it was 150 million and zero respectively.[117] While stocks were progressively reduced, a 2013 rationale stated the aim to reduce costs of acquisition and storage, now distributing this effort to all private enterprises as an optional best practice to ensure their workers' protection.[117] This was especially relevant to FFP2 masks, more costly to acquire and store.[117][119] As the COVID-19 pandemic in France took an increasing toll on medical supplies, masks and PPE supplies ran low, causing national outrage. France needs 40 millions masks per week, according to French president Emmanuel Macron.[120] France instructed its few remaining mask-producing factories to work 24/7 shifts, and to ramp up national production to 40 million masks per month.[120] French lawmakers opened an inquiry on the past management of these strategic stocks.[121] The mask shortage has been called a "scandal d'État" (State scandal).[122]

In late-March/early-April 2020, as Western countries were in turn dependent on China for supplies of masks and other equipment, China was seen as making soft-power play to influence world opinion.[123][13] However, a batch of masks purchased by the Netherlands was reportedly rejected as being sub-standard. The Dutch health ministry issued a recall of 600,000 face masks from a Chinese supplier on 21 March which did not fit properly and whose filters did not work as intended despite them having a quality certificate.[123][13] The Chinese Ministry of Foreign Affairs responded that the customer should "double-check the instructions to make sure that you ordered, paid for and distributed the right ones. Do not use non-surgical masks for surgical purposes".[13] Eight million of 11 million masks delivered to Canada in May also failed to meet standards.[124][125]

N95 and FFP masks

N95 and FFP masks were in short supply and high demand during the COVID-19 pandemic.[126][117] Production of N95 masks was limited due to constraints on the supply of nonwoven polypropylene fabric (which is used as the primary filter), as well as the cessation of exports from China.[49][127] China controls 50 percent of global production of masks, and facing its own coronavirus epidemic, dedicated all its production for domestic use, only allowing exports through government-allocated humanitarian assistance.[49]

In March 2020, US President Donald Trump applied the Defense Production Act against the American company 3M, which allows the Federal Emergency Management Agency to obtain N95 respirators from 3M.[128][129] White House trade adviser Peter Navarro stated that there were concerns that 3M products were not making their way to the US.[128] 3M replied that it has not changed the prices it charges, and was unable to control the prices its dealers or retailers charge.[128]

In early April 2020, Berlin politician Andreas Geisel alleged that a shipment of 200,000 N95 masks that it had ordered from American producer 3M's China facility were intercepted in Bangkok and diverted to the United States. Berlin Police president Barbara Slowik stated that she believed "this is related to the US government's export ban."[130] 3M said they had no knowledge of the shipment, stating "We know nothing of an order from the Berlin police for 3M masks that come from China," and the US government denied that any confiscation had taken place and said that they use appropriate channels for all their purchases.[130][131]

Berlin police later confirmed that the shipment was not seized by US authorities, but was said to have simply been bought at a better price, widely believed to be from a German dealer or China. This revelation outraged the Berlin opposition, whose CDU parliamentary group leader Burkard Dregger accused Geisel of "deliberately misleading Berliners" in order "to cover up its own inability to obtain protective equipment". FDP interior expert Marcel Luthe said "Big names in international politics like Berlin's senator Geisel are blaming others and telling US piracy to serve anti-American clichés."[132] Politico Europe reported that "the Berliners are taking a page straight out of the Trump playbook and not letting facts get in the way of a good story."[133] The Guardian also reported that "There is no solid proof Trump [nor any other American official] approved the [German] heist".[134]

Jared Moskowitz, head of the Florida Division of Emergency Management, accused 3M of selling N95 masks directly to foreign countries for cash, instead of the US. Moskowitz stated that 3M agreed to authorized distributors and brokers to represent they were selling the masks to Florida, but instead his team for the last several weeks "get to warehouses that are completely empty." He then said the 3M-authorized US distributors later told him the masks Florida contracted for never showed up because the company instead prioritized orders that came in later, for higher prices, from foreign countries (including Germany, Russia, and France). As a result, Moskowitz highlighted the issue on Twitter, saying he decided to "troll" 3M.[135][136][137] Forbes reported that "roughly 280 million masks from warehouses around the US had been purchased by foreign buyers [on March 30, 2020] and were earmarked to leave the country, according to the broker — and that was in one day", causing massive critical shortages of masks in the US.[138][139]

As more and more countries restricted the export of N95 masks, Novo Textiles in British Columbia announced plans to start producing N95 masks in Canada.[140] AMD Medicom in Quebec had long been the main Canadian company producing N95s, but after China, France, the Republic of China (Taiwan) and the United States barred them from repatriating the masks produced by Medicom in their factories, the Government of Canada awarded them a 10-year contract to build a factory to produce masks in Montreal.[141]

The mask industry


With population of 24 million, Taiwan has been producing 13 million masks per day since March.

