The most important things to know about your cloth face mask
July 23, 2020
Have you heard a lot of information about face masks lately and wondered if the information is accurate? Me too. I am skeptical of news that isn't backed by research. As a researcher who values scientific data, it’s very important to me that the business decisions we make are data driven. As we started making face masks in April it’s been paramount that our designs are made with the most up to date information. The safety and health of our fellow humans isn’t something to be taken lightly. It’s my goal to make masks that provide the best protection possible while also being functional. It is important that we have masks that are effective in protecting us, reusable, washable, comfortable, breathable and soft against our skin. I also value transparency and want to share the work that goes into what we are doing.
To make masks that are effective, I first had a lot of questions. And, if you’re overwhelmed by the amount of mask information out there, you’re not alone! To save you time, provide clear answers and help you make the best decision for protecting yourself and others, I’ve put together a series of questions with their answers - all backed by research. I’ve read through countless research articles about textiles, filters, layering, particulate distribution, Bioparticle Filtration Emission (BFE), water vapor, water droplets, coughing in different masks, and figuring out what size, style and shapes of masks are most effective.
This blog shows the information I sought out in order for us to provide the best quality face masks. If there are any additional questions that I missed, please feel free to send us an email at kadevos@kadevos.com and we’ll do our best to answer it.
What masks have the best protection?
| Masks differ primarily in their maximum internal leakage rate limit. Studies have found that a range of mask types provide at least some protective value against various infectious agents (Davies et al., 2013; Driessche et al., 2015; Stockwell et al., 2018; van der Sande et al., 2008; Leung et al.,2020 ). So if you’re wearing an N95 or a Bandana, there is protection - just not equally. There are a lot of things to consider and I am going to keep it as simple as possible. When buying a mask you want to look for the number of layers, type of materials used, the dimensions and style, how it fits on the face and customer reviews to determine comfort. If something is comfortable, we are more likely to wear it.
Here are the most important things to have in a cloth face mask and why they are essential.
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| Look for a mask with: |
Why? |
Does Kade & Vos have these? |
| 3 Layers |
A three layer cloth face mask is the most effective in preventing transmission of viruses (Konda, 2020; Mueller and Fernandez, 2020; Verma, Dhanak, & Frankenfield, 2020; Zangmeister et.al, 2020;
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Yes. All of our masks are made of three layers. |
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Top Layer: 100% Cotton or Cotton/ Polyester Blend
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Tightly woven cotton prevents 2-way air transmission and polyester materials are hydrophobic and can repel moisture (Konda, 2020; Zhao et. al, 2020; Davies et al., 2013; Ho et. al, 2020; Stanford Medicine, 2020; Konda, 2020;
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Yes. All of our masks use a tightly woven 100% cotton or a cotton/ polyester blend. |
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Middle Layer (filter): Non-woven polypropylene or paper products.
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Non-woven materials are significantly better at preventing microparticulates from transmitting in our out of the material, (Zhao et. al, 2020; Verma, Dhanak, & Frankenfield, 2020; Aydin et. al, 2020;
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Yes. All of our masks have a layer of non-woven polypropylene. Our First Responder & Essential Workers mask comes with non-woven meltblown filters with a manufacturer test proving >95% filtration efficiency. The same amount as a surgical mask.
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Bottom Layer (touching the face): 100% Cotton
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Cotton absorbs moisture and can prevent glasses from fogging and keep your mask dry against your skin (Stanford Medicine, 2020; Cruz et. al, 2017; Cotton Inc. 2002; Norton, 2018).
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Yes. All of our masks use 100% soft cotton. We even offer an Egyptian Cotton option for those who have sensitive skin or want a little luxury in their mask. |
| A style measures a minimum of 8”x6” with pleats on the sides. |
Mueller and Fernandez, 2020; Verma, Dhanak, & Frankenfield, 2020; Tang, Liebner, Craven, and Settles 2019).
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All of our Large masks have measurements of at least 8”x6”. Our smaller sized masks are designed in proportion to that size to provide adequate protection and the right fit for smaller sizes. |
| A wire across the nose. |
A secure fit prevents users from inhaling and exhaling small airborne particles (Smereka et. al, 2020; Mueller and Fernandez, 2020; Tang, Liebner, Craven, and Settles 2019; Lawrence et.al, 2006; Coffey et. al, 2004).
