We’ve fast adapted to wearing face masks to curb the spread of COVID-19. Now, face shields are gaining attention. But are they effective in protecting us, and others, from the spread of disease? For now, and until more research is done, they can’t be recommended in place of face masks.
Wearing a protective cloth face mask when we’re out in public is something we’re quickly growing accustomed to. Globally, leading healthcare organisations such as the United States of America’s Centers for Disease Control and Prevention (CDC) and the World Health Organization recommend we all wear cloth face masks. In South Africa our National Department of Health recommends that everyone wear a cloth face masks (also known as a non medical mask) when we are out in public.
But it’s very likely that you have also seen people wearing face shields out in public. Some people wear face masks and face shields together.
Members of the public who are wearing face shields follow the thinking that the shields provide barriers for respiratory droplets going out, and coming in – but the extent to which they do this isn’t clear. Keep in mind that we are all currently wearing face masks to help protect those around us from the particles we exhale or cough out, and not necessarily to protect ourselves from others.
What exactly is a face shield?
A face shield is a curved piece of clear plastic that is worn over the face and that reaches from the forehead to just below the chin so it covers the face. The shield is usually attached to a plastic or elastic headband that can be adjusted for size, fits around the whole head and holds the face shield in place over the face. And, because they cover the face in this way, face shields protect the three areas where pathogens (like the COVID-19 virus or the influenza (flu) virus and bacteria) can enter the body through the face – the eyes, nose and mouth.
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What are the possible advantages of wearing a face shield?
- Face shields are made from commonly used materials, so they are easy and inexpensive to produce.
- Unlike cloth or medical face masks, face shields can be reused indefinitely and simply cleaned with an antibacterial wipe or soap and water between uses.
- They are reported to be more comfortable to wear than face masks.
- People are more likely to touch their face mask and transfer any viruses or bacteria on their hands to their face (this is a process called ‘autoinoculation‘). People are less likely to touch a face shield that is suspended in front of their face.
- People wearing medical masks may have to remove them to communicate with others but this is not necessary when they only wear face shields.
- Face shields remind us to maintain physical distancing, but allow us to see others’ facial expressions and lip movements for speech perception and communication through non-verbal cues.
- Face shields may be easier to wear for individuals who are capable of limited compliance when it comes to wearing protective face masks – such as those with certain mental health disorders, developmental disabilities, those who are deaf or hard of hearing, and children.
Are you, or those around you, protected when you wear a face shield?
“No studies have been done on how effective face shields are in stopping the spray of virus-containing droplets exhaled or coughed out by an (asymptomatic or symptomatic) infected person who is wearing a face shield,” says Dr Noluthando Nematswerani, Discovery Health’s Head of the Centre for Clinical Excellence.
Dr Nematswerani adds that, though evidence is lacking, for face shields to be most effective in stopping viral spread, a face shield must at least:
- Extend to below the chin
- Cover the ears
- Feature no exposed area or gap between the forehead and the shield’s headpiece
“Preliminary evidence around the efficacy of face shields shows promise. However, more evidence is required before face shields can be recommended in place of protective face masks,” she adds. “Face shields do have some very appealing advantages over face masks. They should therefore be evaluated urgently so that they can be safely included as part of our local and international COVID-19 containment strategy.”
THE TAKE-HOME MESSAGE: So, for now, to protect yourself and others from any airborne illness (like COVID-19 or the flu), it’s better to wear a cloth face mask.
Furthermore, according to latest updates by the CDC, face shields are not recommended protection. On their website, officials say:
- It is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles.
- The CDC does not recommend using face shields for normal everyday activities or as a substitute for cloth face coverings.
- It is expected that some people may choose to use a face shield when in sustained close contact with other people.
- If face shields are used without a mask, they should wrap around the sides of the wearer’s face and extend to below the chin.
- Disposable face shields should only be worn for a single use. Reusable face shields should be cleaned and disinfected after each use.
Should children wear face shields?
According to the South African Paediatric Association’s ‘Position Statement: Return of South African Children to school’, children older than four should wear a cloth face mask to prevent disease transmission. “Use of plastic shield masks or other higher safety-category masks is unnecessary, although not discouraged. There is no need for children to routinely put on aprons, gloves or other protective gear.”
And the CDC states that “Plastic face shields for newborns and infants are NOT recommended.”
Where are face shields commonly, and correctly, used?
In medical settings, face shields are traditionally used for infection control. They are, for example, necessary for those doctors, nurses and other healthcare providers who treat patients who have COVID-19, particularly when intubating these patients. They are also worn when doctors are undertaking other procedures where bodily fluids, or blood or pieces of bone could spray or splash, and enter the attending doctor’s eyes, nose or mouth. Face shields are generally not used alone in healthcare settings but in conjunction with medical face masks, gloves and protective clothing, and so are part of a comprehensive infection-control protocol.
Remember the bigger, disease-prevention picture
It’s important to remember that using cloth face masks and/or face shields to reduce the spread of COVID-19 goes hand in hand with other preventive measures such as handwashing (or sanitising), cleaning and disinfecting frequently touched objects, physical distancing and cough and sneeze hygiene as well as ensuring that there is good cross-ventilation of the spaces in which we spend our time, allowing for the free flow of fresh air to help to move any virus particles out.
Remember that if you wear a face shield in accordance with current recommendations, you need to sanitise it frequently – every time you remove it – with soap and water, antibacterial wipes or alcohol-based sanitisers. Research shows that the COVID-19 virus can live longer on plastic (up to three days) than it does on cloth, paper or cardboard. If your face shield becomes damaged in any way, replace it immediately.
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