Why You Should Think Twice Before Using a Cloth Mask

Why You Should Think Twice Before Using a Cloth Mask

  • This page was last updated at September 20, 2020.

Cloth face masks are a recommended alternative when disposable masks and respirators are not available. However, the effectiveness of a cloth mask is concerning. The Centers for Disease Control and Prevention (CDC) is studying the spread and effects of the novel coronavirus across the United States. The agency advises:

“We now know from recent studies that a significant portion of individuals with coronavirus lack symptoms (“asymptomatic”) and that even those who eventually develop symptoms (“pre-symptomatic”) can transmit the virus to others before showing symptoms [6].”

Wearing face masks in public is especially important in settings like stores where social distancing is difficult to maintain [6]. Likewise in areas where virus transmission levels in the community are high. COVID-19 can be spread between people in close proximity to each other, even if they are not showing symptoms of infection. Pre-symptomatic and asymptomatic individuals will have no way of knowing if they are spreading COVID-19. We must all act as if we may be contagious.

Cloth Face Masks and DIY Face Masks

The CDC has asked that people opt for masks that are not in demand by healthcare workers [6]. It is very important that healthcare workers have N-95 respirators to keep themselves safe while working with highly infectious patients. The CDC has recommended the public wear cloth masks that can be purchased or made at home. Some interesting and innovative solutions have been sighted:

Comparison of Face Masks

Surprisingly, a study of homemade cloth mask effectiveness was done in 2013 with the influenza pandemic in mind [2]. Surgical masks are known to provide ample protection from the flu. Researchers found that surgical masks were three times more effective than homemade masks at blocking flu transmission.

That is, homemade face masks are less than half as effective at blocking flu virus than surgical masks [2]. However, this is only one study and ultimately researchers concluded:

“Our findings suggest that a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.”

Surgical Masks

Surgical masks are disposable 3-ply masks with ear loops or ties. Particles like droplets, splashes, and sprays that could contain chemicals, viruses, or bacteria are blocked by surgical masks. They cover both the nose and mouth but do not form a tight seal against the face.

  • A surgical mask blocks 0.04 to 1.3𝜇m sized particles [4].
  • That is eight to twelve times less than an N95 mask [4].
  • Both masks are equivalent to blocking low concentrations of the flu virus [4].

Face Filtering Respirators (FFRs)

Face filtering respirators like an N95 and a KN95 mask are designed to help purify the air. Respirators are accredited by NIOSH in the US and bear the EU’s “CE” mark in other countries. NIOSH requires 95% air purification by N95 masks, and 99.97% by P100 masks. The EU has a similar standard for their masks. FFP2 or KN95 masks must purify 94% of the air inhaled. FFP3 face masks must filter at a 99% efficiency.

The Cost of Getting COVID-19

Reporting on the cost of getting COVID-19 is bringing to light massive financial impacts. In the case of another severe respiratory illness, pneumonia, overall hospitalization costs in 2018 ranged from $10,000 to $20,000 [5]. Out of pocket costs for pneumonia, hospitalization can exceed $1,300.

Time has reported on the case of one COVID-19 patient’s treatment and costs [1]. She made four trips to the emergency room in her first week of infection. She was initially diagnosed with pneumonia until over a week later when she tested positive for COVID-19. For this uninsured patient, her final cost of getting COVID-19 was $34,927.43. Her hope is that she can get retroactive reimbursement through Medicaid.

Health Insurance

It is estimated that 27 million Americans are uninsured [3]. COVID-19 symptoms can vary widely in severity. In some cases, hospitalization may not be required. However, Business Insider projects that a six-day hospital stay could cost the uninsured 100% more than a Medicaid patient. They report the following cost for a six-day COVID-19 hospitalization, broken down by types of insurance.

  • $73,300 uninsured
  • $38,221 insured privately
  • $10,561 insured through Medicare
  • $7,533 insured through Medicaid
Photo courtesy of DIY mask maker Elizabeth Nichols

    DIY Cloth Face Mask FAQ

    To start with some basics, cloth face coverings should fit snugly but comfortably against the side of the face [7]. They should be secured with ties or ear loops. The cloth mask should be made of multiple layers of fabric that allow for breathing without restriction. Cloth face masks should withstand laundering without damage or changing shape.

    Other Cloth Mask Questions

    Can children wear face masks?

    Children over the age of 2 may wear cloth face masks [7]. However, regardless of age, face masks should not be worn by anyone who has trouble breathing, or is unconscious, incapacitated. Masks should only be worn if someone is able to remove the mask without assistance.

    Should I wash DIY cloth face masks?

    You should definitely wash your cloth face mask regularly, and any time you suspect it may have had contact with the virus [7]. Good mask hygiene may also help prevent acne and skin irritation to your face. Masks should be able to be machine washed and dried if they are made properly.

    How do you use a DIY cloth face mask?

    Wash your hands before putting on your mask [7]. Next, expand the mask over your nose and chin. Secure the mask, then pinch in the metal nose piece so it forms to the bridge of your nose. Don’t touch your eyes, nose, or mouth when your face mask is on or while removing it. Simply pull it away from your face by the straps. Finally, wash your hands after removing your mask and remember that the outer part of it may be contaminated.

    References

    1. Abrams, A. (2020, March 19). Total Cost of Her COVID-19 Treatment: $34,927.43. Retrieved from https://time.com/5806312/coronavirus-treatment-cost/
    2. Davies, A., Thompson, K. A., Giri, K., Kafatos, G., Walker, J., & Bennett, A. (2013). Testing the efficacy of homemade masks: would they protect in an influenza pandemic?. Disaster medicine and public health preparedness, 7(4), 413–418. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7108646/
    3. Hoffower, H. (2020, March 27). COVID-19 treatment could cost $73,000 for those without insurance - Business Insider. Retrieved April 17, 2020, from Business Insider website: https://www.businessinsider.com/coronavirus-covid-19-treatment-testing-costs-2020-3
    4. Lee, S. A., Hwang, D. C., Li, H. Y., Tsai, C. F., Chen, C. W., & Chen, J. K. (2016). Particle size-selective assessment of protection of European standard FFP respirators and surgical masks against particles-tested with human subjects. Journal of healthcare engineering, 2016. Retrieved from https://www.hindawi.com/journals/jhe/2016/8572493/
    5. Neighmond, P. (2020, March 29). What Is The Cost Of COVID-19 Treatment? Retrieved from https://www.npr.org/2020/03/29/823438983/what-is-the-cost-of-covid-19-treatment
    6. Recommendation Regarding the Use of Cloth Face Coverings. (2020, February 11). Centers for Disease Control and Prevention (CDC). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html
    7. Use Cloth Face Coverings to Help Slow Spread. (2020, February 11).Centers for Disease Control and Prevention (CDC). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html