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Yes. All of our masks have a wire across the bridge of the nose so the mask fits securely to your face shape. |
| Elastic or adjustable elastic ear-loops |
Mueller & Fernandez, 2020; Stockwell et al., 2018.
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Yes. We provide both elastic ear-loops and masks with adjustable ear-loops. |
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References: Stanford Medicine June 2020; American Chemical Society published in June, 2020 ; Disaster Medical Public Health Preparation, 2013; Davies et al., 2013; Driessche et al., 2015; Stockwell et al., 2018; Leung et al.,2020; Mueller and Fernandez, 2020; Physics of Fluids 32, 061708 2020; Tang, Liebner, Craven, and Settles 2019; Leung et. al, 2020.See last tab of blog for more references with supporting evidence that face masks are effective in preventing transmission of viruses.
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Is a cloth face mask effective in protecting me from COVID-19?
| Yes. In the most simple form, a face mask prevents particles from my respiratory system getting into the air and then, getting into your respiratory system. As an effective and inexpensive source that reduces transmission of COVID-19, past and recent research overwhelmingly recommends the adoption of wearing cloth face masks in public to prevent transmission of respiratory viruses such as COVID-19, SARS, Influenza (H1N1), pneumonia, and Bronchiectasis.
Davies et al., 2013; Dbouk & Drikakis, 2020; Chughtai, Seale, and Macintyre, 2020; van der Sande, Teunis, & Sabel, 2008; New England Journal of Medicine, 2020; Wang, Ng, & Brook, 2020; Leung et. al, 2020; Lau, Tsui, Lau, & Yang, 2004; Wu et al., 2004; Dharmadhikari et al., 2012; Davies et al., 2013; Lai, Poon, & Cheung, 2012; MacIntyre et al., 2017; Offeddu, Yung, Low, & Tam, 2017; Davies et al., 2013; van der Sande, Teunis, & Sabel, 2008….. See last tab for more references with supporting evidence that face masks are effective in preventing transmission of viruses.
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What are the different filter types and what does it all mean?
If you’ve been looking for filters and wondering what the metrics mean, I’ve got you covered. If you don’t care what all the terms mean (I don’t blame you if you don’t) and just want to know what filter is the best, then skip to the next question to find out. This section aims to answer these three questions: What are the tests used to determine filter material efficiency?Who conducts filtration tests?
First, Who approves or certifies the tests? What are the tests? There is more than one way to test filtration efficiency. The main tests for protective fabric determine particle filtration efficiency, bacterial filtration efficiency, fluid resistance, differential pressure, and flammability. This chart explains terminology, different testing outcomes and what they mean.
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Filter Test
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What does it mean?
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Bacterial Filtration Efficiency
Bioparticle Filtration Emission (BFE)
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Bioparticle Filtration Emission indicates filtration efficiency. The higher the percentage, the higher the efficiency. For example, 95% BFE indicates 5% of the aerosolized bacteria used in testing passed through the mask material, while 99.7% BFE indicates only 0.3% passed through.
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Particle Filtration Efficiency
(PFE)
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Particle Filtration Efficiency measures the filtration efficiency of filter fabric against µm (sub-micron particles and aerosols).
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Delta P
Differential Pressure
Pressure Drop
Pressure Loss
(PSID)
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Measures the effort it takes to force air through material. Essentially, how easy it is to breathe. The lower the Delta P, the more breathable and comfortable the mask.
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Fluid Resistance
(FR)
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Fluid resistance of face masks is measured by spraying synthetic blood at various levels of pressure (80, 120, 160 mm). The higher the pressure withstood, the greater the fluid spray and splash resistance. Results are displayed as either a pass or fail for each level of pressure.
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Flammability
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Basically, fabric is set on fire in a controlled environment for a predetermined time and characteristics such as time to ignition, flame spread (propagation rate) and characterization of the residue are determined. Based on that information, the fabric passes certain levels of flammability safety.
