Cloth face mask

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Cloth face mask
Clothfacemask101.jpeg
A cloth face mask made out of 2-ply construction with layers of 85% polyester and 15% cotton fabric
Other namesFabric mask

A cloth face mask is a mask made of common textiles, usually cotton, worn over the mouth and nose. When more effective masks are not available, and when physical distancing is impossible, cloth face masks are recommended by public health agencies for disease "source control" in epidemic situations to protect others from virus laden droplets in infected mask wearers' breath, coughs, and sneezes. Because they are less effective than N95 masks, surgical masks, or physical distancing in protecting the wearer against viruses, they are not considered to be personal protective equipment by public health agencies. [1]

Contents

Cloth face masks were routinely used by healthcare workers starting from the late 19th century. They fell out of use in the developed world in favor of disposable surgical masks with an electret (electrically charged) filter material, but cloth masks persisted in developing countries. [2] During the COVID-19 pandemic, their use in developed countries was revived due to shortages, as well as for environmental concerns and practicality. Launderable cloth electret filters were also being developed. [3]

Usage

Guidance from the U.S. Centers for Disease Control and Prevention on using and making cloth masks during the COVID-19 pandemic Use of Cloth Face Coverings to Help Slow the Spread of COVID-19.pdf
Guidance from the U.S. Centers for Disease Control and Prevention on using and making cloth masks during the COVID-19 pandemic

Prior to the COVID-19 pandemic, reusable cloth face masks were predominantly used by healthcare workers in developing countries and were especially prominent in Asia. Cloth face masks contrast with surgical masks and respirators such as N95 masks, which are made of nonwoven fabric formed through a melt blowing process. In addition, respirators, unlike cloth face masks, are regulated for their effectiveness based upon efficiency of minimum particle size filtered and/or maximum penetrating particle (MPP) size, along with other criteria such as outer splash/spray protection, inner splash/spray absorption, contaminant accumulation and shedding, air flow, and inflammability. [5] Like surgical masks, and unlike respirators, cloth face masks do not provide a seal around the face, and prior to the 2019 COVID-19 outbreak were generally not authorized by institutions for protection from sub-HEPA particle size (less than 0.3 um) Influenza Like Illness (ILI). [2]

In healthcare settings, they are used on sick patients as source control to reduce disease transmission through respiratory droplets, and by healthcare workers when surgical masks and respirators are unavailable. Cloth face masks are only recommended for use by healthcare workers as a last resort if supplies of surgical masks and respirators are exhausted. [2] They are also used by the general public in household and community settings as perceived protection against both infectious diseases and particulate air pollution and to contain the wearer's exhaled virus laden droplets. [2] [6]

Several types of cloth face masks are available commercially, especially in Asia. [6] Homemade masks can also be improvised using bandanas, [4] T-shirts, [4] [5] handkerchiefs, [5] scarves, [5] or towels. [7] But depending on the situation, reusable cloth masks with incorporated filters can block particles nearly as well as medical-grade masks can, as long as they fit securely. [8]

Recommendations

Infographic from the World Health Organization showing the do's and don'ts of wearing a fabric mask to prevent the spread of COVID-19 How to wear a non-medical fabric mask safely - Do's & Don'ts.png
Infographic from the World Health Organization showing the do's and don'ts of wearing a fabric mask to prevent the spread of COVID-19
Two French cloth masks certified by AFNOR. The white mask is made of polypropylene and the black one is made of cotton. Deux masques grand public.jpg
Two French cloth masks certified by AFNOR. The white mask is made of polypropylene and the black one is made of cotton.

The World Health Organization (WHO) recommends that cloth face masks should be worn in public where social distancing is not possible to help stop the spread of coronavirus. It notes that wearing a cloth face mask is just one of a range of tools that can be used to reduce the risk of transmission. [9] The US Center for Disease Control, along with Johns Hopkins University School of Medicine, The Mayo Clinic, and Cleveland Clinic all concur with this recommendation. [10] [11] [12] [13] The World Health Organization also recommended that those aged over 60 years old or with underlying health risks require more protection and should wear medical masks in areas where there is community transmission. [9]

The World Health Organization recommends using masks with at least three layers of different materials. Two spunbond polypropylene layers are also believed to offer adequate filtration and breathability. [14] When producing cloth face masks, two parameters should be considered: filtration efficiency of the material and breathability. The filter quality factor known as "Q" is commonly used as an integrated filter quality indicator. It is a function of filtration efficiency and breathability, with higher values indicating better performance. Experts recommend Q-factor of three or higher. [14]

A peer-reviewed summary [15] of the filtration properties of cloth and cloth masks concluded that, pending further research, evidence is strongest for 2 to 4 layers of plain weave cotton or flannel, at least 100 thread count. A plain-language summary of this review is available.

