Omicron's transmissibility is driving calls for better masks. Should kids be wearing N95s, too?
Many companies report significant increase in orders for children's respirators
In November, the Public Health Agency of Canada (PHAC) suggested that people may want to look at upgrading their masks to protect themselves and help prevent the transmission of COVID-19.
"In general, while non-medical masks can help prevent the spread of COVID-19, medical masks and respirators provide better protection," PHAC said on its COVID-19 mask information webpage.
Respirators (such as N95 and KN95 masks) are considered the highest level of mask protection and were previously recommended only for health-care workers coming into direct contact with infectious patients.
But the updated mask guidance has raised some questions as to whether children should be wearing respirators — especially given that so many kids ages five to 11 are only partially vaccinated against COVID-19, or, if under age five, not yet eligible for a shot.
And, if so, what should parents keep in mind before purchasing such devices for kids?
Can children wear respirators?
Yes. Although the PHAC website acknowledges that it "may be hard to find smaller sizes for children."
"There is is nothing against kids wearing respirators, and it's the same rule that applies for kids as it does for adults," said Dr. Faria Sakhia, a Toronto-based doctor and volunteer with Masks4Canada, a group that advocates for masking, vaccines, and rapid tests.
"We really need masks that are good for the three Fs: ... fit, filter and function."
All three medical experts CBC spoke with agreed with PHAC's guidance that medical masks and respirators provide better protection, and agree the same is true for children, too.
But — and it's a big but — that's only if they actually wear the respirator properly. If a child is having trouble keeping on a respirator, or keeps fiddling with it, it may not be the best device for them, said Toronto pediatric infectious diseases specialist Dr. Anna Banerji.
"The main thing is you want to keep the mask on the kid's face," Banerji said.
It may be better to have multiple layers, for example, using a surgical mask with a cloth mask on top, that fits snug to the face and is comfortable, instead of a respirator, she said.
"If you have a [respirator] on a kid and it's hanging off the nose, if they take it off because it's uncomfortable most of the time, and it's supposed to be a tight fit, then it defeats its purpose."
What types of respirators should parents consider?
Experts say that respirators for adults and children should be approved by Health Canada. On the PHAC website, those include NIOSH N95, CSA certified CA-N95 and CA-N99 type respirators, and KN95 and KF94 respirators that meet specific standards.
"There are a lot of counterfeit products that are out there that are obviously not good quality products," said Sakhia. "If you can get it, if you can get access to good quality respirators, get yourself as many respirators that you can."
How much of an issue is respirator size?
Masks, just like faces, come in every size and shape, says Sakhia, so making sure the mask fits well is key.
"If you're getting the wrong fit mask, it's not going to work to protect them," she said.
"The guidance that we have is to make sure that there's no leakage of air coming from the sides of the mask and that it's very secure from around the nose area."
B.C.-based Vitacore, one of the Canadian companies manufacturing respirators for children, offers size "three to 13+ years old, or small faces" for kids. Eclipse Innovations, another Canadian company, says its small respirators will fit children from ages nine to 14, based on face height measurements of 98.5 to 108.5 millimetres and face width of 120.5 to 132.5 millimetres.
"I think what you're going to have to do is look at the manufacturer's website and see what guidance they're giving," said Dr. Catherine Clase, an epidemiologist and member of the Centre of Excellence in Protective Equipment and Materials at McMaster University.
"Are they giving any kind of dimensions ... weights or heights? Or if they're just saying it's a child's mask, then you can assume it's smaller than an adults mask. Is it going to be small enough for a five year old? It may not be."
Sakhia advised parents not to purchase too many respirators until they know they have the right fit.
How should parents help children with their respirators?
It's important that parents help get their children comfortable wearing respirators and practice putting them on, Sakhia said.
WATCH | Respirators are considered the highest level of mask protection:
"These are different from regular masks that kids would be pulling on," she said. "They're not as fun looking as the old masks were with the prints and the colours and things like that. So you do have to get kids excited about it again."
Has there been a surge in demand for children's respirators?
Since PHAC upgraded its mask guidelines, many companies report a significant increase in orders for respirators in general, but also respirators that come in children's sizes.
"Prior to Christmas, just crazy, crazy, crazy orders for those," said Barry Hunt, president of the Canadian Association of PPE Manufacturers.
According to Hunt, there are nine Canadian manufacturers making disposable respirators, and of those, three make children's disposable respirators. As well, there are three reusable respirator manufacturers, and one making kids respirators, he said.
"There's definitely been an increase in the demand going across the board, of course, for all of our product line. But specifically on children's respirators, we are seeing more and more customers on the retail side and on our online commerce side wanting higher level protection for children," said Vitacore's president Mikhail Moore.