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What You Should Know about Face Masks

Does the path back to normalcy involve face masks? It may -- when we can procure them. Some kinds are better at protecting others than protecting oneself. Using the medical kind outside medical or high-risk situations doesn't make sense in a time of shortage. Some kinds may make a lot of sense -- especially if one makes them oneself. The United States is taking a page from the play book of some nations across the waters.

Some organizations have found themselves answering the wrong question. It's less a matter of whether a mask can protect a person but whether it can protect the people around them. Assuming that some besides healthcare workers are ‘essential’, the question may not be about whether masks are foolproof but about how much they cut the chances.

As March churns into April, the United States is making some changes in its recommendations. Organizations from NPR to The Seattle Times are reporting that the CDC is re-considering evidence regarding face masks. And as of today, 4/3/2020, the CDC is recommending everyone wear cloth masks in public where it is difficult to social distance. Places like the grocery store and pharmacies.

The Case for Masks

It has been suggested that nearly half of Covid19 cases are spread by pre-symptomatic individuals, and that many don't ever develop symptoms (https://www.sciencemag.org/news/2020/03/would-everyone-wearing-face-masks-help-us-slow-pandemic). Some people have noted logical inconsistencies in the messages that 1) you don’t need to (or shouldn’t) wear a mask unless you're sick or caring for someone who is and 2) you should assume everyone's sick including yourself.

The term 'face mask' can refer to multiple things. There are disposable respirators, designed to keep out minute particles and disposable surgical masks designed to offer protection from larger droplets. The latter offer some protection from the tiny particles, though at a lower rate. There's some controversy around the N-95 respirators. They can keep most virus-sized particles out if they're properly fit and worn. Professionals are trained to use them. There are machines to check the fit. Some have voiced concern that a lay person with a poorly fitted face mask could increase their risk if particles were allowed in and then trapped near the face. The N-95 can, not surprisingly, make breathing more difficult. A huge issue in 2020, of course, is that medical professionals need them! At this time, surgical masks, too, are in short supply.

While there are shortages on some types of mask, there are others that are readily available, as people can -- and are -- making them. Masks are within reach of all those who have the equipment and know-how to sew. They won’t block virus-sized particles at the same rate as the respirators that those at the front lines favor. They offer some protection in blocking tiny particles but are better at blocking the relatively large droplets of water that people emit. Droplets, after all, aren’t just emitted when people are coughing, but when they’re talking -- and even breathing.

Data on efficacy varies. Past studies have found that while cloth masks allow more virus-sized particles in than surgical or N95 masks do, they can greatly reduce them (https://smartairfilters.com/en/blog/diy-homemade-mask-protect-virus-coronavirus). Researchers from Cambridge and the Netherlands, using different protocol, found cloth masks captured 50% - 60+% of particles 1 micron or smaller. (Interestingly, the Netherlands study found a slight increase in the dishtowel mask performance after a few hours of wear.)

Microbiologist Adrien Burch, Ph.D., writing for Better Humans, argues that cloth masks make sense because droplets, not aerosols, are the more likely common source of community transmission (https://medium.com/better-humans/should-you-be-worried-about-catching-covid-19-from-aerosols-6c97d023bb6d).

The masks with the highest filtration rates should go to healthcare workers at the front lines. They’re the ones most likely to be exposed – in quantity and in aerosol form.

Next Steps

The time has come when many healthcare organizations want fabric masks, though they may be using them to work with patients who are at low risk of having coronavirus – or handing them to patients. Wake Forest Baptist Health states that the intent is to give donated cloth masks to patients at check-in.

There are trade-offs with regard to fabric. Some are better at keeping tiny particles out but make it harder for the person who wears them to breathe. While cloth masks are not all equal, even a bandana may be better than a bare face.

Industry and individuals alike are rising to meet demand. Clothing companies like Ralph Lauren and Prada have turned their attention to medical supplies like masks. Individuals do have options for buying re-usable masks – the Etsy marketplace is one place they’re widely available. And with the change in public health advice, designers are having their day.

Efficacy depends partly on the fabric and the construction. Wake Forest Baptist Health has collected recent data about the relative effectiveness of different types of cloth (https://www.newswise.com/articles/testing-shows-type-of-cloth-used-in-homemade-masks-makes-a-difference-doctors-say). Among the best performing was a heavyweight, high thread-count quilter’s cotton, sewn two-ply. The best constructed masks, their researchers reported, had a 79% filtration rate. The worst constructed don’t offer a lot of protection.

Some people have been using their at-home time to sew masks. They may well want to stay up with the latest recommendations. This is an area where knowledge is evolving – and at a fast rate.

Resources

Deaconess Hospital in Evansville, Indiana has put together a public directory of organizations seeking masks -- to be used by individuals or organizations able to create them (https://www.deaconess.com/How-to-make-a-Face-Mask).

Wake Forest has provided basic information about fabric masks, including links to several possible patterns, one of which was created by a nurse (https://www.wakehealth.edu/About-Us/Philanthropy/COVID19-How-You-Can-Help). Tips about fabric choice can be accessed separately (https://www.newswise.com/articles/testing-shows-type-of-cloth-used-in-homemade-masks-makes-a-difference-doctors-say).

Adrien Burch, Ph.D. has provided practical resources, as well as a case for wearing masks (https://medium.com/better-humans/whats-the-evidence-on-face-masks-5f3c27a18cc). Readers can comment to suggest additional resources.

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