As of 2019, mainland China manufactured half the world output of masks.[142] As Covid-19 spread, enterprises in several countries quickly started or increased the production of face masks.[143] Cottage industries and volunteer groups also emerged, manufacturing cloth masks for localized use. They used various patterns, including some with a bend-to-fit nosepiece inserts. Individual hospitals developed and requested a library of specific patterns.[144][145][146][147]

One of the cotton face masks manufactured in China during the COVID-19 pandemic, distributed by a retailer in the United States.

In the first five months of 2020, 70802 new companies registered in China to make or trade face masks, a 1256% increase compared to 2019, and 7296 new companies registered to make or trade meltblown fabric, a key component of face masks, a 2277% rise from 2019.[148]

In April, however, the Chinese government stepped in with tighter regulations. 867 producers of the meltblown fabric were shut down in Yangzhong city alone. Many speculative manufacturers have been forced to quit due to changing export rules and tighter licensing requirements in China and weaker demand for lower quality products globally.[148]


Some clinical stockpiles have proved inadequate in scale, and markets have expanded as non-medical consumers started obeying mandated mask-wearing or determined that masks might help or encourage them. Worldwide demand for face masks has resulted in masks shipping around the globe as a result of commercial transactions or of donations.[149]

Society and culture


Slovakia was one of the first countries in the world to introduce universal masking in public places.[150]
A sign language interpreter (on the right) is wearing a transparent mask to allow lip reading.

In East Asian societies, a primary reason for mask-wearing is to protect others from oneself.[151][152] The broad assumption behind the act is that anyone, including seemingly healthy people, can be a carrier of the virus.[152] The usage of masks is seen as a collective responsibility to reduce the transmission of the coronavirus.[153] A face mask is thus seen as a symbol of solidarity in Eastern countries.[153] Elsewhere, the need for mask-wearing is still often seen in an individual's perspective where masks only serve to protect oneself.[151] However, a cultural shift towards the message of solidarity has gradually taken place as the pandemic continued.[154]

Cultural norms and social pressure may impede mask-wearing in public, which explains why masking has been avoided in the West.[155] According to Joseph Tsang, a Hong Kong doctor and infectious disease expert, the promotion of universal masking may resolve perceptions against mask-wearing, because mask-wearing is intimidating if few people wear masks due to cultural barriers, but if all people wear masks it shows a message that people are in this together.[100] Consistent with this intuition, empirical evidence shows that an individual's likelihood of voluntarily wearing a mask is positively correlated with the proportion of uptake in the surrounding area.[156]

In the Western world, the public usage of masks still often carries a large stigma,[151][153][157] as it is seen as a sign of sickness.[157] This stigmatization is a large obstacle to overcome, because people may feel too ashamed to wear a mask in public and therefore opt to not wear one.[158] However, there is also a divide within the Western world, as seen in the Czech Republic and Slovakia where mass mobilization has occurred to reinforce the solidarity in mask-wearing since March 2020.[151]

Masking has been subjected to racial politics in Western countries.[159] For instance, it has been heavily racialized as an Asian phenomenon.[153] This has been reinforced in a lot of media discourses, where unrelated stories about the pandemic are often accompanied by imagery of Asian people in masks.[159][160] The focus on race has brought hostility towards Asians who are confronted with the choice to mask as precaution while they face discrimination for it.[159][161] Huang Yinxiang, a sociologist from the University of Manchester, described maskaphobia—negative prejudice, fear or hatred against people wearing face masks—as making Asians in Western countries into targets for racists who want to normalize and justify xenophobia during the COVID-19 outbreak.[162] Likewise, people from certain groups such as Black Americans may not feel comfortable wearing masks, especially those that are not clearly medical but homemade masks, due to concerns of racial profiling.[163][164][165]

