Interview

Face masks: What GPs and patients need to know


Matt Woodley


8/01/2021 8:18:19 PM

UPDATED: As Victoria emerges from a five-day lockdown, masks remain mandatory in all public indoor spaces.

Young woman wearing a face mask.
Masks will be mandatory on public transport in Greater Sydney.

A version of this article was first published in July 2020. This article was updated at 8.10 am on 17 February.

Although Victoria ended its snap five-day lockdown at 11.59pm on Wednesday 17 February, masks remain mandatory in a number of settings, including all public indoor spaces.

In addition, masks must be worn:

  • on public transport
  • when riding in a ride share or taxi
  • on domestic flights to and from Victoria
  • at airports
  • when visiting hospitals and care facilities.
In Western Australia, mask-wearing is no longer mandatory for people in the Perth and Peel regions, as life slowly begins returning to normal following a snap five-day lockdown that began on 31 January.

WA Premier said the state ‘revert back to where we were on the 30th of January’ as of 12.01 am Sunday 14 February.

In Greater Sydney, mandated mask requirements were eased on 29 January, however masks remain mandatory across a number of social settings, including:
  • on public transport and at public transport waiting areas
  • at airports and on commercial domestic flights
  • in places of worship and indoor services, weddings and funerals
  • hair and beauty premises
  • tattoo parlours
  • massage parlours and spas
  • gaming areas in licensed premises
  • hospitality staff with a customer-facing role 
NSW Health also recommends that a face mask be worn at shopping centres.

In Queensland, the state government continues to strongly encourage people to carry a face mask with them at all times when they leave home for use in settings where social distancing is not possible.
 
Face masks remain mandatory at all times in the following situations:
  • at all Queensland airports – both indoor and outdoor areas
  • during a domestic commercial flight
  • when arriving to Queensland from overseas or from a COVID-19 hotspot while travelling from the airport to quarantine accommodation while transporting a person required to quarantine.
Earlier this year, newsGP spoke with long-time Melbourne GP Dr Vicki Kotsirilos after she had seen increasing numbers of patients presenting with queries and concerns about face masks when the Victorian Government made them mandatory in July 2020.

Dr Kotsirilos said some had worn masks incorrectly, while others questioned their purpose altogether. She discussed her experiences and what she learnt from practising in an area where mask has been commonplace.
 
What do GPs need to know about face masks?
There are two types of masks available to the community – disposable and cloth masks.
 
I encourage patients to purchase or make the proper masks according to the Victorian Department of Health and Humans Services [DHHS] guidelines. Cloth masks can be washed in hot water and detergent, as it is well known that hot water above 56°C can kill the virus.
 
Pharmacies and post-offices are good places to buy masks, as many sold on the internet may not be appropriate. P2 masks should not be used because they are difficult to take on and off without contaminating hands, are expensive and not as accessible.
 
Cloth masks must have three layers of closely woven fabric [cotton on the inside, cotton blend in the middle and polyester outer layer] and fit snugly around the patient’s face. Care is required when removing the masks to avoid touching the outer and inner surface of the mask.
 
I encourage patients to use cloth masks because they are recyclable and better for the environment than disposable masks.
 
What are the most important things to consider when discussing masks with a patient?
It helps to reinforce that when patients go out to public areas for the four reasons allowed during lockdown, wearing a mask is advisable [and mandatory in Victoria] even if people feel or appear to be well.
 
If patients ask why they need to wear a mask if they are feeling well, it can be helpful to explain that 80% of people who have contracted coronavirus either show no symptoms or mild respiratory symptoms like a mild flu, posing a real danger to those with chronic diseases and other high-risk groups for whom the virus is a major threat.
 
If we all wear masks we are protecting ourselves and others – being well can be deceptive, as people can be harboring the COVID-19 virus or infection and not know it, unwittingly spreading the virus.
 
Patients should be reminded that face masks are not a replacement for physical distancing, rigorous hand hygiene, or sneeze and cough etiquette. In addition, if they have any respiratory symptoms, no matter how mild, that they stay home, not go to work or school and get tested for COVID-19.
 
If they are unwell and live with other people, a mask worn in communal areas such as the kitchen may help.
 
It’s important to instruct patients on how to put masks on and take them off carefully to avoid hand contamination. I also provide patients with a link to the Government website to reinforce these instructions.

Dr-Vicki-Kotsirilos-article-1.jpg
Melbourne-based GP Dr Vicki Kotsirilos has first-hand experience discussing mask use with patients.
 
What if a patient is skeptical about the value of wearing a mask?
While most patients are now open to wearing masks following the latest Government announcements, some patients find them ‘suffocating’ and difficult to wear for long periods of time.
 
In areas outside of Victoria, it may be helpful to reassure them that masks need only be worn when out in crowded environments where physical distancing cannot occur; for example, supermarkets or public transport.
 
The real challenge will be in certain work environments. At our clinic, for example, where physical distancing is not always possible, all our staff are required to wear masks and we also separate ourselves to have our lunches.
 
They are encouraged by our receptionists to have a phone consultation with the doctors if they have any respiratory symptoms. If they are unwell and need to come in, we now ask patients to wear masks.
 
Some GPs report that patients have requested medical exemptions from wearing a mask. Are there any scenarios in which this may be appropriate?*
GPs should not advise against wearing masks, as we must consider the vulnerable groups at high risk of catching COVID.
 
But it’s also important that we reassure patients asking for an exemption that it is vital now for everyone in the community to be dynamic and make short-term sacrifices for long-term community health gain.
 
Medico-legally, if the patient catches COVID and we’ve given them an exemption, we may be at risk of providing incorrect advice against health authority guidelines. However, we must also understand the patient and try to explore what works for them.
 
