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6 Essentials for an Effective Face Mask

face mask sewing
Arefa Cassoobhoy, MD, MPH - Blogs
By Arefa Cassoobhoy, MD, MPHBoard-certified internistMay 07, 2020

Editor's note: This content was updated on June 9, 2020, to include new information.

At some point, all of us will have to leave our homes and venture into public places. For now, it may be the grocery store or the doctor’s office, but later as social distancing measures slowly ease, we may actually be able to get a haircut or return to the office for work. The new normal will be different – seating will be spaced far apart, there will be plenty of clear barriers to protect workers, and you will likely be wearing a face mask.

In many places, you are already required to wear a cloth face covering, and it makes good sense. According to Dr. Anthony Fauci between 25% to 50% of people can be infectious and spread the virus without symptoms. It is easily transmitted by respiratory droplets simply by speaking or laughing, along with coughing or sneezing.

Of course, a cloth face mask is not foolproof protection from COVID-19, but it is much better than no mask. It is another important layer to physical distancing when used in combination with 6 foot spacing from others and hand hygiene. Unfortunately, there aren’t enough N95 or other medical masks in the U.S. for everyone. We need to save those masks for people on the frontline caring for those sick with COVID-19.

Not surprisingly, the cloth face mask market is increasing exponentially to meet demand, and the science behind what makes a good cloth face mask is inching along slowly. It is difficult to know what qualities to prioritize when searching for a face mask.

Here is what we know about what makes a good cloth face mask:

Sew or no-sew: Either sew or no-sew options are fine when used correctly. Do what’s reasonable for you. If you’re in a rush, go with a no-sew option. If you’re crafty, make your own mask at home. Or, order your masks locally or online. Choose mask designs recommended by reliable sources like the CDC. Another option is to check your local hospital’s website. Many are posting patterns with precise instructions to make masks they’ll accept as donations.

Not all face masks are ok to wear. Certain N95 masks used in the construction industry include a valve that stays closed when breathing in to protect the wearer from harmful fumes or particles, but opens when exhaling to make breathing easier and more comfortable. These specific types of masks are being prohibited for COVID protection in some cities because, while they may protect you, they don’t protect anyone around you. In areas without a restriction, you could wear a cloth mask over the N95 mask with a valve to protect others and yourself.

Fabric: The WHO updated guidelines recently for non-medical masks. Cloth masks made of cotton bandana material should have at least 4 layers. All the cloth masks should use at least 3 layers of a tightly woven, washable fabrics. Ideally the inner layer against the wearer’s mouth and nose is of cotton or a cotton blend that can absorb moisture. The outer layer should be of polypropylene or polyester blends that can block contamination from the environment penetrating the mask and reaching the wearer’s nose or mouth. The middle layer can be either cotton or polypropylene to improve filtration or hold droplets. Avoid stretchy fabrics that might not filter as well and not be durable when washed in hot water.

Filter: Some masks will have a space to slip in a filter for an added layer of protection. The CDC recommends adding coffee filters to homemade masks. Online I’ve seen many filter options pop-up as people experiment with products in their home. These include cutouts from reusable fabric grocery bags made of polypropylene non-woven fibers, nylon fabric from pantyhose, paper towels, kitchen towels, bra pads, denim, and canvas to name a few.

Also, filters for PM2.5 masks, which protect the user from very small particles like smoke and dust (but not the virus), are being repurposed to slip into cloth masks. These filters, like the cloth masks won’t guarantee protection from the COVID-19 virus, but it could improve the level of protection you get from a cloth mask. Some sellers are not credible, so double check before you order.

We do not have much science to go on, so common sense is critical here. Is the filter worth adding when you consider safety and usability? The filter needs to be dense enough to block tiny, moist particles while also being breathable and comfortable.

And, an important question to ask: Are you inadvertently breathing something toxic? For example, some HEPA (high-efficiency particulate air) filters can have fiberglass, which would be very dangerous to inhale. Definitely do your own research to keep up with new information.

Fit: You need to be able to breathe comfortably with the mask on so that you do not have to slip it off while you’re in public to take a breath. The face mask must have a snug fit from nose to under the chin and back towards the ears. It’s useless if there are gaps that allow the air in. There are face masks available that come in different sizes.  Also, you don’t want to have to fiddle with the mask, for example if it’s stiff, and potentially contaminate your fingers touching the outside layer of the mask. If you feel like you can’t breathe comfortably with your mask, don’t use it, and talk to your doctor about other face covering options.

Ease of use: Once you find a face mask you like, it’s only as good as how you use it. Make sure you can easily untie or remove the loops from your face and pull the mask away from your face without being contaminated by touching the front of the mask. Infinity scarves are not a good option for masks because they’re difficult to cleanly take on and off.

Plan your outings knowing you should not slip the mask on and off to eat or talk on the phone. If you’re exercising outdoors, you may not be able to tolerate a mask when you breathe hard. In that case, choose your exercise location carefully to make sure you can keep a physical distance from others and be safe.

Durability: You will need to wash the cloth mask in hot water after each use, so look for reviews online that comment on the masks wear and tear. If the mask loses shape, you will not be able to use it. If you are adding a filter, cleaning it will depend on what kind of filter you use. A coffee filter should be thrown away after each use. Also, the fabric should be pre-washed so that you don’t need to worry about shrinkage.

When you wear a cloth face mask, it shows you care about your own health and the health of others. It signals to others to be respectful of physical distancing measures and keep a 6-foot distance from you. A cloth face covering is also a subtle reminder that the professional masks are for those on the front line. With all the cool colors and patterns out now, you can even make it a style statement.

 

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About the Author
Arefa Cassoobhoy, MD, MPH

Arefa Cassoobhoy, MD, MPH is a board-certified internal medicine doctor and a WebMD Medical Editor. She is on the team that makes sure all WebMD content is medically correct, current and understandable. She sees patients at the Women’s Wellness Clinic at the Atlanta Veterans Affairs Medical Center.

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