PolyU Study Shows One in Eight Not Wearing Face Masks Properly • Almost 80% of People Reusing Them • Experts Urge Users to Wear Face Masks Correctly and Formulate Guidelines on Reuse to Minimise Contagion Risks

The outbreak of COVID-19 in Hong Kong has recently eased slightly. The number of confirmed cases has declined, and we see the first signs of success in the fight against the pandemic. However, both the government and experts have called on the public to continue stringent anti-contagion measures for the foreseeable future, in particular, to wear face masks and maintain good personal hygiene. The Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University (PolyU) conducted a research study from February to April 2020 on the behaviour and attitudes of Hong Kong people towards the use of face masks during the COVID-19 outbreak. The results were published in EClinicalMedicine (https://info.thelancet.com/eclinm-covid-19), a clinical journal published under the auspices of The Lancet.

In February, the research team conducted an observational study of 10,211 people in different areas of Hong Kong, recording how people wear their masks. The study found that most people wore face masks when going out (95%) of whom 84% wore disposable surgical masks. However, more than one-eighth (13%) wore their surgical masks incorrectly; major mistakes include: wearing a mask inside-out or upside-down (36%) and wearing it too low exposing their nostrils and/or mouth (43%).

The team has also been conducting an online survey since mid-March to collect local citizens’ views and attitudes on wearing face marks. Among the 2,859 responses collected so far, most respondents (94%) agreed that wearing a face mask could prevent infection and reduce the risk of viral transmission in the community. However, a significant number of respondents said that they would reuse face masks (76%), with people in the 46-65 and >65 age groups showing a higher percentage of reuse.

Despite heightened awareness of the need for prevention of viral spread, many fail to wear their masks properly
According to Dr Shara Lee, Associate Professor of the Department of Health Technology and Informatics who led the study, the majority of the public have been on high alert and have taken effective preventive measures since the outbreak of COVID-19, and wearing face masks is seen as one of the key measures in the fight against the disease. “Our studies found that people have a high awareness of COVID-19 and agree that wearing face masks is an effective way to prevent viral transmission and community outbreak,” said Dr Lee.

Many of them put this into practice by consistently wearing a face mask. However, despite months of public health education, one in eight have not mastered the correct way to wear a surgical mask. Surprisingly, nearly 80% of the respondents said they would reuse them. This shows that reuse of disposable face masks is widely accepted by the public, probably due to reasons such as an inadequate supply, poor awareness a mask’s disposable nature, financial reasons or receiving incorrect information. These factors potentially increase the risk of transmission and infection, and project a false sense of security when people wear a mask in the belief that they are now protected. The situation is worrying.

The research team identified some common mistakes when using face masks:

• Wearing the mask inside-out or upside-down
• Positioning it too low on the face, exposing the nostrils and/or mouth
• Touching the outer layer of the mask during use or disposal
• Pulling down the mask when eating or smoking, or hanging the mask around the neck/other part of the body

Keep up the anti-pandemic effort Do your bit by wearing a face mask correctly
The fight against the COVID-19 outbreak requires perseverance and the cooperation of every member of the public. The research team advises that the public should “do the right thing” by adhering to the proper practices of wearing face masks at all times and keep up the hard-earned effort in containing the community outbreak.

The team also recommends solutions to improve protection from infection due to improper use of face masks, including:

• Experts formulating comprehensible guidelines for safe handling and storage of face masks for reuse, to minimize the risk of both virus spread and self-contamination
• Publicity and education on the potential risks of incorrect use of face masks
• Printing a symbol on the outer layer of the face mask to indicate correct orientation
• Inclusion of information made available by face mask manufacturers, e.g. a clear visual guide or QR code printed on the box for easier access.

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