The use of masks and personal protective equipment, especially for people living with HIV during COVID-19. 

Disposable mask and gloves with a stethoscope on a bench

Positive Life NSW Position Paper: The use of masks and personal protective equipment

pdfDownload a printable copy here

Updated: May 2020

Positive Life NSW is aware there has been conflicting, and even confusing messaging, on the use of masks for protecting people against SARS-CoV-2 (also known as Coronavirus), the virus that causes the infection COVID-19.

This position statement is to clarify and summarise the appropriate use of personal protective equipment (PPE), such as disposable masks and gloves especially for the communities of people living with HIV (PLHIV) and their partners, family and friends.

I. Personal Protective Equipment

  1. The voluntary use of additional PPE
  2. Appropriate Use of Face Masks
  3. Limitations of Disposable Masks
  4. Advantages of Disposable Masks
  5. Use of Disposable Gloves

II. Who is most at risk?

  1. Recommendations for people living with HIV
  2. The current recommendations for everyone

 

I Personal Protective Equipment

1. The voluntary use of additional PPE

Positive Life understands that some people are voluntarily using PPE (masks and/or gloves) as a further added precaution against coronavirus. Currently, these are not recommended as first line prevention against acquiring coronavirus.

Unfortunately, when people use these added precautions they are often doing so in a way that puts them, their partners, their loved ones at greater risk by using PPE incorrectly.[1]

Positive Life shares the concern that the misuse of PPE can build a false sense of security, undermine or encourage people not to follow the primary prevention guidelines and may increase the risk for the acquisition of coronavirus due to the incorrect use of PPE equipment.[2]

The correct use of PPE is complex within clinical settings. Translating this out into the general community adds uncertainty to the effectiveness of PPE.

Some countries are recommending the use of cloth face masks. This is based on the density and concentrations of the population within these places[3] which make physical distancing challenging in slowing the transmission of coronavirus and this does not apply in its entirety to the Australian context.  We urge people to consider the safety and effectiveness of these masks.  Masks made of waterproof material afford slightly better protection as they are less likely to allow the virus to track across through to your nose and face.

2. Appropriate Use of Face Masks (adapted from WHO use of PPE Guidelines[4])

The use of face masks has remained unclear within the current recommendations. Hand washing and social [physical] distancing remaining the key strategies for the ongoing prevention of acquiring SARS-CoV-2 that causes the illness COVID-19. These are measures that have clearly worked to date in keeping infection rates low in Australia.[5]

There is emerging evidence that the use of face masks by 50% of the population even if only used correctly 20% of the time may be beneficial.[6] This is because it was first thought that SARS-CoV-2 was spread mainly by droplet infection and was acquired by mainly touching surfaces then touching your face. There are recommendations emerging for the use of face masks as an added precaution in protecting people against acquiring SARS-CoV-2.[7]

Therefore, the personal choice to use masks can be an additional precaution in reducing risks in spaces that are more confined or where distancing is not easy to maintain. Examples include supermarkets, shops with narrow aisles, on public transport or as a passenger in a car, for people who have a chronic health condition, are an age or identified high risk category, and are leaving their place of residence for an essential purpose. 

All masks should fit the face with a complete seal over the nose, down each side of the face and under the chin so only filtered air is breathed in through the mask. Men may need to trim or shave their beard entirely to ensure proper fitting. The mask once in place should not be removed until the identified period of risk is over, such as when you return home, or until the manufacturer’s specified time says the mask should be discarded or cleaned.[8]

Reusable masks should be removed, cleaned/washed and filters replaced as per the manufacturer's instructions. This will vary between the different types of masks, the material they are manufactured from, the level of protection they provide, and if they are manufactured or homemade.

Before placing the mask on your face ensure that your hands have been washed, then place the mask over your face ensuring that all surfaces of the mask fit to the face snugly and secure it. The mask should not be removed or shifted until you are in a lower risk environment. Remove the mask by using the securing ties from behind your head or ears and not by touching the front of the mask. Dispose of it immediately in a bin, and thoroughly wash your hands.

The use of masks can be an additional precaution in reducing risks in spaces that are more confined or where distancing is not easy to maintain. Examples include supermarkets, shops with narrow aisles, on public transport or as a passenger in a car, for people who have a chronic health condition, are an age or identified high risk category, and are leaving their place of residence for an essential purpose.

3. Limitations of Disposable Masks

While effective, these masks are manufactured of material that is not designed to be cleaned and should be discarded immediately after only one use.

These masks are usually cheaper e.g. paper-like masks. Moving them to below your nose or chin, to answer the phone, smoke, drink, order something at the café etc. compromises the mask and you must not put this mask back onto your face.

It has potentially become contaminated and could transfer the virus to your face, nose and eyes. This means, the mask should be removed carefully from behind your head, not touching the front of the mask.

If you use disposable masks, you will need to carry several masks with you. If you use your phone while you have the mask on, you will need to clean your phone before using it again, after you take off your mask.

4. Advantages of Disposable Masks

Face masks worn by someone who has respiratory symptoms, who lives with others in the same household, or if going out in public, may reduce the risk of onward transmission.