Comparison of materials for fabric masks [14]
Material (source)StructureInitial
Filtration
Efficiency (%)		Initial
Pressure
drop (Pa)		Filter
quality
factor, Q
(kPa−1)
Polypropylene (interfacing material) spunbond 61.616.9
Cotton (sweater)knit26177.6
Cotton (T-shirt)knit2114.57.4
Polyester (toddler wrap)knit1712.36.8
Cotton (T-shirt)woven54.55.4
Cellulose (tissue paper)bonded20195.1
Cellulose (paper towel)bonded10114.3
Silk (napkin)woven47.32.8
Cotton (handkerchief)woven1.19.80.48
Cotton, gauze woven0.76.50.47
Nylon (exercise pants)woven232440.4

Effectiveness

Cloth face masks can be used for source control to reduce disease transmission arising from the wearer's respiratory droplets, but are not considered personal protective equipment for the wearer [16] [17] [18] as they typically have very low filter efficiency. [19] [20] There are no standards or regulation for self-made cloth face masks. [20]

As of 2015, there had been no randomized clinical trials or guidance on the use of reusable cloth face masks. [2] [7] Most research had been performed in the early 20th century, before disposable surgical masks became prevalent. One 2010 study found that 40–90% of particles in the 20–1000 nm range penetrated a cloth mask and other fabric materials. [19] The performance of cloth face masks varies greatly with the shape, fit, and type of fabric, [6] as well as the fabric fineness and number of layers. [7] As of 2006, no cloth face masks had been cleared by the U.S. Food and Drug Administration for use as surgical masks. [5] A Vietnamese study of healthcare workers compared influenza-like illness outcome among those wearing cloth masks versus medical masks. [21] They concluded that cloth masks were ineffective at preventing transmission in high-risk clinical settings. Although discouraged in clinical settings, cloth masks may still serve a useful role in reducing disease transmission in public settings according to a systematic review. [22]

The primary role of masks worn by the general public is to "stop those who are already infected broadcasting the virus into the air around them". [23] This is of particular importance with the COVID-19 pandemic, as silent transmission seems to be a key feature of its rapid spread. For example, of the people on board the Diamond Princess cruise ship, 634 people were found to be infected—52% had no symptoms at the time of testing, including 18% who never developed symptoms. [24] It is important to note that mask wearers are more likely to engage in other hygiene measures such as hand washing and social distancing. Best practice is to implement multiple prevention techniques to reduce risk, as characterized by the Swiss cheese model. [25]

Compared with bacteria recovery from unmasked volunteers, a mask made of muslin and flannel reduced bacteria recovered on agar sedimentation plates by 99%, total airborne microorganisms by 99%, and bacteria recovered from aerosols (<4 μm) by 88% to 99%. [26] In 1975, 4 medical masks and 1 commercially produced reusable mask made of 4 layers of cotton muslin were compared. Filtration efficiency, assessed by bacterial counts, was 96% to 99% for the medical masks and 99% for the cloth mask; for aerosols (<3.3 μm), it was 72% to 89% and 89%, respectively. [27]

An experiment carried out in 2013 by Public Health England, that country's health-protection agency, found that a commercially made surgical mask filtered 90% of virus particles from the air coughed out by participants, a vacuum cleaner bag filtered out 86%, a tea towel blocked 72% and a cotton t-shirt 51%—though fitting any DIY mask properly and ensuring a good seal around the mouth and nose is crucial. [28] [23] The use of common fabrics in making face masks has been tested. [29] [30] [31] [32] Filter efficiency can be improved with multiple layers, high weave density, and a mix of different types of fabrics. Cotton is the most commonly used material, and filter efficiencies can reach >80% for particles <300 nm with fabric combinations such as cotton-silk, cotton-chiffon, or cotton-flannel. [32] The most protective cloth masks need at least three layers with a hydrophilic inner layer (e.g. cotton) to absorb moisture from the wearer's breathing and hydrophobic outer layers (e.g. polyester). [14] Masks should be cleaned after each use. They can either be laundered or hand-washed in soapy hot water and dried with high heat. [33]

History

19180927 Gauze Mask to Halt Spread of Plague (Spanish flu) - The Washington Times.jpg
In 1918, the Red Cross recommended two-layer gauze masks. [34]
Tram operator refuses man without mask detail, from- 165-WW-269B-11-trolley-l (cropped).jpg
During the 1918 flu pandemic, a streetcar conductor in Seattle refuses a person who attempts to board without wearing a mask.