Mask-wearing has been called a prosocial behavior in which one protects others within their community.[166][167] On social media, there has been an effort with the #masks4all campaign to encourage people to use masks.[168] Nevertheless, there have been a lot of attacks and threats by people who became aggressive after they were requested to wear a mask or saw people in masks in places related to the service industry.[169][170][171][172]


The U.S. Surgeon General urged people to wear face masks, reversing his earlier statements that masks were not effective for the general public.[173]
The heads of state and government of Portugal and Spain wearing face masks during an official ceremony in July 2020

In the United States, public masking has become a political issue, as opponents argue that it inhibits personal freedom and proponents emphasize the importance of masks for public health.[174] It is seen as a political statement by some people,[175] with party affiliation determining whether people were likely to embrace the wearing of masks in public.[175][176] Democrats were more likely to wear masks than Republicans.[175][176] The issue is seen as a part of a culture war.[174][175][176] Commentators argue that the resistance against masks partly stems from the confusing and mixed messaging about masking.[174][177][178]

Although authorities in especially Asia have been recommending people to wear face masks in public, in many other parts of the world, conflicting advice have caused a lot of confusion among the general population.[179] Several governments and institutions, such as in the United States, have initially dismissed the use of face masks by the general population, often with misleading or incomplete information about the usefulness of masks.[180][181][182] Commentators have attributed the anti-mask messaging to efforts to manage the mask shortages, as governments did not act quickly enough, remarking that the claims go beyond the science or were simply lies.[182][183][184][185] On 12 June 2020, Anthony Fauci, a key member of the White House coronavirus task force, confirmed that the American public were not told to wear masks from the beginning due to the shortages of masks and explained that masks do actually work.[186][187][188][189][190]

In April 2020, health officials from Taiwan's Central Epidemic Command Center (CECC) pushed back on school bullying of young boys in pink face masks. At a press conference breaking gender norm barriers, the health officials wore pink masks, as various government agencies demonstrated solidarity by changing the colors on their Facebook pages to pink. One of the officials participating in the press conference later tweeted, "Pink is for everyone and no color is exclusive for girls or boys. Gender equality lies at the heart of Taiwan values." The press conference was held amid reports that male students were too embarrassed to wear their pink face masks, jeopardizing their safety and the safety of others in the face of COVID-19.[191]


Face masks have had an impact on fashion, with the masks themselves becoming fashion statements, haute couture brands having pivoted to address both public health and aesthetic needs.[192][193][194][195] As public usage of fabric masks have become more commonplace, people have started to consider the aesthetical design of it.[196]

