It’s the end of the mask as we know it, but when and where should you still wear one?

For over 18 months, the wearing of face-masks on public transport, in shops, hairdressers, cinemas, churches and other public spaces was mandatory in Ireland. Secondary school students and later primary school pupils also had to wear them in classrooms and school corridors. But from Monday, February 28th, people are no longer legally obliged to wear face masks in any public or commercial settings and in schools. The only exception is healthcare settings where visitors, patients and hospital staff will still be expected to wear masks.

However, as everyone acknowledges, Covid-19 hasn’t gone away and many medical experts continue to advise people to wear masks in certain settings both to protect themselves and also to protect vulnerable people from catching the virus. Here, we ask Professor Sam McConkey, infectious disease consultant at Beaumont Hospital and head of the Department of International Health and Tropical Medicine at the Royal College of Surgeons of Ireland for his advice on whether masks should still be worn in specific settings and situations.

Should you wear a mask outside?

Wearing masks outdoors has always been a personal choice during the pandemic. Some people chose to wear them even when walking alone on breezy coastal routes while others only wore masks outdoors when chatting closely with friends during the height of the pandemic. Prof McConkey says, “it depends on how crowded it is. If you are walking in the middle of nowhere with nobody around, obviously there is no need to wear a mask. But, if you are in a crowded outdoor space – say as a spectator in a stadium, it’s still reasonable to wear a mask. In this case, you are wearing the mask to protect those around you rather than yourself. When people wear masks in crowded outdoor spaces, older people and vulnerable people can be more comfortable and safe in these spaces. I will continue to wear masks in crowded outdoor spaces.”

How about indoors spaces like supermarkets, gyms and hairdressers?

With the lifting of mandatory masks in supermarkets, churches, gyms, hair salons and cinemas on Monday, people will begin to assess indoor spaces for themselves, making calculations about their riskiness based on whether they are crowded and stuffy or fresh-feeling with plenty of space between people and high ceilings in which the air can circulate. The problem with this analysis is that you are assessing the space for yourself – not for other people you are sharing the space with and if it’s a public space, you won’t have any knowledge of whether there are some people who are at risk of severe illness if they become infected with the virus.

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Many people representing vulnerable groups have expressed their concerns about the lifting of mandatory face masks on public transport

Prof McConkey says that it’s worth reminding people that Covid-19 is still around so any measures to prevent spreading it to vulnerable people are worth doing. “It’s not a national emergency anymore but it is still a problem. Consider that one in six intensive care beds are still occupied by people with Covid which means it is still a significant health issue.”

He advises people to continue to wear masks in indoor spaces for the same reasons as wearing them in crowded outdoor spaces – to protect older and vulnerable people from catching Covid-19. Unvaccinated people are also at much higher risk of becoming severely ill from Covid-19 so people wearing masks in indoor spaces which are crowded and/or poorly ventilated protects unvaccinated people from catching the virus too.

What about on public transport? Should I continue to wear masks on buses, trains and planes?

Many people representing vulnerable groups have expressed their concerns about the lifting of mandatory face masks on public transport. Medical experts have also advised people to continue to wear masks on crowded public transport if they feel comfortable doing so.

Prof McConkey says that he would encourage people to continue to wear masks on public transport when there are travelling in close proximity to other people. “You won’t have to wear a mask if you are travelling on an empty Dart and if you are travelling on a well ventilated public transport where people are more than two metres away from you, it’s not an issue. But, travelling when people are closer than that, I’d encourage people to continue to wear face masks.”

Most airlines continue to request passengers to wear masks when boarding planes, for the duration of flights and when disembarking from the plane. There are exceptions for people who can’t wear masks due to medical conditions and have a medical note to confirm this. It is expected that mask-wearing on international flights will be one of the last Covid-19 measures to be dropped globally due to the uneven spread of the disease and variation in uptake/availability of vaccines in certain parts of the world.

What about children going back to school after the mid-term break? Should they continue to wear masks?

Many children – and parents will sigh with relief at the relaxation of mask-wearing in schools when children return to school on Monday. Throughout the pandemic, the rates of transmission between school children in school was a contentious issue – with some suggesting Covid-19 spread rampantly in schools while others were adamant that schools with Covid protocols in place were safe spaces (and that child-to-child transmission happened outside school).

Prof Sam McConkey says that it is particularly difficult to generalise when it comes to giving advice about whether school children should continue to wear masks or not.

Cloth face-coverings are not classified as official personal protective equipment and really only protect others if you are infected

“It depends on the layout and size of the classroom and the quality of the ventilation. Many schools have bought HEPA filters which ventilate rooms well.  Also, I have found it difficult to evaluate the impact masks have had on transmission of the virus in schools,” he says.

He suggests that it’s not sensible or feasible to protect young children from interacting fully, but if there is a child in a particular classroom that requires protecting, then it is a good idea for children to wear face masks. “If a child is immunocompromised in some way – following a transplant or during/after chemotherapy, that child would benefit from their peers wearing face masks,” he adds.

What if you have the sniffles and are feeling a bit under par?

Public health experts fervently hope that if there is one big lesson that people can learn from the pandemic, it’s that you stay at home if you are feeling unwell. Prof McConkey says that as academics in third level institutions, he and his colleagues have been strongly spreading this message. “We strongly advice those with the sniffles to stay at home until they are better. We don’t want to catch any respiratory illness from our friends so if you are unwell, you should stay out of all social spaces – cinemas, supermarkets and work. And at home, you should wear a mask if there is an older or vulnerable family member in your house. To prevent the spread of all respiratory viruses, we should continue with good respiratory etiquette such as regular hand-washing and disposing of tissues after sneezing.”

And, when I do wear a mask, which one should it be?

Well, that depends on whether you are vulnerable to severe illness from Covid-19 or if you are currently a confirmed case of Covid-19. The increased transmissibility of the Omicron variant resulted in much greater usage of higher quality face masks by vulnerable people. In January 2022, the National Public Health Emergency Services also advised confirmed cases of Covid-19 to wear medical masks rather than cloth face-coverings.

The white beak-like masks – known as FFP2/FFP3 or N95/N99 respiratory face masks are the best available protection against Covid-19 and other respiratory illnesses. They reduce the wearer’s exposure to at least 95 per cent of airborne particles.

The more widely available surgical masks (mostly blue but also white and pink) protect against larger droplets but are often loose fitting which allows leakage around the edges.

Cloth face-coverings are not classified as official personal protective equipment and really only protect others if you are infected. So, if you aren’t at risk of severe illness from catching Covid-19, the wearing of face-coverings in crowded indoor or outdoor spaces is a benevolent gesture towards more vulnerable individuals in your company.