In Roman times, Pliny the Elder recommended that miners use animal bladders to protect against inhaling lead oxides. Some followers of Jainism, which originated in India around 500 B.C.E, wear cloth masks to avoid accidentally inhaling insects as part of practicing ahimsa. [35] [36] [37] In the 16th century, Leonardo da Vinci advised the use of a wet woven cloth to protect against toxic agents[ which? ] of chemical warfare. [38] In the early modern period, the plague-doctor costume included a beaked face-mask worn to protect the wearer from infectious "miasma".

Conventional cowboy attire in the American West often included a bandanna, which could protect the face from blown dust and also potentially doubled as a means of obscuring identity. [39]

In 1890 William Stewart Halsted pioneered the use of rubber gloves and surgical face masks, although some European surgeons such as Paul Berger and Jan Mikulicz-Radecki had worn cotton gloves and masks earlier. These masks became commonplace after World War I and the Spanish flu epidemic of 1918. [40] [41] Cloth face masks were promoted by Wu Lien-teh in the 1910–11 Manchurian pneumonic plague outbreak, although Western medics doubted their efficacy in preventing the spread of disease. [42]

Cloth masks were largely supplanted by modern surgical masks made of nonwoven fabric in the 1960s, [5] [7] although their use continued in developing countries. [2] They were used in Asia during the 2002–2004 SARS outbreak, and in West Africa during the 2013–2016 Ebola epidemic. [2] Compared with bacteria recovery from unmasked volunteers, a mask made of muslin and flannel reduced bacteria recovered on agar sedimentation plates by 99%, total airborne microorganisms by 99%, and bacteria recovered from aerosols (<4 μm) by 88% to 99%. [26] In 1975, 4 medical masks and 1 commercially produced reusable mask made of 4 layers of cotton muslin were compared. Filtration efficiency, assessed by bacterial counts, was 96% to 99% for the medical masks and 99% for the cloth mask; for aerosols (<3.3 μm), it was 72% to 89% and 89%, respectively. [27]

COVID-19 pandemic

Rhode Island National Guardsmen sew face masks during the COVID-19 pandemic, April 6, 2020. Rhode Island National Guard.jpg
Rhode Island National Guardsmen sew face masks during the COVID-19 pandemic, April 6, 2020.

During the COVID-19 pandemic, most countries recommended the use of cloth masks to reduce the spread of the virus. [43]

On June 5, 2020, WHO changed its advice on face masks, recommending that the general public should wear fabric masks where widespread COVID-19 transmission exists and physical distancing is not possible (for example, "on public transport, in shops or in other confined or crowded environments"). [44] [45]

See also

Related Research Articles

<span class="mw-page-title-main">Personal protective equipment</span> Equipment designed to help protect an individual from hazards

Personal protective equipment (PPE) is protective clothing, helmets, goggles, or other garments or equipment designed to protect the wearer's body from injury or infection. The hazards addressed by protective equipment include physical, electrical, heat, chemical, biohazards, and airborne particulate matter. Protective equipment may be worn for job-related occupational safety and health purposes, as well as for sports and other recreational activities. Protective clothing is applied to traditional categories of clothing, and protective gear applies to items such as pads, guards, shields, or masks, and others. PPE suits can be similar in appearance to a cleanroom suit.

<span class="mw-page-title-main">HEPA</span> Efficiency standard of air filters

HEPA filter, also known as high-efficiency particulate absorbing filter and high-efficiency particulate arrestance filter, is an efficiency standard of air filters.

<span class="mw-page-title-main">Surgical mask</span> Mouth and nose cover against bacterial aerosols

A surgical mask, also known by other names such as a medical face mask or procedure mask, is a personal protective equipment used by healthcare professionals that serves as a mechanical barrier that interferes with direct airflow in and out of respiratory orifices. This helps reduce airborne transmission of pathogens and other aerosolized contaminants between the wearer and nearby people via respiratory droplets ejected when sneezing, coughing, forceful expiration or unintentionally spitting when talking, etc. Surgical masks may be labeled as surgical, isolation, dental or medical procedure masks.

