Do Homemade Face Masks Help Stop the Spread of Coronavirus?

You’ve probably seen calls for DIY cloth face masks for hospitals and healthcare facilities in recent weeks, and if you own a sewing machine, you might have made some yourself. There are now suggestions that perhaps we should all wear masks . If we do, homemade sheet masks can be a responsible choice to keep medical grade masks for healthcare professionals.

But do they work? And will the habit of wearing them do more harm than good? Answer: it is difficult. But if you’ve decided to make masks for yourself or others, here’s what you need to know.

Cloth masks don’t work as well as surgical masks

There are two studies that I have cited repeatedly to show that sheet masks can be effective in the general population, and one from healthcare professionals that seems to show the opposite. Let’s take a look at them.

Before we start talking about how effective sheet masks are, it is important to consider how they are used so that we can say: effective for what ? There are three main use cases people are discussing, so let’s go over these topics so we can cover each one:

• medical professionals, as a replacement for medical masks or in addition
• sick people to avoid transmitting germs to others
• healthy people in daily life to reduce the risk of contracting infections

People who believe they are healthy may unknowingly end up sick, so when we talk about wearing masks by the general public, it is often a combination of protecting the wearer from others and protecting others from the wearer.

None of these three studies accurately capture the full effects of telling the population to wear (or not wear) masks. Each of them looks only at a specific scenario and studies it in a narrow sense.

One study, published in PLoS One in 2008 , measured the number of particles on either side of a mask worn by a volunteer when they sat, talked, and walked. In the study, n95 masks filtered particles (including respiratory droplets) better than surgical masks, which in turn perform better than a tea towel mask.

The authors concluded that homemade masks are imperfect but may provide some protection when worn by the general public. But it’s important to remember that volunteers were only asked to wear masks for a few hours in a particular laboratory experiment, doing what the researchers asked them to do.

The researchers did consider whether people would take off their masks when they shouldn’t have, and found that compliance with the rules is better when using homemade masks, suggesting that they may be more comfortable. But they paid little attention to people’s ability and willingness to maintain mask hygiene, including knowing when and how to change masks.

In another study published in the journal Disaster Medicine and Public Health Preparedness in 2013, volunteers were asked to make their own masks. They then tested whether the masks blocked bacteria when (healthy) volunteers cough, and used the machine to test the filtering ability of a variety of materials, including cotton fabric for T-shirts and pillowcases.

This study is often cited as showing that sheet masks “work,” but a few caveats can be made when going into the details. The masks were tested fresh and dry, with the researchers noted that after the mask became wet from use, the results were not applicable. Homemade masks didn’t filter as well as surgical masks, and they didn’t fit either.

The researchers conclude, “An impromptu face mask should be considered the last possible alternative if commercial face masks are not available … However, these masks will provide little protection to wearers from germs from other people infected with respiratory infections. illness. As a result, we do not recommend using homemade face masks as a method to reduce aerosol transmission. ”

The third study , published in the BMJ Open in 2015, was a randomized study examining whether healthcare workers who wore cloth masks for an entire shift were more likely to get sick than those who wore medical masks for the entire shift or who wore masks. occasionally. (None of the study participants walked completely without masks.)

This study found that hospital staff who wore cloth masks for an entire shift were more likely to get sick than the other two groups. It is possible that wearing cloth masks increased their risk, but since there was no group that rejected masks, it cannot be said that cloth masks are worse than nothing – just that in this study, it is worse than using surgical masks all the time or from time to time. … …

We still don’t have a study that examines whether the habit of wearing masks can protect people in general in our daily lives. Based on these studies, it is possible, but not fully known, that a properly worn mask is better than nothing.

There is still no definitive answer as to whether the general public should wear masks.

There have been several impassioned calls lately to get people to wear masks when they go out in public. Several news outlets report that the CDC is considering changing its leadership to begin recommending them. The CDC tweeted on March 28 that they have no “planned” changes to the instructions, which I suppose might mean they are thinking about it. Dr. Fauci told CNN that the idea of ​​recommending masks to the general public is “highly debated,” with the main challenge being to ensure that any such recommendation does not exacerbate a shortage of personal protective equipment (PPE) for healthcare workers. …

Zeynep Toufekchi argued that banning people from wearing masks was a confusing message . Medical professionals desperately need masks, so we must protect them; but if they work so well, why don’t we all wear them too?

In fact, these facts do not contradict each other, but it may seem so. As we wrote back in February , the delivery of masks to medical workers is a top priority. If the supply of masks were infinite, one could say that everyone can choose for themselves whether to wear a mask.

But the supply is limited, and this has been the case since the beginning of the Wuhan outbreak. (Science journalist Marin McKenna warned us in 2018 that since most of our masks are manufactured in China and Mexico, a pandemic that starts in either of these countries could run out of supply of masks before this pandemic reaches us. , what’s happened.)