Mask use and policies by country and territory

% of population wearing face masks in public, by country/territory (as of 5 May)[197]
Country/territory %
Hong Kong Hong Kong 90
Singapore Singapore 90
China China 88
Italy Italy 87
Taiwan Taiwan 87
Thailand Thailand 87
Japan Japan 86
Vietnam Vietnam 86
Malaysia Malaysia 85
Indonesia Indonesia 84
Philippines Philippines 84
India India 82
United Arab Emirates United Arab Emirates 78
Spain Spain 72
Mexico Mexico 67
United States United States 63
Germany Germany 62
France France 56
Saudi Arabia Saudi Arabia 56
Canada Canada 41
Australia Australia 25
United Kingdom United Kingdom 13
Finland Finland 7
Norway Norway 7
Denmark Denmark 5
Sweden Sweden 2
  • Argentina Argentina: After appearance of three asymptomatic cases, the capital Buenos Aires introduced compulsory masking since 14 April. Wearing a mask was made obligatory for everyone on public transit and everyone who contacts with the public in their position. Violators can face a fine. Authorities also prohibited the sale of N95 face masks to non-medical workers, suggesting the general public to use home-made masks instead.[198]
  • Austria Austria: Everyone entering a supermarket, a grocery store, or a drug store or using public transportation must wear a face mask, mandatory since 14 April.[199][200][201]
  • The Bahamas Bahamas: On 19 April, the prime minister announced that wearing a mask or covering one's face with clothing is mandatory in public. Employers must provide their employees who are serving the general public with masks.[202]
  • Bahrain Bahrain: The Kingdom made wearing face masks in public areas compulsory for citizens and residents as well as shop workers.[203]
  • Benin Benin: From 8 April, Benin's authorities began enforcing the mandatory wearing of face masks to halt the coronavirus.[204]
  • Bosnia and Herzegovina Bosnia and Herzegovina: Wearing a face mask is compulsory.[205][206]
  • Bulgaria Bulgaria: Bulgaria's government passed an order imposing an obligation to wear face masks on 30 March. The order was cancelled the next day and changed into a recommendation, due to legal complaints.[207]
  • Cambodia Cambodia: Many Cambodians started wearing face masks soon after the outbreak began in Wuhan. Businesses started to require customers to wear masks.[208]
  • Cameroon Cameroon: On 6 April, mayor of Douala announced that wearing a mask will be mandatory to slow the spread of coronavirus.[209]
  • Canada Canada: Since 6 April, health officials recommend wearing non-medical masks in situations where physical distancing from others is difficult (like buying groceries, or public transit).[210] The use of face coverings in indoor, publicly accessible settings became mandatory in Toronto on July 7 2020.[211]
  • Chile Chile: From 8 April, Chilean Health Minister announced wearing a mask is mandatory in public transit.[212]
  • China China: Healthy individuals are advised to wear disposable medical masks in public places.[12][89] Some local governments require wearing masks when going outside. Shanghai makes wearing masks mandatory in public places.[213]
    • Hong Kong Hong Kong: Members of the public are recommended to wear a surgical mask when taking public transport or staying in crowded places.[90]
  • Colombia Colombia: In response to recommendations from the WHO, Colombia changed its policy on the use of masks and made it mandatory throughout the country for the use of public transport during the coronavirus emergency.[214]
  • Croatia Croatia: Since 8 July, everyone entering any enclosed place, like shops and other buildings, must wear a face mask.[215]
  • Cuba Cuba: On 11 March, the government urged citizens to make their own masks, while the textile industry was drafted to fabricate them. People were advised to carry several cloth masks with them, depending on how many hours they plan to spend in public areas.[216] Later, wearing a mask was made mandatory.[217]
  • Czech Republic Czech Republic: It was forbidden to go out in public without wearing a mask, or covering one's nose and mouth until 25 May.[218]
  • Dominican Republic Dominican Republic: Since 16 April, the use of face masks is mandatory in all public spaces and in the workplace.[219]
  • Democratic Republic of the Congo DR Congo: Since 20 April, wearing masks in the capital of Kinshasa is mandatory.[220]
  • Denmark Denmark: The Danish Health Authority does not recommend the wearing of face masks in public places by healthy residents, arguing that it is unclear as to whether doing so will affect the outcome of the virus, and that doing so may provide residents with a false sense of security. Hand-made face masks are more strongly advised against than surgical face masks, as the Danish Health Authority perceives them to be less capable of protection from the virus than the latter.[221] However, starting on 15 June 2020, face masks will become mandatory at all airports.[222]
  • Ecuador Ecuador: On 8 April, the Emergency Operations Committee (COE) decided to make face masks obligatory in public spaces.[223]
  • Egypt Egypt: On 30 May 2020, the wearing of face masks in public places and on public transportation became mandatory; failure to comply can result in fines of up to EGP4,000 (US$247).[224]
  • Ethiopia Ethiopia: The Council of Ministers approved a regulation that outlaws handshakes, and obligates the use of face masks in public places.[225]