If you are in a higher risk category, and when physical spacing in public is difficult or unable to be guaranteed, these disposable masks may reduce the risk of exposure to the virus when used correctly.

5. Use of Disposable Gloves

Gloves are not a replacement for the recommended hand hygiene practice of washing hands regularly with soap and water for 20 seconds, or the use of a 60% alcohol based sanitiser. Their use outside clinical or usual cleaning activities can compromise their protective value. They are only useful as a reminder not to touch your face. If you are wearing gloves and touch your face, you have transferred organisms to your face via the glove. Slipping them on and off regularly also transfers organisms inside the glove.  

II Who is most at risk?

People at higher risk from acquiring coronavirus[9] are people who:

  • have recently returned from overseas
  • have been in close contact with someone who has been diagnosed with COVID-19
  • have compromised immune systems (e.g. cancer)
  • have diagnosed chronic medical conditions such as diabetes hypertension, cardiovascular or lung disease
  • are elderly people aged 70+ (or 50+ for Aboriginal and Torres Strait Islander people)[10]
  • are Aboriginal and Torres Strait Islander, as they have higher rates of chronic illness
  • are living in residential aged care facilities and disability group homes
  • are in detention facilities
  • are students in boarding schools
  • are on Cruise Ships.

1. Recommendations for people living with HIV[11] ,[12],[13]

  • People with a CD4 count over 200, who are taking HIV treatment andhave an undetectable viral load and no other underlying health conditions are considered at no greater risk than the general population. They should follow general advice to stay at home and maintain physical distancing.
  • People with a CD4 count below 200orwho are not taking HIV treatmentor who have a detectable viral load may be at higher risk of severe illness. Nonetheless, they should still follow the same general advice.
  • People with a very low CD4 count below 50 orwho have had an opportunistic illness in the last six months should follow isolation practices under their doctor’s instructions.

2. The current recommendations for everyone[14],[15]

  • regularly wash your hands for 20 seconds, or use a hand gel sanitiser with 60% alcohol
  • maintain physical distancing of 1.5 meters between people
  • avoid touching your face (mouth, nose and eyes)
  • only leave your place of permanent residence for essential activities which include exercising, medical appointments or fulfilling one’s carer responsibilities, shopping for food, moving house, picking up medications, providing care or assistance to a vulnerable person, undertaking any legal obligation, accessing public services, avoiding injury or illness or to escape a risk of harm, and travelling to work or education if unable to be carried out at home. Other ‘Reasonable excuses’ are listed under Schedule 1 in Public Health (COVID-19 Restrictions on Gathering and Movement) Order 2020 [NSW)

If you want to talk about your concerns regarding coronavirus as a person living with HIV, or have questions about your use of PPE, please contact Positive Life NSW and talk to a Treatments or Peer Support Officer, on  (02) 9206-2177 or 1800 245 677 (freecall) or email This email address is being protected from spambots. You need JavaScript enabled to view it.

 

FOOTNOTES

[1] WHO, Coronavirus disease (COVID-19) advice for the public: When and how to use masks https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

[2] The Royal College of Physicians https://www.racp.edu.au/news-and-events/media-releases/racp-says-face-masks-must-be-conserved-for-frontline-health-workers/

[3] CDC, Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community Based Transmission  https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

[4] WHO, Coronavirus disease (COVID-19) advice for the public: When and how to use masks https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

[5] https://www.health.nsw.gov.au/Infectious/Influenza/Publications/2020/march-influenza-report.pdf page 6

[6] The COVID-19 pandemic update: transmission, herd immunity and is an exit strategy possible?  Professor Raina MacIntyre, Head, Biosecurity Program, Kirby Institute and NHMRC Principal Research Fellow, 21 April 2020.

[7] https://www.health.nsw.gov.au/Infectious/Influenza/Publications/2020/march-influenza-report.pdf 

[8] WHO, Coronavirus disease (COVID-19) advice for the public: When and how to use masks https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

[9] NSW Health- Who is most at risk? https://www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx#1-14

[10] Fact Sheet: for older Australians on covid-19  https://www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-for-older-australians.pdf

[11] Australian Government Department of Health – Isolating at home if you are unwell https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/self-isolation-self-quarantine-for-coronavirus-covid-19#isolating-at-home-if-you-are-unwell-or-have-coronavirus

[12] Australian Government Department of Health – Isolating at home if you are unwell https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/how-to-protect-yourself-and-others-from-coronavirus-covid-19/self-isolation-self-quarantine-for-coronavirus-covid-19#isolating-at-home-if-you-are-unwell-or-have-coronavirus

[13] NAM AIDSmap: Coronavirus (COVID-19) and HIV https://www.aidsmap.com/about-hiv/coronavirus-covid-19-and-hiv

[14] Australian Government Department of Health COVID-19—Frequently asked questions https://www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx#2-1

[15] Australian Government Department of Health COVID-19- Frequently asked questions https://www.health.gov.au/sites/default/files/documents/2020/04/coronavirus-covid-19-frequently-asked-questions_0.pdf

 

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