When masks are in short supply, it is important that medical professionals have them. The rest of us can do without. This is why the World Health Organization has stated throughout this pandemic that you only need a mask if you are sick or caring for a sick person. “If you are not sick or caring for the sick, then you are wasting the mask,” they say on their Q&A page . But they talk about medical masks and they don’t say anything about cloth masks.

Mask hygiene is important

Protecting yourself with a mask is not as easy as putting it on. Even if the masks work, everything else you do also affects your chances of getting infected or spreading the disease.

For example, if you feel safer with a mask, you may put yourself at greater risk by shopping more often or getting close to people.

If you touch your mask and then touch your face or touch any nearby surfaces, you could contaminate your face or those surfaces.

When removing the mask, particles of infection can get onto your hands. And if someone else takes hold of the mask – for example, during the wash – they can also be naked.

The World Health Organization’s guidelines for mask use suggest the use of disposable masks, for example when they tell you to discard the masks immediately after use in a bin with a lid. However, if you are going to wear a mask, you must know how to use it. WHO advises:

• Before putting on the mask, clean your hands with an alcohol-based hand rub or soap and water.
• Cover your mouth and nose with the mask and make sure there are no gaps between your face and mask.
• Do not touch the mask while using it; If you do, wash your hands with an alcohol-based hand rub or soap and water.
• Replace the mask with a new one as soon as it becomes wet and do not reuse disposable masks.
• To remove the mask: remove it from the back (do not touch the front of the mask); immediately throw it into a closed basket; Wipe your hands with an alcohol-based hand cleaner or soap and water.

Cloth masks are not a substitute for medical masks for healthcare professionals.

So what about the masks that volunteers sew for hospitals and healthcare facilities? Cloth masks are problematic here, as you may recall from a study that showed that hospital workers were more likely to get sick if they wore cloth masks for an entire shift than if they were using medical grade masks. While there are many agencies that request masks, I have also corresponded with several nurses who are shocked that any medical facility is even considering this.

So let’s be clear on one thing: Cloth masks are not considered PPE. They do not replace actual N95 masks or surgical masks worn by hospital staff. You may have heard that the Centers for Disease Control recommends them as a “last resort,” but they really do act last. Here’s what the CDC says:

In an environment where face masks are not available, [health care providers] may use homemade masks (eg, bandana, scarf) to care for COVID-19 patients as a last resort. However, homemade masks are not considered PPE because their ability to protect [health care providers] is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in conjunction with a face shield that covers the entire front (up to the chin or below) and the sides of the face.

This recommendation is the very, very, very bottom of the CDC’s strategy to optimize the supply of face masks . The most recommended strategies include:

• finding additional medical grade masks (requesting donations, buying from places other than regular suppliers)
• limiting the number of patients who come to clinics at all and canceling planned procedures and appointments
• reducing the number of times a provider has to wear a mask (for example, setting limits on the number of people in a patient room or operating room)
• using masks after the expiration date

The guidelines also include limiting the available masks to vendors only, if necessary. Typically, infectious patients may be asked to wear a mask as a “source of control”.

If you keep scrolling down the page, you’ll find a grim section on what to do if there are no face masks at all. One hypothesis is that COVID-19 patients may be assisted by medical professionals who themselves have suffered and recovered from COVID-19. Another is to use clear plastic face masks without a mask. Finally, at the end – a proposal to use homemade masks and, if so, cover them with a face mask.

In other words, homemade masks for healthcare professionals are considered arguably better than nothing at all. They do not replace respirators, splash-proof surgical masks, or even medical grade treatment masks. But if the situation gets dire enough, they can be used.

Who uses the donated masks?

Before contributing to a crafting project, it’s important to figure out where your finished objects will go and if they are needed. Charitable craft projects often get out of hand, such as the call for penguin sweaters, which was quickly answered . The tiny sweaters kept falling in, so penguin rescuers began to put them on stuffed penguins to sell as a fundraiser. Or perhaps you remember the koala mitten debacle when the organization called for mittens for the burnt paws of the koalas, but soon asked people to please, please don’t send mittens after all.

Lack of personal protective equipment is real and can threaten life and death. If you are making masks, you are not making PPE. But some clinics and care facilities accept homemade masks, either as a potential protection in the worst-case scenario, as we discussed above, or for the following purposes:

• Reducing the likelihood of transmitting the virus to other sick patients or residents (in this case, the cloth mask is worn on the patient and not on the provider)
• Attempting to extend the lifespan of PPE such as N95 masks. Many hospitals provide staff with one N95 mask per day and are expected to reuse it. This is generally not recommended, but some employees say cloth masks can help keep the mask free from visible contamination, causing them to throw it away.

Dark times come when hospital workers cannot get the personal protective equipment they need, but supplies are already running low and everyone is doing what they can. General public masks may be one solution to help slow the transmission of coronavirus, but they have many caveats and uncertainties.