There may be other reasons why a patient might feel they can’t wear a mask, but whatever it might be, it’s important that GPs try to work with the patient to modify the protective clothing or mask for their benefit and the community as a whole.
 
Of course, we empathise with the members of our community who may experience anxiety and/or claustrophobia from wearing a mask.
 
However, it’s also imperative to consider the anxiety experienced by people in our community when we see people who aren’t wearing a mask. It’s a very stressful time for frontline healthcare providers and immunocompromised people particularly.
 
We need an attitude shift towards mask-wearing. Wearing a mask should not be connotative of ‘fear’ and ‘COVID-19 conspiracy’, but a symbol of compassion and union to keep our communities protected and healthy.

The Victorian Government has listed a number of lawful excuses or exceptions for not wearing a mask.

A face mask is not required in some circumstances, including for:

  • infants and children under the age of 12 years
  • a person who is affected by a relevant medical condition, including problems with their breathing, a serious condition of the face, a disability or a mental health condition
  • communicating with those who are deaf or hard of hearing
  • persons for whom wearing a face mask would create a risk to that person’s health and safety related to their work, as determined through OH&S guidelines
  • professional sportspeople when training or competing
  • strenuous physical exercise such as running, jogging or swimming
  • riding a bicycle or motorcycle
  • undergoing dental or medical care or treatment to the extent that such care or treatment requires no face mask be worn
  • the person is consuming food, drink or medicine
  • if required or authorised by law
  • the person is travelling in a vehicle by themselves or with members of their household
  • during emergencies.

More information on face masks is available on the Victorian Government website.

The WA Government has listed a number of exceptions for not wearing a mask, including where a person is:
  • a child under 12 years
  • has an illness, condition or disability which makes wearing a face mask unsuitable
  • engaged in work that requires clear enunciation or visibility of the mouth
  • swimming
  • the sole occupant of a private vehicle
  • eating or drinking
  • asked to remove the face covering for identity purposes
  • a prisoner or detainee in a place of custody.
More information on face masks is available on the WA Government website.

The NSW Government has also published a list of people who should not wear a mask.

Masks should not be worn by:

  • toddlers under two years of age and babies, as they are a choking and suffocation risk
  • children under 12 years of age, as they do not need to wear a mask and may not be able to handle it safely
  • anyone who has trouble breathing wearing a mask
  • anyone who is unable to remove the mask themselves without assistance
  • people assisting people who are deaf or hard of hearing (and their contacts), as for some people with hearing disabilities seeing the mouth is essential for communication. 

More information, including further lawful excuses or exceptions, is available on the NSW Government website.

The Queensland Government also has its own guidelines on exceptions for not wearing a mask.


Face masks do not have to be worn by:

  • infants and children under the age of 12
  • anyone who has a medical condition or disability that may be made worse by wearing a mask, including problems with their breathing, a serious skin condition on their face, a mental health condition or experienced trauma
  • anyone who is communicating with those who are deaf or hard of hearing, where the ability to see the mouth is essential for communication
  • anyone who has past experiences of trauma and is unable to wear a face mask due to psychological impacts
  • anyone whose health and safety would be at risk if they wore a face mask while conducting their work, as determined through occupational health and safety guidelines
  • prisoners of corrective facilities or detainees in detention centres
  • residents of residential aged care facilities or shared disability accommodation services
  • anyone who is being married while in the process of being married
  • people during an emergency.
​More information on face masks is available on the Queensland Government website.

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A.Prof Vicki Kotsirilos, AM   22/07/2020 8:08:31 PM

The Victorian Department of Health and Human services just issued this statement for medical exemptions of masks following the above interview:

"Exemptions will be “a relevant medical condition — including problems with breathing, a serious skin condition on the face, a disability or a mental health condition”, according to Victoria’s Department of Health and Human Services.
The department has specifically flagged asthma as an exemption."


Dr Samir Munaim   24/07/2020 12:44:30 AM

Need more detailed rules for exemptions to satisfy our patients otherwise all those with mild asthma would ask for exemption.Today 5 of my patients ask for exemption letter.


Dr David Lee   1/08/2020 8:31:34 AM

I do not give any patients exemptions letter. I just print them a health summary. So many selfish people in this country.


Dr Ruth Sophie Ratner   5/01/2021 7:44:12 AM

Are there any tips for how not to flip a hearing aid out when removing masks? I've heard of a few (very expensive) losses!


Dr Michael Smith   5/01/2021 8:51:12 AM

This article does not offer proof that face masks are of any benefit. If the evidence is sketchy, then how can we confidently encourage our patients to don them?


A.Prof Vicki Kotsirilos, AM   17/01/2021 1:45:13 PM

This review explores studies and effectiveness of masks Source: https://www.cell.com/med/pdf/S2666-6340(20)30072-6.pdf


Dr Md Zahidul Haque   18/01/2021 12:05:29 PM

"anyone who has trouble breathing wearing a mask" - Really!
2 patients so far brought to me this as their valid evidence to get exemption. Saying "anyone" & "trouble breathing" gives open ticket for everyone to seek a letter just by saying they have trouble in breathing. Either this language needs to be changed, or GPs need criteria given for it's use. This is another evidence how GPs get difficult situations, which could have been managed better.


Dr Israt Ara Khair   13/02/2021 9:12:24 AM

I totally agree with Dr. Zahidul Haque.The two words “ anyone “ and “difficulty breathing “ need more clarification. Does the difficulty breathing needs to be objective or GPs should take patients word for word? These loopholes in the statement put GPs in a harsh and vulnerable situation.