The use of masks and personal protective equipment (PPE), especially for people living with HIV in NSW.  ***UPDATED: 23 July

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: July 2020

Positive Life NSW is aware there continues to be confusing, and even conflicting 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.

Updated in July 2020, 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 our partners, family and friends in NSW.

CONTENTS

I Personal Protective Equipment

a) The voluntary use of additional PPE
b) Appropriate Use of Face Masks
c) Limitations of Disposable Masks
d) Advantages of Disposable Masks
e) Use of Disposable Gloves

II Who is most at risk and current recommendations

a) Specific recommendations for people living with HIV
b) Current recommendations for everyone

 

I Personal Protective Equipment

a) 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, within NSW these are not recommended as first line prevention against acquiring coronavirus. It is recommended that masks be used in situations where physical distancing of 1.5 meters cannot be comfortably maintained.

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]

There is a concern that the misuse of PPE could potentially 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] We also highlight the importance of correctly disposing of masks into a secure container or bin after use as an added precaution to protect others.[3]

The correct use of PPE is complex within clinical settings. Translating this out into the general community adds uncertainty to the effectiveness of PPE. This document contains the current recommendations for NSW. Other states[4] and cities[5] may have different requirements and this information may change.

We urge people to consider the safety and effectiveness of 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 when they become damp from moisture in your breath.

b) Appropriate Use of Face Masks (adapted from WHO use of PPE Guidelines)[6]

Hand washing and physical distancing remain the key strategies for the ongoing prevention of acquiring SARS-CoV-2 that causes COVID-19. These are measures that have clearly so far in keeping infection rates low in Australia[7], where self-isolation and quarantine measure have been adhered to strictly.

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.[8] There are also emerging calls for the use of face masks as an added precaution as protection against acquiring SARS-CoV-2, particularly on public transport within NSW and in areas where physical distancing cannot be maintained.[9]

Therefore, the personal choice to use masks in NSW 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 in an age or identified high risk category, and are leaving their place of residence for an essential purpose or living with someone who has respiratory symptoms or has respiratory symptoms. 

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. Once in place, the mask 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.[10]

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.

c) 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. Be mindful that the mask is possibly contaminated and should be disposed of in a waste container where no one else will need to touch it to prevent risk to others. It is important you wash your hands after removing your mask, after touching any object or surface[11] or after disposing of a mask.  

These masks are also 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.

We encourage people to remain vigilant and follow the recommendations of NSW Health, monitor the news for changes and adjust your activity to essential appointments, work and grocery shopping. If you are feeling at all uncertain, please contact the Treatments Officer at Positive Life NSW 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. to discuss and address your concerns.

d) 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.

e) 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.

Gloves 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 and current recommendations

People at higher risk from acquiring coronavirus[12] 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)[13]
  • 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.

a) Specific recommendations for people living with HIV[14],[15],[16]

  • 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.

b) Current recommendations for everyone[17],[18]

  • 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 a Positive Life NSW 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.

 

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

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

[3] Single-use masks could be a coronavirus hazard if we don’t dispose of them properly https://theconversation.com/single-use-masks-could-be-a-coronavirus-hazard-if-we-dont-dispose-of-them-properly-143007

[4] Health and Human Services, Victoria State Government, 19 July 2020. www.dhhs.vic.gov.au/updates/coronavirus-covid-19/face-coverings-mandatory-melbourne-and-mitchell-shire

[5] USA Centre for Disease Control (CDC), Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community Based Transmission  www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

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

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

[8] 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. www.youtube.com/watch?v=3wnne5pdBdQ

[9] Coronavirus NSW: Calls for masks to be used on public transport: https://www.news.com.au/world/coronavirus/australia/coronavirus-nsw-calls-for-masks-to-be-used-on-public-transport/news-story/f20e8205d3f7ab158dd7daeac88ca75a

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

[11]Single-use masks could be a coronavirus hazard if we don’t dispose of them properly https://theconversation.com/single-use-masks-could-be-a-coronavirus-hazard-if-we-dont-dispose-of-them-properly-143007

[12] NSW Health, COVID-19 Frequently Asked Questions, Who is most at risk? www.health.nsw.gov.au/Infectious/alerts/Pages/coronavirus-faqs.aspx#1-14

[13] Australian Government Department of Health Fact Sheet: for older Australians on covid-19  www.health.gov.au/sites/default/files/documents/2020/03/coronavirus-covid-19-information-for-older-australians.pdf

[14] Australian Government Department of Health – Isolating at home if you are unwell 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

[15] Australian Government Department of Health – Isolating at home if you are unwell 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

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

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

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

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