  • France France: On 3 March, the government issued a degree announcing requisition of stocks of FFP2 and anti-splash masks until 31 May 2020.[226] On 8 May 2020, the government announced that 200 million masks per week will be available starting on 11 May: 100 million for medical workers and 100 million for the general public.[227]
  • Gabon Gabon: On 10 April, the Gabonese government announced individuals in all parts of the country are required to wear masks in public to limit the spread of COVID-19.[228]
  • Germany Germany: On 31 March, city-county Jena, Thuringia, was the first large German city to introduce an obligation to wear masks, or makeshift masks including scarves, in supermarkets, public transport, and buildings with public traffic, from 6 April, very successfully. On 2 April, the Robert Koch Institute, the federal epidemic authority, changed its previous recommendation that only people with symptoms should wear masks to also include people without symptoms.[229][230] Later in April, Germany made the wearing of cloth face masks mandatory on public transport, as well as for shopping in most German states.[231]
  • Guinea Guinea: Guinean President Alpha Conde decided to make wearing masks compulsory.[232]
  • Honduras Honduras: From 7 April, Honduras President announced all citizens will now be required to cover their mouths when they are outside.[233]
  • India India: On 3 April, the Office of the Principal Scientific Adviser to the Government of India issued an advisory and manual, asking healthy people to wear handmade reusable face covers when stepping out of their homes, especially for those in densely populated areas.[234][235] Some individual states, like Odisha, West Bengal, Maharashtra and Uttar Pradesh made wearing of masks compulsory in public places.[236][237][238]
  • Indonesia Indonesia: Citizens were ordered to wear face masks when they leave the house.[239]
  • Republic of Ireland Ireland: From 18 May, the use of cloth face covering is recommend in enclosed public spaces where it's difficult to maintain social distance.[240][241]
  • Israel Israel: All residents are asked to wear face masks when in public.[242]
  • Italy Italy: Regions of Lombardy and Tuscany made wearing a face mask compulsory before going out in early April.[243]
  • Ivory Coast Ivory Coast: From April, 26 masks have become compulsory to enter shopping malls or supermarkets in the Southern suburb of Abidjan, Marcory.[244]
  • Japan Japan: Masks have been widely used by healthy individuals despite absence of official advice to do so.[245] On 1 March, prime minister Shinzo Abe enacted a policy in Hokkaido instructing manufacturers to sell face masks directly to the government, which would then deliver them to residents.[246]
  • Kenya Kenya: Wearing a face mask is compulsory since 4 April. The government has Kenyans to strictly observe social distancing, which has been proved to one of the most efficient ways of preventing infection risks.[247]
  • Liberia Liberia: From 21 April, it is now compulsory to wear a face mask or covering in public.[248]
  • Lithuania Lithuania: Wearing a face mask or any other means of covering one's nose and mouth in public places is compulsory since 10 April 2020.
  • Luxembourg Luxembourg: From 20 April, wearing a mask is mandatory in places where it is not possible to keep enough distance to others such as supermarkets or on public transport.[249]
  • Malaysia Malaysia: Masks have been widely used by healthy individuals despite absence of official advice to do so.[250] On 17 March, Malaysia banned exports of medical and surgical masks, to meet local demand.[251] In April, the government was set to distribute 24.62 million masks, four for each household, while advising people to only use them if they have symptoms.[239]
  • Mexico Mexico: From 17 April, all Mexico City Metro passengers must wear masks while inside stations and on trains, Mayor Claudia Sheinbaum announced on 15 April.[252]
  • Mongolia Mongolia: Wearing a mask is now mandatory while riding public transportation in Ulaanbaatar. Public officials and news broadcasters had even adopted to wearing masks through press conferences and news broadcasts.[253]
  • Morocco Morocco: Wearing a face mask is compulsory.[254]
  • Mozambique Mozambique: The Mozambican government announced on 8 April that wearing face masks is now compulsory on all forms of passenger transport, and wherever groups of people are gathered.[255]
  • North Macedonia North Macedonia: As of 22 April, citizens of Kumanovo, Tetovo, and Prilep must wear protective masks and gloves outside their homes, at public places, outdoor and indoor areas, markets, and shops announced the government.[256]
  • Pakistan Pakistan: The Balochistan government on 18 April told citizens to wear face masks when going outside. According to provincial government spokesperson Liaquat Shahwani, citizens have been urged to wear masks or to cover their faces with any cloth in the wake of the COVID-19 outbreak.[257]
  • Panama Panama: Panama has made it obligatory to wear a face mask whenever going outside, while also recommending the manufacture of a homemade cloth face mask to those who cannot purchase face masks.[258]
  • Peru Peru: From 7 April, the Peruvian government started distributing free masks after decreeing their mandatory use in the streets to chase away the new coronavirus, said President Martin Vizcarra.[259]
