Now that the Centers for Disease Control and Prevention has advised (opens in new tab) people to wear cloth face coverings in public, many are wondering about the effectiveness of handmade face masks. Do they actually work? If so, how? And how do they compare to a surgical mask? The latest study (opens in new tab) attempting to answer such questions comes from scientists at the University of Edinburgh, who tested seven types of face covering to determine how effectively each helps limit the spread of the novel coronavirus.
The face coverings tested were a surgical mask, a handmade mask, respirator, FFP1 and FFP2 masks, and face shields (both lightweight and heavy duty). The research showed that all of the face coverings, with the exception of the respirator, reduced the forward distance (front flow) travelled by an exhaled breath by over 90%. However, some of the masks, including the handmade mask and the surgical mask, ‘enabled strong jets of air to escape from the back and sides’. Heavy breathing and coughing, in particular, were shown to generate backward jets.
Explaining what this means for the general public, Dr Felicity Mehendale, Surgeon, Centre for Global Health, the University of Edinburgh’s Usher Institute, said: “It was reassuring to see the hand-made mask worked just as well as the surgical mask to stop the wearer’s breath flowing directly forwards. This suggests that some hand-made masks can help to prevent the wearer from infecting the public. But the strong backward jets mean you need to think twice before turning your head if you cough while wearing a mask; and be careful if you stand behind or beside someone wearing a mask.”
The team hopes its research will shape new guidance on the wearing of face masks to help tackle the virus, which can be spread in the droplets of water in a person’s breath.
The researchers used a special imaging technique, called Background Oriented Schileren imaging, to measure the distance and direction travelled by air when a person exhales or coughs while wearing a face covering. Measurements were taken from people wearing different coverings while standing or lying down, and from a manikin connected to a cough-simulating machine.
While the FFP2 mask (equivalent to an N95 mask) was the most effective in reducing all exhaled air dispersal, scientists found that only masks that form a tight seal with the face prevent the escape of virus-laden fluid particles. The team also noted that there are many different types of homemade face masks, of varying levels of quality, and that some will therefore be more effective than others.
Last month, a research team at Northeastern University (opens in new tab), led by Loretta Fernandez, Assistant Professor of Civil and Environmental Engineering, found that the most effective homemade face masks include a filter layer, so basically a layer within the cloth mask itself. That filter could be layered toilet paper, a coffee filter, or any material that’s safe to breathe.
"Even for masks that might not filter out everything, a tight fit against the face significantly lowers the chances of viral droplets making it to the airway," Fernandez said. "That’s why any sort of filtering people can use in their masks could be highly protective. The idea is to create an efficient series of layers with bends within the fabric that make it harder for the virus to have a straight shot at a person’s nose."
Attitudes towards wearing face masks
Last month, an Ispos poll (opens in new tab) suggested that 3 in 5 Americans were wearing a face mask or some type of face covering when leaving their homes. More, recently, however, there has been a growing backlash amongst some people over the wearing of face coverings. Despite US health experts continuing to encourage face mask use in public, protesters across the states have been photographed (opens in new tab) defying social distancing guidelines while not wearing face coverings.
Elsewhere, researchers from Middlesex University London and the Mathematical Science Research Institute in Berkeley conducted a study (opens in new tab) that showed, in situations where masks were both mandatory and non-mandatory, American men are more likely to not use a face mask when venturing outside. The study found that men are less likely to believe they’ll be seriously impacted by COVID-19. Some also questioned the effectiveness of face masks, which is a common coronavirus question (opens in new tab) regularly leveled at health experts.
Current guidance on homemade face masks
The important thing to note, and something that is mentioned in each study we have seen so far on the effectiveness of cloth face masks, is that people should not see these coverings as a substitute for social distancing and frequent hand washing. Instead, think of them as an add-on protective measure.
According to the CDC, a handmade face mask should include multiple layers of fabric – at least two layers of fabric, plus a filter – which echoes the results of the research conducted at Northeastern University. The denser the weave of material, the better, as explained by Dr Scott Segal, Chairman of Anesthesiology at Wake Forest Baptist Health, in an interview with the New York Times (opens in new tab).
In our homemade face masks 101 (opens in new tab) feature, we walk you through how to make your own face mask, and list the best materials to use and why. Remember: don’t buy medical grade or surgical masks – leave those for health care workers. If you don’t have any suitable face mask material at home, and you’re worried that shopping in a public place could expose you to the virus, consider buying materials online at sites such as Amazon (opens in new tab), Best Buy (opens in new tab), Target (opens in new tab) and others. If you’d prefer to buy ready-made cloth face masks, Purple mattresses has recently launched the Purple Face Mask (opens in new tab), which is made using materials from its bed pillow (opens in new tab) range, and sells for $20 for a twin-pack in either kids or adult sizes.
Best practice for wearing cloth face masks:
- Clean your hands with soap and water or with an alcohol-based hand sanitizer before touching the mask
- Touch the mask by its elasticated straps or fabric ties when putting it on
- Ensure the face mask fits snugly around the mouth and nose
- If your mask has metal wire running through the top, press it gently so that it fits more snuggly against the bridge of your nose
- When removing it, handle it by the straps or ties – never touch the front
- Wash the face mask after use, removing the filter before doing so
- Wash your hands for at least 20 seconds after removing your mask
- Never wear a face mask that's damp from mucus, spit or moisture from breathing
The CDC has also updated its list of coronavirus symptoms to include a new loss of taste or smell, a sore throat, muscle pain, fatigue, chills, shortness of breath, a new or persistent cough, and a fever – see our guide to the best digital thermometers (opens in new tab) for fever monitoring in adults and kids. Other less common symptoms include gastrointestinal symptoms like nausea, vomiting, or diarrhea. Some mild GI symptoms can also be caused by post-nasal drip arising from hayfever, which has led to confusion over coronavirus symptoms vs seasonal allergies (opens in new tab).
As the coronavirus pandemic continues, one concern many Americans have is how much they’ll need to pay for treatment of COVID-19. Early cost predictions (opens in new tab) by the Peterson Centre on Healthcare and the Kaiser Family Foundation suggest that people with coverage from their employer could expect to pay at least $1,300 in out-of-pocket costs for medical care, if hospitalized with a severe case of COVID-19.
A recent think tank study (opens in new tab) by the Robert Wood Johnson Foundation (RWJF) and the Urban Institute, which looked at how the COVID-19 recession could affect health coverage, estimates that up to 43 million Americans could lose insurance (opens in new tab). If you are currently without coverage, take a look at our guide to the best health insurance companies (opens in new tab) that might be able to help.