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Who conducts filtration tests? Who approves or certifies the tests? These two questions are best answered together. Fabric manufacturers use individual labs and research centers to test their materials. Then the manufacturer submits the test results for particle filtration efficiency, bacterial filtration efficiency, fluid resistance, differential pressure, and flammability for approval and certifications. Certification standards are set by different organizations. For example, ASTM International is one of the world's largest standards developing organizations. They have a series of tests that categorize masks into levels (1, 2, 3) and they grant certifications based on efficiency. The National Institute for Occupational Safety and Health (NIOSH) is another research center. The Occupational Safety and Health Act of 1970 established the National Institute for Occupational Safety and Health (NIOSH) which is part of the U.S. Centers for Disease Control and Prevention, in the U.S. Department of Health and Human Services. NIOSH provides a testing, approval, and certification program ensuring respirators, PPE and N95 masks used in the workplace meet certain safety standards. Furthermore, the FDA clears surgical masks based on manufacturer-submitted test data and proposed claims.3
Common tests include EN14683:14 and Level Barrier in ASTM F2100-11. These tests require certain levels of particle filtration efficiency, bacterial filtration efficiency, fluid resistance, differential pressure, and flammability to be considered EN14683:14 and/or ASTM F2100-11 certified. If a material has one of these certifications it means that it has a Bacterial Filtration Efficiency BFE >95% (high filtration) and a Differential Pressure rate of 3-5mm H20/cm2 (meaning it’s breathable) and/ or the following: a PFE <95%, Fluid Resistance of 80mmHg, microbial cleanliness <30 cfu/g. Kade & Vos face mask filters have passed EN14683 testing.
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Ok, so what are the best filters?
| First, you want to buy filters that have scientific data stated. If there isn’t information about the manufacturing testing results, I would not purchase the filter because it might only provide a false sense of security.
The best type of filter is a non-woven polypropylene (which is what we use in our masks). This material is used in medical and surgical face masks. Some Meltblown components have an equivalent rating of Bacterial Filtration Efficiency (BFE) 95% per ASTM F2101 and EN 14683.
I recommend buying them from actual fabric filtration suppliers. While products on Amazon can ship quickly, not all sellers are honest in their offering. A medical grade fabric supplier is required to have their materials tested before making any claims and selling them to the public. This way you can make sure the material you are using is safe.
Here are a few USA non-woven polypropylene suppliers including some that Kade & Vos uses for our filters:
Air Filters Incorporated
Protective Gear Technologies
SuperHuman Streetwear -$7.90/ yard with BFE >95%
MaskBond PFE>90%
If you’re in a pinch, you can use a reusable grocery bag that is also made of non-woven PP. One lab found that 2 layers of a grocery bag provides 34% filtration efficiency. Used as a filter inside a mask made of high thread count cotton is sure to provide adequate protection because 2 layers of cotton fabric provides between 69%-74% filtration efficiency.
Here are what a few other studies found about the BFE and pressure drop of common household items as filters.
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Material
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Results
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Oil Only Sorbent Pads
(made of polypropylene)
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1 layer of it captured 35.02% of particles and it had a pressure drop of 2.67 mm H20.
(* indicates results from Michigan Mask Response Research study).
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Meltblown Polypropylene (PP):
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Meltblown PP with a pore diameter between 28-40μm (micrometer) captured 86.86-88.64% of particles (an N95 captures 95%+) and it had a pressure drop of 7.7 mm H20 (an N95 is 9 mm H20). MPP provides high filtration efficiency while still being easy to breath in (Xiao, 2019).
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Reusable polypropylene grocery bags
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One study found that 2 layers captured 34% of particles (an N95 captures 95%+) and it had a pressure drop of 96 (a surgical mask is 140).
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Coffee filters
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As it turns out 2 layers of coffee filters are hard to breathe through and don’t filter particles well. The coffee filter in this study captured 14.1% of particles (an N95 captures 95%+) and it had a pressure drop of 16.42 mm H20 (an N95 is 9 mm H20), making it very difficult to breathe.*
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Fusible Interfacing
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Its filtration captured 17.24% of particles and was very easy to breathe through with a pressure drop of 1.08 mm H20. An N95 is normally 9mm H20.*
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| Pellon Embroidery Stabilizer |
Its filtration captured 65.82% of particles and was very easy to breathe through with a pressure drop of 18.58 mm H20. An N95 is normally 9mm H20.* |
| Black Out Curtain Lining Fabric |
It captured more than 95% of particles and had a pressure drop of 190.28 mm H20!!! (an N95 is typically 9 mm H20).* |
| Furnace Filters |
It captured 80.85% of particles and had a pressure drop of 8.15 mm H20 (an N95 is typically 9 mm H20).*
However, most furnace filter companies are saying they don’t support people using their furnace filters in masks. It’s not designed for this use, so they don’t know how safe it is.
