We are learning new information on COVID-19 every day. As much as we are saddened, stressed and fatigued with news of the virus, we do need to pay attention to the news because what we need to do—how we need to change our behaviour—is constantly changing.
The consensus on whether the public should wear masks is changing too. Various countries have taken a different approach to masks and researchers are noticing that masks for all is one of the strategies that successful countries, with the flattest curves on graphs of both cases and deaths, included masks along with physical distancing, washing hands, disinfecting surfaces regularly and staying home as much as possible.
The reasons given for not advising the public to wear masks when outside their homes include:
1. They have not been proven to be effective
2. They may encourage people to touch their faces to adjust the mask
3. Non-healthcare people don’t know how to put on and remove a mask properly
4. Masks need to be saved for healthcare workers, as there are not enough available for everyone (at least in North America)
In my opinion, reason #4 should be listed first…
There is no question that high-level masks should be reserved for those working directly with people who are infected. The N95 mask is designed to filter out 95% of particles from air the wearer is inhaling. This includes bacteria, viruses and fine mist that is generated during certain medical procedures. But simple, inexpensive, homemade cloth masks may be all the is needed by the general public.
The key function of masks worn by the public is to prevent people from exhaling bacteria and viruses when they talk or cough. It is known that some people have few or no symptoms of COVID-19 but can still unknowingly spread the disease. When you wear a mask to the grocery store or pharmacy, you are mainly protecting others, more than yourself. Wearing a mask doesn’t mean you don’t still have to wash your hands and avoid touching your face…it’s an extra measure of safety that is added onto what we are already doing to help protect others. Any of us could have the coronavirus but not realize we do because we do not have any symptoms. Because of the way they work, homemade cloth masks work best when everyone wears one.
Reason #1: not proven to be effective
So, are masks worn by the public effective? As medical policy makers have been saying, there is no proof they are…until now. Research in Asian countries and in Czechoslovakia, where rates of coronavirus spread are impressively low, is suggesting that their policy of masks for all is making a difference. Countries, like South Korea, Japan and Hong Kong where wearing a mask in public when you are sick is a custom, are among those with the lowest curves showing numbers of cases. As China opens up businesses and people there return to work, we will see a further test of masks combined with other strategies as the world watches whether a second wave of coronavirus can be prevented there.
Meanwhile, growing evidence of virus spread by people without symptoms is prompting the World Health Organization and governments to reconsider their policies stating that masks do not need to be worn by the public. Masks are recommended to be worn by those with symptoms that suggest COVID-19 infection, but it is beginning to seem likely that it is also being spread unknowingly by people with the virus who do not have a cough, sore throat or fever.
Reason #2: “may” encourage people to touch their faces
My first question is: do healthcare workers touch their faces more when wearing a mask or to they adapt to it quickly when told they must not do this? This, again, has not been proven to be a problem when wearing a mask and, in fact, I’ve read the opposite expert opinion elsewhere: that a mask stops a person from touching their face…it physically block you from doing this. The jury is certainly out on this one… Let’s just say that the rule of avoiding touching the face is still an important one and must be remembered whether you wear a mask or not.
Reason #3: lack of education about how to use a mask
A significant cause of infections of healthcare workers is improper removal of contaminate protective clothing. Remember that the purpose of Personal Protective Equipment (PPE) in hospitals is to create a layer that blocks viruses from reaching the worker. In the process, the outside of the equipment (including the mask) is very likely to be contaminated. The worker must learn to remove the equipment without touching the outside as this would expose them to viruses and bacteria.
But is this also an issue for people who wear a mask in public? The main purpose (as stated earlier) is to prevent the public from expelling droplets that may contain viruses when they talk or cough. This makes removal technique much less important than for those who are surrounded by viruses as they work with sick patients every day. But, just like learning to wash our hands properly, members of the public can learn to take precautions when removing their masks.
When removing your mask, it is best to handle it only by the straps or elastic, avoid touching the outside or inside and put it directly into hot soapy water (soap kills the coronavirus) or a mild bleach solution (1 part bleach to 9 parts water). Leaving it in a laundry basket can create risk of exposure for the person doing the laundry later, although generally viruses do not live more than a few hours on porous surfaces like cloth or paper. You could also put your masks into a laundry bag or pillowcase to enclose them until wash day. After removing your mask, you should wash your hands…but if you’ve just returned from an “outdoor adventure” (like shopping 😊) you should be washing your hands anyway.
The mask also needs to be put on properly for best effectiveness…it should fit as snugly as possible to maximize the filtering effect, including squeezing the metal clip or wire that is (hopefully) inserted in the edge positioned over the nose. The mask must be kept over both the nose and mouth to be effective, and we’ve all seen photos of people who have only covered their mouth with the mask or (heaven forbid!) dropped it below their chin to talk.
Remember that it is also possible to catch viruses through the eyes (although less common than through the mouth and nose), so wearing glasses to protect the eyes is also a good idea.
Reason #4: not enough masks to go around
We know that there are problems providing enough masks for our front-line healthcare workers who really need them. If everyone starts competing for the limited supply currently available, the problem will become worse. We cannot allow that to happen.
