The PPE Debate

Should members of the public be wearing masks and gloves to prevent the spread of COVID-19? CONNECTED speaks to two academics who are helping inform the public debate.

Personal protective equipment (PPE) is needed around the world in order to protect our frontline health workers, but there is also fierce debate as to whether the public should also use PPE to prevent the spread of the virus. The University’s Dr Simon Clarke, a cellular microbiologist, and Professor Ian Jones, a virologist, both from the School of Biological Sciences, discuss whether PPE should be used by the public.

The danger of gloves

The COVID-19 pandemic has sparked a great deal of interest in how people might avoid becoming infected. Public health officials strongly encourage handwashing. But as repeatedly cleaning your hands can lead to damaged skin and soreness, could wearing disposable gloves be the solution? Dr Clarke examines the evidence around wearing gloves in the community to determine which option is the safest.

Dr Clarke advises that to get a better idea of how to use gloves properly and to understand their limitations, it’s helpful to look at an environment where they are used routinely.

“It’s important to remember that most gloves come in large packs that are not sterile and are associated with a risk of cross-contamination and spread of disease,” he said. Risks can be increased if gloves are used when they aren’t needed, put on too early, taken off too late or not changed at the appropriate times.

“Gloves should only ever be worn to protect healthcare workers from blood, bodily fluids or certain drugs,” he said.

“When the patient needs protection, such as during surgery, gloves should be sterile. Either way, they need to be removed when they become contaminated and the same pair of gloves should never be used to touch more than one patient.”

Dr Clarke explains that gloves are used differently in the community:

“When you see someone wearing gloves in a food preparation or retail environment, it’s worth remembering that they may have had them on for hours and might have handled contaminated material with them. For example, did the person who’s just cooked your burger handle the raw meat with gloves on, only to then give you the cooked product while wearing the same pair of gloves?

“Similarly, if someone has touched a contaminated surface with a gloved hand, they are just as likely to transmit contamination as someone who hasn’t worn gloves. Failing to change gloves when needed is no different from failing to wash your hands.

“People touch their faces all the time, often without realising, so an infected person can get the virus on their hands from their mouth or nose and pass it on to others, either directly, or by contaminating a surface which others then touch, such as a door handle, computer keyboard or handrail. If you handle something contaminated with coronavirus and then touch your face, the gloves won’t stop you from getting infected.”

Dr Clarke concludes that wearing gloves may make someone less aware that they have contaminated their hand, when they might otherwise notice and simply wash them.

“Wearing gloves is a convenient way to minimise contamination and keep our hands clean, but they are only really useful when handwashing is either not possible, or insufficient to prevent chemical or biological contamination. And if they are worn, they will need to be changed as often as hands need to be washed.

“It’s also worth remembering that while soap or hand sanitiser can cause unpleasant soreness, latex gloves can cause allergic reactions and irritation.”

Can face masks protect us?

As some countries advise their citizens to wear masks in public to prevent the spread of COVID-19, such advice has sparked a live debate. The University’s Dr Clarke and Professor Jones provide a range of perspectives on the usefulness of wearing masks in public places.

A scientific article published in the British Medical Journal, discusses published studies on how effective face masks are at stopping viruses being transmitted. With only incomplete scientific evidence available, but public health guidance required now, such expertise is critical to help guide scientists to properly inform governments and the public.

Professor Jones argued anything that prevents droplets carrying the virus from entering a person’s mouth, even if some droplets do pass through the mesh, is helpful to some extent.

He said: “If an aerosol droplet hits the weave of the mask fabric rather than the hole it is clearly arrested. And lessening the aerosol dose chips away at the R0 [reproduction number] and helps to slow the epidemic.

“They are not a cure, but they address the longer flatter epidemic curve everyone is trying to achieve.”

However, Dr Clarke suggested that mask wearing by the general public should not be encouraged because there was little evidence that it would protect the wearer from catching COVID-19. He said:

“There is only very limited evidence of the benefits of wearing face masks by the general public, no evidence that wearing them in crowded places helps at all, and no evidence at all yet related to COVID-19.”

Dr Clarke also pointed out that mass wearing of masks could cause a shortage for medical staff who genuinely need them, such as those on the frontline in hospitals.

The World Health Organisation and the UK government are currently not asking the general population to wear face masks, saying that there is very little evidence of widespread benefit of their use outside of clinical settings, such as hospitals. However, the UK Prime Minister and Scotland’s First Minister have both hinted at changes to the current guidance as the ‘stay at home’ policy is eased.

Find out more about Dr Clarke’s and Professor Jones’ research – and how they and other Reading experts are informing the public and policymakers about the science around the coronavirus crisis.

This article was first published in The Conversation on 8 April 2020.