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| Swiffer Pads |
2 layers captured 34.94% of particles and had a pressure drop of 0.95 mm H20 (an N95 is typically 9 mm H20).*
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| Vacuum bag liner |
1 layer captured 68.48% of particles and had a pressure drop of 10.82 mm H20 (an N95 is typically 9 mm H20).There are mixed opinions about the safety of vacuum bags. In my opinion, there is not enough research about having vacuum bag chemicals close to the face. *
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| Shop towel (the blue ones from Home Depot). |
They’re made from paper waste, tree fibers, and synthetic latex resin. The study tested shop towels made by Toolbox. 2 layers of it captured 41.94% of particles.* A Home Depot representative says that the shop towel is designed for cleaning and would not recommend or advise anyone to utilize it for face masks.
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| Zep Towels (like the blue ones from Home Depot). |
1 layer captured 39% of particles and had a pressure drop of 11.5 mm H20 (an N95 is typically 9 mm H20).*
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| Paper towels |
4 layers of Viva paper towels captured 22.54% of particles.*
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| Craft Felt |
1 layer captured 14.8% of particles and had a pressure drop of 1.97 mm H20 (an N95 is typically 9 mm H20).*
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| Wypall Cleaning Towels |
2 layers captured 35.8% of particles and had a pressure drop of 6.1 mm H20 (an N95 is typically 9 mm H20).*
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| Microfiber Towel |
2 layers captured 57.56% of particles and had a pressure drop of 11.2 mm H20 (an N95 is typically 9 mm H20).*
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How do I know if the mask I’ve bought will protect me?
| There are a few different ways you can check your mask. ER doctor Kevin Soden and Bill Nye say to try and blow out a lighter. If you can, the mask is most likely either not fitted properly, made of insufficient fabrics or doesn't have enough layers.
You can also hold your mask up to the light and you shouldn’t be able to see any visible pores or dots of light coming through (Divya, 2016; Amutha, 2016). The image below shows many pores and dots of light pouring through.
Lastly, check the fit. Does it fully cover your nose and chin? Is it fitted close to your face on the sides, nose and chin without any major gaps? If yes, then your mask is most likely sufficient. These must fit tightly to the user’s face.2
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What about other styles like a bandana or scarf? Do they protect me too?
While something is better than nothing, studies found that a bandana is the least effective cloth face mask. Below you’ll find some charts, brief descriptions of research studies and references to other sources supporting that the best cloth masks have:
- 3 layers
- With at least 2 of the 3 layers made of 100% cotton
- 1 filter layer
- A wire across the nose bridge
- Elastic or adjustable elastic ear-loops
- As for the best style of mask, one study found that the most protective design for adults is a minimum width of 8” across the face and a minimum height of 6” with pleats along the side
In a study from April 2020, researchers at Northwestern University compared the effectiveness of both commercial and cloth face masks. The researchers used an instrument that reports particle counts in the air from both the inside the mask and the surrounding air just outside the mask. They tested 3 commercial grade masks and 9 Cloth Face Masks. The cloth face masks varied in the number of fabric layers, fabric type, the measurements, if there was pleating or gathering on the sizes and if there was a nose wire.