<span class="mw-page-title-main">Respirator</span> Device worn to protect the user from inhaling contaminants

A respirator is a device designed to protect the wearer from inhaling hazardous atmospheres including lead fumes, vapors, gases and particulate matter such as dusts and airborne pathogens such as viruses. There are two main categories of respirators: the air-purifying respirator, in which respirable air is obtained by filtering a contaminated atmosphere, and the air-supplied respirator, in which an alternate supply of breathable air is delivered. Within each category, different techniques are employed to reduce or eliminate noxious airborne contaminants.

<span class="mw-page-title-main">Dust mask</span> Pad held over the nose and mouth to protect against dust

A dust mask is a flexible paper pad held over the nose and mouth made for protection against chronically toxic nuisance dusts, like from occupational exposure to plant dusts like hay. They are not intended to provide protection from most airborne hazards. The European FFP1 mask, the lowest-grade standard available in the jurisdiction, is an example of a dust mask, being only certified to remove ~80% of dusts and mists.

<span class="mw-page-title-main">Airborne transmission</span> Disease transmission by airborne particles

Airborne transmission or aerosol transmission is transmission of an infectious disease through small particles suspended in the air. Infectious diseases capable of airborne transmission include many of considerable importance both in human and veterinary medicine. The relevant infectious agent may be viruses, bacteria, or fungi, and they may be spread through breathing, talking, coughing, sneezing, raising of dust, spraying of liquids, flushing toilets, or any activities which generate aerosol particles or droplets.

<span class="mw-page-title-main">Respiratory droplet</span> Type of particle formed by breathing

A respiratory droplet is a small aqueous droplet produced by exhalation, consisting of saliva or mucus and other matter derived from respiratory tract surfaces. Respiratory droplets are produced naturally as a result of breathing, speaking, sneezing, coughing, or vomiting, so they are always present in our breath, but speaking and coughing increase their number.

<span class="mw-page-title-main">NIOSH air filtration rating</span> U.S. rating of respirators

The NIOSH air filtration rating is the U.S. National Institute for Occupational Safety and Health (NIOSH)'s classification of filtering respirators. The ratings describe the ability of the device to protect the wearer from solid and liquid particulates in the air. The certification and approval process for respiratory protective devices is governed by Part 84 of Title 42 of the Code of Federal Regulations. Respiratory protective devices so classified include air-purifying respirators (APR) such as filtering facepiece respirators and chemical protective cartridges that have incorporated particulate filter elements.

<span class="mw-page-title-main">N95 respirator</span> Particulate respirator meeting the N95 standard

An N95 respirator is a disposable filtering facepiece respirator or reusable elastomeric respirator filter that meets the U.S. National Institute for Occupational Safety and Health (NIOSH) N95 standard of air filtration, filtering at least 95% of airborne particles that have a mass median aerodynamic diameter of 0.3 micrometers under 42 CFR 84, effective July 10, 1995. A surgical N95 is also rated against fluids, and is regulated by the US Food and Drug Administration under 21 CFR 878.4040, in addition to NIOSH 42 CFR 84. 42 CFR 84, the federal standard which the N95 is part of, was created to address shortcomings in the prior United States Bureau of Mines respirator testing standards, as well as tuberculosis outbreaks, caused by the HIV/AIDS epidemic in the United States. Since then, N95 respirator has continued to be solidified as a source control measure in various pandemics that have been experienced in the United States and Canada, including the 2009 swine flu and the COVID-19 pandemic.

<span class="mw-page-title-main">Workplace hazard controls for COVID-19</span> Prevention measures for COVID-19

Hazard controls for COVID-19 in workplaces are the application of occupational safety and health methodologies for hazard controls to the prevention of COVID-19. Multiple layers of controls are recommended, including measures such as remote work and flextime, personal protective equipment (PPE) and face coverings, social distancing, and enhanced cleaning programs. Recently, engineering controls have been emphasized, particularly stressing the importance of HVAC systems meeting a minimum of 5 air changes per hour with ventilation or MERV-13 filters, as well as the installation of UVGI systems in public areas.

An aerosol-generating procedure (AGP) is a medical or health-care procedure that a public health agency such as the World Health Organization or the United States Centers for Disease Control and Prevention (CDC) has designated as creating an increased risk of transmission of an aerosol borne contagious disease, such as COVID-19. The presumption is that the risk of transmission of the contagious disease from a patient having an AGP performed on them is higher than for a patient who is not having an AGP performed upon them. This then informs decisions on infection control, such as what personal protective equipment (PPE) is required by a healthcare worker performing the medical procedure, or what PPE healthcare workers are allowed to use.

