Covid-19: getting the right mask
The latest medical advice is that you should wear a mask while stepping out. We tell you how to make, sanitize and dispose of them
When news of the novel coronavirus outbreak first started spreading, people around the world scampered to get their hands on two essential items: hand sanitizers and face masks. This was in the early stages of an outbreak that has become a pandemic, affecting more than a million people worldwide and resulting in approximately 70,000 deaths. India had more than 4,000 cases of infection at the time of writing.
Shortages of hand sanitizers and masks were reported from almost everywhere. Initially, medical advisories suggested that only people with symptoms, or those who were sick, should wear masks to stem the spread of infection. N95 masks and respirators, critical to the healthcare system and doctors, were advised only for medical professionals.
That has now changed. On 2 April, the office of the principal scientific adviser to the Union government issued a 15-page advisory on the use of home-made masks for people living in densely populated areas. This included ways to make these masks—or “face covers"—at home. In the last week of March, the US Centers for Disease Control and Prevention (CDC) had also updated its mask recommendation. “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. This means that the virus can spread between people interacting in close proximity—for example, speaking, coughing, or sneezing—even if those people are not exhibiting symptoms. In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission," the notification said. Jerome Adams, the US surgeon general, even recorded a video showing how to make a simple mask from cotton cloth and rubber bands.
Experts are now united in their view that even a home-made mask is better than none—both for the wearer and for those around. “The earlier guidelines were quite simple. Masks were only meant for people who were visiting healthcare facilities or had any probability of coming in contact with any suspected covid-19 patients," says Damanjit Singh Chadha, head of department, internal medicine, Fortis Hospital Vasant Kunj, Delhi. “But as the recent advisory from the government shows, it is advisable even for the common man to use face masks," he adds.
While home-made masks might not be as effective as an N95 mask—these respiratory protective devices filter particulate matter and can block at least 95% of very fine (0.3 micron) airborne particles—they can be useful in blocking possible transmission in public settings where social distancing norms may be difficult to follow.
A much-quoted recent study of handmade masks by a team of doctors from the Wake Forest Baptist Health Hospital in North Carolina found that some fabrics are better than others at filtering germs: Regular surgical masks filtered out up to 65% of particles while very thin cotton material worked only at 1%. On the other hand, masks made of two layers of heavy, tightly woven cotton material (with a thread count of at least 180) were quite effective.
One way to check whether the material is good enough is to hold it up against a light source: If it’s more or less opaque, you can use it. Durable cotton bedsheets with a thread count of over 180 are probably the best bet and are likely to be handy as well, though remember to use at least two layers to make the mask. The best material, the study found, was thick cotton material known as “quilter’s cotton"—and although you are unlikely to have this at home, you can use the thickest cotton material you can find. It shouldn’t be restrictive, though any mask takes a little while to get accustomed to.
“Home-made masks can be made with any cloth that has good fabric. You can even use T-shirts, handkerchiefs. But these should be washable," says Dr Chadha. “If you are using or reusing a home-made mask, you have to ensure that they are dipped in boiling water for 5-10 minutes.
“These home-made masks can also be useful in protecting people from any asymptomatic carriers in their vicinity," he adds.
In its advisories, the World Health Organization (WHO) clearly states that if you wear a mask, then you “must know how to use it and dispose of it properly". Disposable surgical masks are good for one-time use. While home-made cloth masks can be sterilized and reused, they will be effective against pathogens only when they are worn properly (to cover the nose and mouth tightly) and taken off in the prescribed way: WHO says you should not touch the front of the mask but take it off using the ear bands or ties at the back of the head.
Masks that aren’t discarded in hygienic or environment-friendly ways can lead to a bigger problem. “There are two things that I can immediately say...one is of course (these items) going into the waste streams, which will get contaminated too. But the more important thing is about the ragpickers, people who are going to be handling the waste. They are virtually exposed to all of this (possible infection). That’s a bigger problem," says Manvel Alur, founder of the Bengaluru-based non-profit EnSYDE India, which has been working with companies and institutions to reduce their environmental footprint.
While most hospitals have a waste management system in place—medical waste facilities collect these items and then incinerate them—there is no such option for the general public. A lot of these masks are made from polypropylene material, which is worse than plastic. “It is extremely important that these are collected in enclosed bags and those bags are taken for sanitary waste disposal. In most cases, it should go for controlled incineration and not open burning," says Alur.
Dr Chadha agrees there is a chance of infection if anyone comes in contact with a used mask. It is important to remember two things, he says. First, surgical masks should not be reused. Second, when you are disposing of these masks, they should be put in sealed envelopes before being dumped into the garbage. “I am in touch with a biomedical waste management company to ensure that these masks are disposed of properly. But this might not be possible for everyone. So it’s advisable that when you are handing over your garbage to a waste collector, you hand out the masks, or other medical waste, separately, sealed properly in a plastic bag or envelope. This will at least ensure that they are not mixed with other waste materials when being processed further," says Dr Chadha. In several areas, waste is segregated on the basis of “wet", “dry" and “medical/sanitary".
Simple DIY masks
In a short 3-minute video, Anuj Sharma, the Ahmedabad-based designer behind the unstitched garment construction technique Button Masala, shows a simple technique of making your own mask. You need a few pieces of cloth (in this case, cotton), six buttons and around 10 rubber bands. If you don’t have buttons, you can even use coins to give the mask its facial shape and hold it in place, Sharma explains in the video.
You can even try making a face cover with just two rubber bands and cotton material, as shown in the recent video released by the US CDC featuring the US surgeon general.
Wear it right
According to WHO guidelines, you should clean your hands with alcohol-based hand rub or soap and water before putting on a mask. Your mouth and nose should be covered fully and there should be no gaps between your face and the mask. Avoid touching the mask while you are using it, and if you do, wash your hands properly.
It is important to replace the mask with a new one as soon as it is damp. Single-use masks should not be reused. When you are removing a mask, remove it from behind (do not touch the front of the mask). If it is a disposable mask, discard it immediately in a closed bin (after putting it in a sealed packet if possible) and wash your hands thoroughly with an alcohol-based hand rub or soap and water.
With inputs from Shrabonti Bagchi.