Below is a summary of the findings:
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| Mask # |
Effectiveness |
Total Layers |
Filter |
Fabric |
Nose Wire |
Size |
Pleats |
| N95 |
99% |
4 |
Fabric is the filter |
Non-woven* |
Yes |
Fitted |
No |
| 3M Surgical Mask |
75% |
3 |
Fabric is the filter |
Non-Woven* |
Yes |
Fitted |
No |
| Charcoal Mask |
73% |
3 |
Yes. Charcoal Filter |
Non-woven* 100% synthetic
|
Yes |
Fitted |
No |
| *Non-Woven: Made directly from molten plastic or plastic film and melted with chemicals to bond short strands. |
| Cloth Mask 1 |
72% |
3 |
Yes |
100% cotton |
Yes |
8”x6” |
Yes |
| Cloth Mask 2 & 3. |
45-65% |
2 |
No |
100% cotton |
No |
6.25x6” |
No |
| Loth Mask 4. |
59% |
3 |
Yes (Vacuum cleaner bag) |
100% Cotton |
No |
6.25x6” |
Gathered |
| Cloth Mask 5. |
36% |
2 |
Yes. Cotton Batting |
100% Organic Cotton |
Yes |
8.25”x5” |
Gathered |
| Cloth Mask 6. |
34% |
2 |
Yes. Cotton Batting |
Polyester |
No |
8”x4” |
No |
| Cloth Mask 7. |
32% |
2 |
No |
100% Cotton |
Yes |
8.25X5” |
Gathered |
| Cloth Mask 8. |
32% |
3 |
Yes.Halyard H600 Halyard cloth is the material used to line surgical trays.
|
100% Cotton |
No |
7”x6” |
No |
| Cloth Mask 9. |
27% |
2 |
No |
100% Cotton Jersey Knit (t-shirt) |
No |
7.5”x6.25” |
Gathered |
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Results from a cough box experiments of these masks showed that both the surgical mask and the homemade mask reduced the total number of microorganisms expelled when coughing Non-mask wearers spread 3-4X more microorganism sized particles than people who wear face masks. For example, microorganism sized particles are liquid droplets from talking and breathing, the human sneeze, and human cough. For example, bacteria size particles are liquid droplets from talking and breathing, the human sneeze, and human cough. Other examples of bacteria size particles include: Anthrax, Yeast Cells, Coal Dust, Car emissions, fiberglas insulation, ash, Carbon dioxide, pesticides, herbicides, asbestos, Zinc dust, talc dust, insecticides, skin flakes and pet dander among others. Another study published by the Society for Disaster Medicine and Public Health, Inc. in 2013 looked at the capacity of cloth face masks to block bacterial and viral aerosols. The key takeaway from this is the filtration efficiency (FE) and the breathability. Notice that in some cases the higher the FE the more difficult it is to breathe.
|
| Material |
FE |
Breathability |
Notes from the researchers |
| 2 Layers of Tea Towel |
96.71% |
Very hard |
Tea Towels are a strong fabric with a thick weave and show relatively high filtration efficiency but it was found difficult to inhale. Not recommended for face masks. |
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Surgical Mask
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96.35%
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Somewhat easy
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Should be reserved for medical professionals.
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Vacuum Cleaner Bag
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94.35%
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Hard
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High Filtration but stiff and difficult for inhalation. Vacuum cleaner bags also include a health warning indicating that it contains carcinogens and teratogens, so these types of masks or filters would not be suitable for face masks.
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Tea Towel
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83.24%
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Somewhat hard
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Tea Towels are a strong fabric with a thick weave and show relatively high filtration efficiency but it was found difficult to inhale. Not recommended for face masks.
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Cotton/ Polyester Blend
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74.60%
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Somewhat easy
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Cotton blends have an excellent balance of FE and breathability. It is the most recommended material for cloth face masks.
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One layer 100% cotton t-shirt
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69% -70%
|
Easy
|
The slightly stretchy quality of the t-shirt made this a more preferable choice for a face mask and it was considered likely to provide a better fit.
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Antimicrobial Pillowcase
(polyester)
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65.62%
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Somewhat easy
|
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Scarf
|
62.30%
|
Easy
|
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Pillowcase
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61.28%
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Easy
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Linen
|
60%
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Easy
|
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Silk
|
58%
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Easy
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One study looked at mask types and how far droplets traveled. When wearing a bandana, droplets made it through the fabric and traveled up to 3 feet, 7 inches. The bandana below is folded twice and secured with rubber bands around the ears.
With a scarf wrapped around the face, droplets made it through the fabric and traveled 1 foot 3 inches. A stitched cotton mask was the best material according to this study. According to the scientists' findings, a stitched quilted cotton mask proved most effective as droplets only traveled 2.5 inches through the material.
According to the data, some cotton masks seemed to perform even better than what the researchers described as a "professional-grade face mask." It's still worth noting that something is more effective than wearing no mask at all.
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What should I avoid in a cloth face mask?
I do not recommend masks with the following:
- A loose tie around the head because these can be difficult to secure close to the face. We need masks to fit close to the face to prevent any particles going out or coming in. But, if you're able to get a secure fit around the face, ties can be effective.