<span class="mw-page-title-main">Mechanical filter (respirator)</span> Air-filtering face masks or mask attachments

Mechanical filters, a part of particulate respirators, are a class of filter for air-purifying respirators that mechanically stops particulates from reaching the wearer's nose and mouth. They come in multiple physical forms.

<span class="mw-page-title-main">Face masks during the COVID-19 pandemic</span> Health control procedure against COVID-19

During the COVID-19 pandemic, face masks or coverings, including N95, FFP2, surgical, and cloth masks, have been employed as public and personal health control measures against the spread of SARS-CoV-2, the virus that causes COVID-19.

In epidemiology, a non-pharmaceutical intervention (NPI) is any method used to reduce the spread of an epidemic disease without requiring pharmaceutical drug treatments. Examples of non-pharmaceutical interventions that reduce the spread of infectious diseases include wearing a face mask and staying away from sick people.

<span class="mw-page-title-main">Source control (respiratory disease)</span> Strategy for reducing disease transmission

Source control is a strategy for reducing disease transmission by blocking respiratory secretions produced through breathing, speaking, coughing, sneezing or singing. Multiple source control techniques can be used in hospitals, but for the general public wearing personal protective equipment during epidemics or pandemics, respirators provide the greatest source control, followed by surgical masks, with cloth face masks recommended for use by the public only when there are shortages of both respirators and surgical masks.

<span class="mw-page-title-main">Transmission of COVID-19</span> Mechanisms that spread coronavirus disease 2019

The transmission of COVID-19 is the passing of coronavirus disease 2019 from person to person. COVID-19 is mainly transmitted when people breathe in air contaminated by droplets/aerosols and small airborne particles containing the virus. Infected people exhale those particles as they breathe, talk, cough, sneeze, or sing. Transmission is more likely the closer people are. However, infection can occur over longer distances, particularly indoors.

<span class="mw-page-title-main">Elastomeric respirator</span> Respirator with a rubber face seal

Elastomeric respirators, also called reusable air-purifying respirators, seal to the face with elastomeric material, which may be a natural or synthetic rubber. They are generally reusable. Full-face versions of elastomeric respirators seal better and protect the eyes.

The European respirator standards refer to the filtering classification by EN 149, EN 14683, and EN 143, all European standards of testing and marking requirements for respirators. FFP standard masks cover the nose, mouth and chin and may have inhalation and/or exhalation valves.

Nicole M. Bouvier is an American physician who is Professor of Medicine at Icahn School of Medicine at Mount Sinai. Her research considers the environmental and viral factors that impact respiratory transmission of influenza viruses.

<span class="mw-page-title-main">Medical textiles</span> Textiles for medical and healthcare use

Medical textiles are numerous fiber-based materials intended for medical purposes. Medical textile is a sector of technical textiles that emphasizes fiber-based products used in health care applications such as prevention, care, and hygiene.

References

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  38. ↑ "The History of Respirator". Cambridge Mask Co. March 28, 2016. The idea of using respirators was pioneered by Pliny the Elder in the first century A.D. when he recommended the use of animal bladder to protect Roman miners from inhaling lead oxide dust. Early inventions did not stop with Pliny as in the 16th century, Leonardo da Vinci, advised the use of a wet woven cloth to protect against toxic agents of chemical warfare.
  39. ↑ Guttmacher, Peter (1995). Legendary Westerns. MetroBooks. p. 17. ISBN   9781567991727 . Retrieved August 21, 2020. Before Sam Peckinpah ever wore a bandana , before Paul Newman and Robert Redford ever got into western gear, these gentlemen train robbers [...]
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  43. ↑ "Which Countries Are Requiring Face Masks?". Council on Foreign Relations. Retrieved January 5, 2021.
  44. ↑ "Advice on the use of masks in the context of COVID-19: Interim guidance". World health Organization. June 5, 2020. p. 7. Retrieved August 21, 2020. Table 2: Examples of where the general public should be encouraged to use medical and non-medical masks in areas with known or suspected community transmission
  45. ↑ "Coronavirus: WHO advises to wear masks in public areas". BBC News. June 6, 2020. [...] WHO director-general Dr Tedros Adhanom Ghebreyesus said on Friday that 'in light of evolving evidence, the WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments'.
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