The earliest masks were a piece of fabric tied across the face, first used during the bubonic plague. Even these simple masks were reported to result in fewer infections in those that wore them. In areas of the US hardest hit, seamstresses and quilters have started making masks from cloth and many have posted patterns on the internet to encourage others. I saw a photo of homemade masks left hanging outside in Czechoslovakia for anyone needing one to freely help themselves.
The initial thought was that, even though these homemade masks are untested, it was better to have an untested one than nothing at all. But there have been preliminary tests that show this: a cloth mask does not filter as well as an N95 mask, but it does make a difference. Patterns that allow a filter to be inserted may provide even better protection. Paper towel is suggested as a simple filter that adds to the effectiveness while still allowing you to breathe easily. A double layer is more effective. And stay tuned as researchers look at what materials work best. We may need to use these for 12 to 18 months, until a vaccine is available.
So, I made 27 masks this week. I distributed some of these to my friends, family and neighbours along with the pattern so they can make more. A double layer of cotton t-shirt fabric or tightly woven cotton are suggested as effective fabrics and the stretch allows a comfortable and snug fit without using darts or tucks, keeping the construction simple and quick. Five to six adult- and 2 child-sized masks can be made from one large adult cotton t-shirt. The sewing so limited the mask could be sewed by hand if you don’t have a sewing machine. I will post the pattern and instructions for use below. This design fits best if the top straps pass over the ears and the bottom straps are pulled up and fastened at the top of the head. Note that woven cotton, cut on the bias (diagonal) provides some stretch.
I plan to make as many as I can—although I may be limited by my t-shirt supply (any donations welcome!)—and I want to encourage others to wear them and make them too! Will you join me in the movement to slow the spread of COVID-19 by helping to make “masks 4 all”?
Slogan for the mask campaign in Czechoslovakia:
"My mask protects you. Your mask protects me."
References:
WHO considers changing guidance on wearing face masks- The Guardian
CSC considering recommending general public wear face coverings in public—The Washington Post
Alternative fitted face mask pattern--Unity Point Health (made with t-shirt fabric or woven cotton)
Jeannie Beaudin’s Simple Mask Pattern (with filter pocket)
Made from a t-shirt, preferably 100% cotton, heavyweight
Sides are left open so a paper towel (folded in half) can be inserted as a filter for extra protection. One large short sleeve t-shirt makes 5 or 6 adult and 2 child size masks.
Cut across the t-shirt, 13 inches up from the hem. Turn inside out and cut away seams from the sides. Save to use as ties. Cut 9-inch strips, so you have 9 x 13 rectangles with one 9-inch edge already hemmed (from the bottom of the shirt). This edge will form the top of the mask.
You will be able to get 2 from the bottom front, 2 from the bottom back plus 1 to 2 from the upper section , depending on the size of the t-shirt. Sleeves can be made into child-size masks or ties if necessary.
Insert wire of some kind into the pocket formed by the t-shirt hem. Four-inch pieces of pipe cleaner, or 2 to 3 twist ties can be used. Center the wire then stitch across the pocket on each side of it to keep it centered.
Fold up the bottom so it just overlaps the hem stitching. Zigzag along the overlap or hand sew with hem stitch if you don’t have a machine.
The ones from the upper back won’t have a pre-hemmed edge. Fold this 9 x 13-inch rectangle in half. Stitch a ¼-inch seam across the 9-inch side. Place your wire on top of the seam allowance, and stitch in place with a wide zigzag stitch that jumps over the wire or hand-stitch in place. Turn right side out and press lightly.
Cut strips ½ to 1 inch wide from leftover fabric for ties. There will likely be enough in the lengthwise fabric since most t-shirts are more than 18 inches wide, but they can also be cut crossways from the upper part of the t-shirt or the sleeves. If you want to be “fancy” you can pull lengthwise on the strips so they curl, then stitch with a zigzag stitch to keep them folded in half.
Stitch securely to each corner of the mask. Can tuck the end of the strap between the layers before stitching.
Child mask is made the same way from the sleeve fabric or other leftover sections. Trim to width needed to reach from front of one ear to the other. Depth can be adjusted to reach from bridge of nose to under the chin when folded in half.
To wear:
Fold a piece of paper towel in half and insert into the mask through the side opening. One piece of multi-size towel works perfectly. Place the wire edge over the bridge of your nose. Pass the upper ties over your ears and tie snugly behind the head. Pull the lower ties up and tie near the crown of your head. Tuck the sides in under the ties that are pulled upward, making a neat little pocket. Squeeze the wire so it fits snugly over your nose (this will keep your breath from escaping and fogging your glasses!). Wear glasses for extra protection for your eyes!
To remove:
Try to hold the mask by the ties when you remove it (the front could be germy…). Remove the paper towel from the pocket through one of the side openings and discard immediately. Drop the mask into hot soapy water, swish/ soak for 5-10 mins so mask is well exposed to soap (soap kills viruses!), rinse, wring, roll in a towel to absorb excess moisture and hang to dry. Wash hands!
P.S. Won’t we all be stylish this spring! You could make lots of different colours to match your favourite outfits this summer!! ...Just like the Prime Minister of Czechoslovakia 😊