- Without a nose wire. A wire shapes the mask to your specific nose shape and without this security, particles have access to come in and out of our masks. It also helps hold it on your face.
- A fitted mask with a nose wire only allows a small amount to escape from under the chin.
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Ear loops that are too tight OR too loose. If they are too tight, the mask will pull on your ears and not be comfortable. An uncomfortable mask is one of the main reasons people don’t want to wear them (18, 41). If a mask is too loose it can slide down your face causing the wearer to constantly readjust which is really frustrating.
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I do not recommend wearing masks that are made of organic cotton. A two layer Organic cotton mask was only found to be 36% effective at preventing particles breathing in and out of the mask (Mueller and Fernandez, 2020).
- Lastly, I do not recommend wearing fabrics on your face that are rough or cause irritation. Polyester and synthetic fabrics prevent your skin from breathing which can cause excess sweat inside the mask and can fog your glasses. Opt for cotton because it is breathable, is rated as the best fabric that prevents particles from escaping and entering your mask, it absorbs moisture, is hypoallergenic, washes 100% clean and is soft on the skin.
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How many face masks do I need?
It all depends on your schedule and how often you need to leave your home. John Hopkins Medicine says that It’s a good idea to have at least two. But, what is most important to consider is your schedule and how frequently you need to go out. Ideally, you’re staying at home most of the time. But if you need to go out everyday and have limited time for laundry, it’s best to have a set of masks to get you through the week. You always want a clean mask when you go someplace where social distancing (at least 6 feet away from others) might be a challenge, including:
- A trip to the grocery store.
- A ride on public transportation.
- A visit to your doctor.
- Close interactions with others while you’re on the job, if you are an essential employee.
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Why do some news outlets report that face masks are not effective?
| The truth is, there are studies concluding face masks are not effective in preventing respiratory infection. The thing about research is that if you look hard enough, you can find something to support an agenda and generalize it to the mass public - with the hope they won’t fact check. We must not take what we hear as fact - unless it can be proven through quality research. The good news is that I know what quality research looks like and the studies which claim masks are ineffective have major methodological flaws. Flaws included small sample size (Memish, 2012), unclear self-report questionnaires (Gautret, 2015; Deris, 2010; Choudhry, 2013), and only examining one singular symptom (this method is totally prone to biases due to their non-specificity, displaying one symptom doesn’t indicate respiratory illness, and a singular symptom can be a result from something other than infections; like a cough may result from exposure to dust or smoke).
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Am I safe in a crowd or if I go to a large gathering?
| The CDC recommends wearing a face mask in public and many states and counties have mandated masks in public. Yet, a lot of people are questioning if this really makes a difference. Building on the effectiveness of a mask, a 2016 study looked at how many people wore face masks to one of the largest mass gatherings in the world; the Hajj (Barasheed, 2016). The Hajj is an annual Islamic pilgrimage to Mecca, Saudi Arabia, which is the holiest city for Muslims. The pilgrimage lasts approximately 5 to 6 days and is attended by more than 2 million people every year. From 1999-2016, the researchers found that on average 72% of health care workers at Hajj complied with wearing a face mask, which aligns with other studies of health care workers in large mass gatherings (Alqahtani et. al, 2015; MacIntrye, 2015; MacIntyre et al. 2011; Abdin, Choudhry, & Al-Naji, 2005; MacIntyre et al., 2013). On average, 46% of pilgrims wore face masks. The study concluded that for those who are going to be in large gatherings that wearing face masks was associated with significant decrease in respiratory and flu like symptoms among Hajj pilgrims (Barasheed et al, 2014).
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Why do people wear face masks?
Studies found that people wear face masks
- to avoid transmission of infectious organisms and
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to protection from air pollution (Choudhry et al., 2006).
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Why don’t people wear face masks?
| Studies looking at community compliance found that on average 55% of people wore face masks to prevent respiratory illness 1, 2, 3, 4, 5, 6, 7. You might be thinking that is a low number and I agree. This brings us to our next question; why? I found 6 reasons:
Considering all the reasons that some individual are resistant to wearing face masks, Kade & Vos has made it our mission to do the following:
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Not wearing masks because:
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Kade & Vos is helping by:
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Not comfortable 8, 9
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Design masks that are comfortable
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Difficulty breathing 8, 9
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Design masks that provide protection AND are breathable
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Don’t believe it is effective 10, 11, 12
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Share information about the effectiveness of wearing masks
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Availability 11, 12, 13, 14
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Provide one of the most affordable, washable and reusable masks on the market.
