In late March 2020, do-it-yourself and no-sew coronavirus masks were a hot topic — but not before the subject of COVID-19 and face masks became confusing and contentious.
Before COVID-19 was officially declared a pandemic on March 11 2020, officials officially told the general public not to wear or use face masks. A March 2 2020 article (“U.S. health officials say Americans shouldn’t wear face masks to prevent coronavirus — here are 3 other reasons not to wear them”) was one of many stories urging people to eschew face masks as part of avoiding the virus.
As of early March 2020, the Centers for Disease Control and the World Health Organization both advised against the use of masks — except when an individual is exhibiting symptoms or taking care of someone else that they suspect are infected:
Though health officials have warned Americans to prepare for the spread of the novel coronavirus in the U.S., people shouldn’t wear face masks to prevent the spread of the infectious illness, according to the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services and the U.S. surgeon general.
Just a few days before, Surgeon General Jerome Adams told Americans to “Seriously … STOP BUYING MASKS” on Twitter, claiming they are “NOT effective” in preventing the transmission of COVID-19 among members of the general public. Adams instead advised Americans to rely on hand-washing and staying home when sick:
The best way to protect yourself and your community is with everyday preventive actions, like staying home when you are sick and washing hands with soap and water, to help slow the spread of respiratory illness.
Get your #FluShot– fewer flu patients = more resources for#COVID19
— Office of the U.S. Surgeon General (@Surgeon_General) February 29, 2020
Because of a worldwide shortage of supplies, there were still concurrent efforts to enlist people with sewing ability to make as many masks as possible for medical professionals. At the same time, the CDC relaxed its guidelines for personal protective equipment (PPE), and masks in particular.
At a time of increased stock put in official recommendations, the CDC and Adams’ message stuck. A March 17 2020 New York Times editorial appeared just two weeks after the early March 2020 article warning Americans away from masks, speculating that the message taken away from earlier guidance on face masks did little to improve either managing supplies or the mitigating transmission. That, in turn, discouraged their use where available and reduced faith in their efficacy:
Unfortunately, the top-down conversation around masks has become a case study in how not to communicate with the public, especially now that the traditional gatekeepers like media and health authorities have much less control. The message became counterproductive and may have encouraged even more hoarding because it seemed as though authorities were shaping the message around managing the scarcity rather than confronting the reality of the situation.
First, many health experts, including the surgeon general of the United States, told the public simultaneously that masks weren’t necessary for protecting the general public and that health care workers needed the dwindling supply. This contradiction confuses an ordinary listener. How do these masks magically protect the wearers only and only if they work in a particular field?
The Times editorial raised a number of counter-reasons masks should be worn in public during the COVID-19 pandemic, among them their known efficacy in reducing pathogen transmission; the existence of asymptomatic carriers; anecdotally lower rates in areas where masks were commonplace; and their ability to visually reinforce the risk of contracting SARS-CoV-2 in public places.
Conversely, some WHO officials reiterated the “don’t wear masks” guidance as of March 31 2020. However, that advice seemed to hinge in part on supply-level concerns:
“There is no specific evidence to suggest that the wearing of masks by the mass population has any potential benefit. In fact, there’s some evidence to suggest the opposite in the misuse of wearing a mask properly or fitting it properly,” Dr. Mike Ryan, executive director of the WHO health emergencies program, said at a media briefing in Geneva, Switzerland, on [March 30 2020].
“There also is the issue that we have a massive global shortage,” Ryan said about masks and other medical supplies. “Right now the people most at risk from this virus are frontline health workers who are exposed to the virus every second of every day. The thought of them not having masks is horrific.”
Dr. Maria Van Kerkhove, an infectious disease epidemiologist with the WHO, also said at [March 30 2020’s] briefing that it is important “we prioritize the use of masks for those who need it most,” which would be frontline health care workers.
“In the community, we do not recommend the use of wearing masks unless you yourself are sick and as a measure to prevent onward spread from you if you are ill,” Van Kerkhove said.
Van Kerkhove repeated the emphasis on reserving masks for health care workers:
“We need to be clear,” Van Kerkhove said last week. “The world is facing a significant shortage of PPE for our frontline workers — including masks and gloves and gowns and face shields — and protecting our health care workers must be the top priority for use of this PPE.”