  • Philippines Philippines: From 2 April, the government required all those living in areas under enhanced community quarantine to wear face masks.[260]
  • Poland Poland: Since 16 April, covering lips and nose is compulsory before leaving one's house (e.g., by a disposable mask, cloth mask, or scarf).[261]
  • Russia Russia: Khabarovsk has made the wearing of face masks obligatory to fight the spike in respiratory diseases and prevent the spread of the coronavirus.[262]
  • Rwanda Rwanda: On 20 April, Cabinet Minister of Health Daniel Ngamije said the latest guidelines require everyone to wear a mask in public, and at home during the lockdown and thereafter.[220]
  • Serbia Serbia: Wearing face masks has been required since June 29 in public indoor places, including public transportation.[263]
  • Singapore Singapore: Masks have been widely used by healthy individuals despite initial absence of official advice to do so.[264] General mask-wearing was no longer discouraged from 3 April,[265] and made mandatory outside of one's residence from 14 April.[266]
  • Spain Spain: Wearing masks has been required since 4 May while on public transportation, which includes taxis, trains and buses. The government is providing masks to the majority of people riding public transportation, regardless of if they have a mask on.[267][268]On 9 June, the Spanish Ministry of Health and the Ministry of Transport maintains the mandatory nature of masks on public roads, in open air spaces, and in closed spaces for public use[269]
  • Slovakia Slovakia: Face masks were compulsory in public transport and shops since 15 March.[270] On 25 March, it became forbidden to go out in public without wearing a mask or covering one's nose and mouth.[271] Since 20 May, face masks are no longer mandatory when distance between people is at least 5 meters.[272]
  • Slovenia Slovenia: From 29 March, wearing a face mask, even one made at home, or equivalents such as scarves that cover the mouth and nose is mandatory along with protective gloves; the decree stipulates that masks and gloves need to be worn in indoor public spaces.[273]
  • South Africa South Africa: On 10 April, Minister of Health recommended that the general public use cloth face masks when going out in public (in addition to hand-washing and social distancing).[274] After 1 May, covering one's nose and mouth will be mandatory in public (with a cloth mask, scarf, T-shirt, etc.).[275]
  • South Korea South Korea: Masks have been widely used by healthy individuals despite absence of official advice to do so.[276] The government implemented a policy of centralized procurement and rationing of face masks, purchasing 80 percent of national production since early March.[277] On 25 May, the Korean government / Central Disaster and Safety Countermeasure Headquarters required passengers on buses, taxis, subways, and flights to wear masks.[278]
  • Sweden Sweden: Sweden's Public Health Agency states that the scientific evidence does not support public use of face masks, and that public use of face masks would undermine Sweden's COVID-19 response. The government has also warned that wearing them might create a false sense of security, and that public use of masks could do more harm than good.[279][280]
  • Taiwan Taiwan: On 21 January, the government announced a temporary ban on the export of face masks.[281] On 6 February, the government instituted a mask rationing system.[282] The ROC has been producing ten million masks per day since mid-March.[283] On 1 April, passengers on trains and intercity buses were required to wear face masks,[284] unmasked riders facing a fine.[285]
  • Turkey Turkey: Residents will be required to wear masks at markets, as Turkish president announced.[286]
  • Ukraine Ukraine: Since 6 April, wearing a face mask is required by the government in public places. In Kyiv, public places were clarified to include parks and streets.[287]
  • United Kingdom United Kingdom: From 15 June, face coverings are compulsory on public transport in England.[288]
  • United States United States: In March 2020, the CDC recommended that if neither respirators nor surgical masks are available, as a last resort, it may be necessary for healthcare workers to use masks that have never been evaluated or approved by NIOSH or homemade masks, though caution should be exercised when considering this option.[290] On 6 April, the CDC recommended the wearing of non-medical cloth face coverings when in public places.[291][292] As of 18 June 11 states have implemented health orders requiring the wearing of face coverings in most public spaces.[293][294]
  • Uzbekistan Uzbekistan: Officials made protective masks mandatory in all major cities to prevent the spread of coronavirus. Officials on 22 March said citizens not wearing masks in public in major cities would be fined $22 for the first offense and $67 for repeat offenses.[295]
  • Venezuela Venezuela: The government ordered the country's citizens to wear face masks in public in response to the arrival of the novel coronavirus.[296]
  • Vietnam Vietnam: Since 16 March, everyone must wear a face mask when going to public places (such as grocery stores, transportation hubs, and public transport).[297]
  • Zambia Zambia: The government made it mandatory to wear face masks to minimise the spread in the country.[298]


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