Donate cloth face masks to our community
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Proper training on how to wear one 11, 12, 13, 14
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Provide resources for how to properly wear a face mask
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Contradicting Government and Healthcare Policies 11, 12, 13, 14
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Share the most recent CDC policies
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| A few studies showed that providing educational sessions on protective measures against respiratory infections (including the wearing of face masks) before mass gathering was associated with significantly higher uptake of face masks 8, 15, 16, 17, 18. This makes sense because more healthcare workers wear masks because they have been educated about the risks of respiratory infections and the role of preventive measurements.
Similarly, studies looking at smaller gatherings found that the more a person knows about the risks of infectious diseases the more likely they are to wear a mask. 10, 11, 12. How awesome is that! Once again education is found to be helpful!
Does showing someone how to wear a mask really increase the likelihood that they will wear one? Yes. 8, 15, 16, 17, 18.
Does giving someone a free mask increase the likelihood they will wear one? Yes. People are 83% likely to wear a mask if it is for free 8, 15.
There are also cultural differences to consider. One study looked at coronavirus deaths across 198 countries and found that those countries with cultural norms or government policies in favor of mask-wearing had lower death rates (Leffler, et. al, 2020 - Department of Ophthalmology, Virginia Commonwealth University).
References:
- Canini et al., 2010
- Cowling et al., 2009
- Cowling et al., 2008
- Larson et al., 2010
- MacIntyre et al., 2009
- Suess et al., 2012
- Simmerman et al., 2011
- Barasheed et al., 2014
- Alqahtani, Sheikh, Wiley & Heywood, 2015
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Albano, Matuozzo, Marinella & Giuseppe, 2014
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MacIntyre & Chughtai, 2015
- Nichol et al., 2013
- Gershon et al., 1995
- Lau et al., 2004
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Abdin, Choudhry, & Al-Naji, 2005
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Aljoudi, Nooh, & Jamil, 2004
- Al-Zahrani, Chaudhry & Alhamdan, 2006
- Deris et al., 2010
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Can a mask trap in excess amounts of carbon dioxide and cause brain damage?
| No. A properly constructed mask provides more than enough ventilation (Stanford Medicine). Centers for Disease Control and Prevention representative says that carbon dioxide, indeed, will collect between the mask and face but not in dangerous amounts and certainly not enough to cause hypercapnia. A mask is designed to trap viral droplets, much larger than tiny carbon dioxide particles. A mask, either N95 or cloth, cannot trap all carbon dioxide particles — they either go through the mask or escape along the mask’s perimeter.
“Cloth masks will not lead to hypoxia. Surgeons operate for hours wearing them. They don't get these problems," says Infectious Disease Expert Professor Keith Neal.
The WHO says: "The prolonged use of medical masks when properly worn, does not cause CO2 intoxication nor oxygen deficiency.
“There is no risk of hypercapnia (CO2 retention) in healthy adults who use face coverings, including medical and cloth face masks, as well as N95s,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital, New York, told Healthline. “Carbon dioxide molecules freely diffuse through the masks, allowing normal gas exchange while breathing.”
“Rebreathing tiny amounts of CO2 from wearing either properly fitted N95 respirators or more loosely fitted cloth or surgical masks is of no concern for the vast, vast majority of people,” said Darrell Spurlock Jr., PhD, RN, the director of the Leadership Center for Nursing Education Research at Widener University and a professor in Widener’s PhD in Nursing program.
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How often should I wash my mask?
| The CDC says, “Cloth face coverings should be washed after each use. It is important to always remove face coverings correctly and wash your hands after handling or touching a used face covering” (CDC, 2020).
They recommend washing your mask in the washing machine or by hand.
Washing machine
- You can include your face covering with your regular laundry.
- Use regular laundry detergent and the warmest appropriate water setting for the cloth used to make the face covering.
- Opt for non-scented detergent if you’re sensitive to scents.