Nevertheless, masks clearly do work to some degree to reduce the transmission of aerosolized pathogens. A May 2013 study in the Journal of Hospital Infection was unable to say precisely to which degree face masks helped, but concluded “they are to some extent protective.” That research noted a number of variables, both in the structure of masks available in and outside clinical settings as well as inconsistency in their usage:
Most surgical masks are not certified for use as respiratory protective devices (RPDs). In the event of an influenza pandemic, logistical and practical implications such as storage and fit testing will restrict the use of RPDs to certain high-risk procedures that are likely to generate large amounts of infectious bioaerosols. Studies have shown that in such circumstances increased numbers of surgical masks are worn, but the protection afforded to the wearer by a surgical mask against infectious aerosols is not well understood.
Another important point of distinction was between homemade masks and surgical-grade masks or N95 respirators. It is absolutely true that medical-grade equipment is most appropriate front-line workers in clinical settings, and it is further true that alternative PPE or DIY homemade or no-sew masks do not offer the same protection:
These cotton masks and mask covers, made mostly of cotton and elastic, aren’t a substitute for N95 respirators — tightly fitted devices that filter out 95 percent of airborne particles — nor are they as effective as surgical masks, which are disposable items used by doctors to prevent infection or protect against splashes. Yet for some workers, a handmade cotton mask is indeed the best they can do. As one doctor at NYU Langone Health told the New York Times, homemade masks free up the surgical masks for the highest-risk people.
The precise effectiveness of a homemade cotton mask is thus far mostly unknown. One study from 2013 showed that both homemade masks and surgical masks “significantly reduced” the number of microorganisms expelled by participants, although the surgical mask was three times more effective in protecting the wearers themselves. Study authors concluded that homemade masks should “only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.” Yet the study involved just 21 participants, and one Australian study of health care workers cautioned that cloth masks could actually increase the wearer’s risk of infection due to moisture retention and poor filtration.
In short, homemade or DIY no-sew face masks were better than nothing during the coronavirus pandemic. Luckily, the shifting guidance and what seemed to be broad-scale public awareness of the need to reserve medical-grade PPE for doctors and nurses led to increased interest in homemade face masks to reduce COVID-19 transmission.
Huffington Post compiled a list of several tutorials; for those who did not know how or wish to sew, a number of the tutorials involved no-sew masks:
A study of homemade face masks by SmartAirFilters.com found that cotton T-shirts and cotton pillowcases are the best at-home materials for making DIY face masks, based on their ability to capture particles yet remain breathable, and that they perform comparably to surgical-grade masks.
In a New York Times editorial titled “It’s Time to Make Your Own Face Mask (Here’s how to do it),” Farhad Manjoo wrote:
But [earlier guidance about reserving masks for doctors and nurses] doesn’t mean face masks for the public are a bad idea, if we had enough masks. Contrary to what American officials told us, many studies show that widespread mask-wearing might be a very effective complement to hand-washing, social-distancing and other measures to mitigate the pandemic. Health officials in China, Hong Kong, Singapore and Japan suggest that people wear masks in certain situations — if they’re symptomatic, for instance, or if they’re in crowded, not-very-well-ventilated places, like airplanes. Studies have also shown that mask-wearing (in conjunction with hand-washing) reduces the spread of infection within households or other shared living spaces, like residence halls.
Who knew the future would look so apocalyptically homespun — so “Mad Max” meets “Little House on the Prairie”? Yet this is no useless online fad; homemade masks for all could make a huge difference. At least two peer-reviewed studies show that while DIY masks are not nearly as effective as commercial masks made for health care workers, they are far better than nothing. Homemade masks both limit the spread of infectious droplets in the air and discourage people from touching their faces.
Manjoo noted that homemade COVID-19 masks at their easiest involved simply cutting up one t-shirt, and tying it to cover your mouth and nose. Manjoo added that “the research suggests that as long as the mask covers your nose and mouth and is comfortable to wear, the specific pattern you choose may not matter very much.”
Although it is true public health initially discouraged general COVID-19 pandemic face mask usage, those warnings appeared to be predicated largely on averting shortages, which continued to be an issue as of late March 2020. That said, coronavirus masks do afford protection, and a number do-it-yourself face mask tutorials were available. At the very least, a secured piece of fabric covering your nose and mouth offers slightly better coronavirus protection than no mask at all.