Washing by hand
- Hand wash with a bleach solution. First, check to see if your bleach is intended for disinfection and make sure your fabric won’t be ruined.
Mix the following:
- 5 tablespoons (1/3rd cup) household bleach per gallon of room temperature water or
- 4 teaspoons household bleach per quart of room temperature water
- Soak the face covering in the bleach solution for 5 minutes.
- Rinse thoroughly with cool or room temperature water.
You can dry your mask in the dryer on the highest heat setting or air dry laying flat. If possible, let it dry in direct sunlight. Make sure it’s completely dry after washing and before wearing.
Johns Hopkins Medicine also says that we should wash our mask every time we wear it.
- Bandanas, face scarves and masks made of fabric, such as cotton, can be washed in your regular laundry using hot water.
- Disposable, blue surgical masks cannot be laundered or cleaned and should be thrown away when it is visibly soiled or damaged.
- After laundering your fabric masks, tumble dry them in the dryer on a high setting.
- You can also hand wash your mask, using hot, soapy water. Scrub the mask for at least 20 seconds, and dry them on high heat in the dryer.
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Additional References
Recent Studies:
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Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. The New England journal of medicine. 2020;382(10):970-971. PMID: 32003551
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Zou L, Ruan F, Huang M, et al. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. The New England journal of medicine. 2020;382(12):1177-1179. PMID: 32074444
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Pan X, Chen D, Xia Y, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. The Lancet Infectious diseases. 2020. PMID: 32087116
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Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. Jama. 2020. PMID: 32083643
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Kimball A HK, Arons M, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morbidity and mortality weekly report. 2020; ePub: 27 March 2020. PMID: 32240128
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Wei WE LZ, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020. MMWR Morbidity and Mortality Weekly Report. 2020;ePub: 1 April 2020. PMID: 32271722
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Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science (New York, NY). 2020. PMID: 32179701
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Furukawa NW, Brooks JT, Sobel J. Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic [published online ahead of print, 2020 May 4]. Emerg Infect Dis. 2020;26(7):10.3201/eid2607.201595.
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Oran DP, Topol Prevalence of Asymptomatic SARS-CoV-2 Infection: A Narrative Review [published online ahead of print, 2020 Jun 3]. Ann Intern Med. 2020;M20-3012. PMID: 32491919
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National Academies of Sciences, Engineering, and Medicine. 2020. Rapid Expert Consultation on the Possibility of Bioaerosol Spread of SARS-CoV-2 for the COVID-19 Pandemic (April 1, 2020). Washington, DC: The National Academies Press. https://doi.org/10.17226/25769
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Schwartz KL, Murti M, Finkelstein M, et al. Lack of COVID-19 transmission on an international flight. CMAJ. 2020;192(15):E410. PMID: 32392504
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Anfinrud P, Stadnytskyi V, Bax CE, Bax A. Visualizing Speech-Generated Oral Fluid Droplets with Laser Light Scattering. N Engl J Med. 2020 Apr 15. doi:10.1056/NEJMc2007800. PMID: 32294341
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Davies A, Thompson KA, Giri K, Kafatos G, Walker J, Bennett A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep. 2013;7(4):413-8. PMID: 24229526
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Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano. 2020 Apr 24. PMID: 32329337
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Aydin O, Emon B, Saif MTA. Performance of fabrics for home-made masks against spread of respiratory infection through droplets: a quantitative mechanistic study. medRxiv preprint doi: https://doi.org/10.1101/2020.04.19.20071779, posted April 24, 2020.
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Ma QX, Shan H, Zhang HL, Li GM, Yang RM, Chen JM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol. 2020. PMID: 32232986
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Leung, N.H.L., Chu, D.K.W., Shiu, E.Y.C. et al.Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med. 2020. PMID: 32371934
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Johnson DF, Druce JD, Birch C, Grayson ML. A quantitative assessment of the efficacy of surgical and N95 masks to filter influenza virus in patients with acute influenza infection. Clin Infect Dis. 2009 Jul 15;49(2):275-7. PMID: 19522650
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Green CF, Davidson CS, Panlilio AL, et al. Effectiveness of selected surgical masks in arresting vegetative cells and endospores when worn by simulated contagious patients. Infect Control Hosp Epidemiol. 2012;33(5):487‐494. PMID: 22476275
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