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April 6, 2020
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April 7, 2020

Belize: “Masking” the Pandemic

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Posted: Monday, April 6, 2020. 9:38 pm CST.

The views expressed in this article are those of the writer and not necessarily those of Breaking Belize News.

By Abner A. Recinos: In light of this pandemic, the Center for Disease Control and Prevention (CDC) recommends self-isolation for 14 days after travel, monitoring of symptoms, avoiding contact with people with high risk of disease, practicing social distancing, and following guidelines of local health officials if symptoms are suspected [1][2] . In the case of Belize, measures include quarantine for travelers, self-isolation, mandatory curfew, social/physical distancing, closure of deemed non-essential services including, places of worship, educational institutions, workplaces, and event sites.

An additional measure issued by the CDC as of April 4, 2020, is the usage of cloth face covers for protection and minimizing the spread of COVID-19. [3] However, the topic of face covers or masks is in my opinion, not very well understood by most of the population; and in the recent months, weeks and days, social media and other platforms, textiles outlets, sewing amateurs, hobbyists and professionals, and even educations institutions began recommending face masks made from everyday textiles and materials.

In the case of CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), recommendations are now as follows: “the mask must fit comfortably against the face, be secured with ties or ear loops, include multiple layers of fabric, allow for breathing without restriction, and be able to be laundered and machine dried without damage or change to shape. [3] This recommendation for wearing cloth masks are for public settings where social distancing or other measures are difficult to maintain.” [3]

The operative statement is the use of “multiple layers of fabric”, that at the same time will not create breathing difficulties. Multiple video tutorials and DIY instructionals fail to understand the science behind facemasks, and delinquently push for views and likes rather than analyzing the implications of their recommendations.

Science and research is important in these times, and I tasked myself with conducting a mini-analysis of some research on the efficacy of homemade facemasks.

In the first research by Davies et al. (2013), [4] homemade masks as an alternative to commercial or surgical facemasks were evaluated based on their capacity to block bacterial and viral aerosols. The materials used in this study included 100% cotton T-shirt fabric, scarf, pillowcase, antimicrobial pillowcase, vacuum cleaner bag, cotton mix, linen, silk and surgical mask. The study concluded that there was a “significant reduct[ion] in number of microorganisms expelled with both masks, but surgical masks were three (3) times more effective at blocking transmission than homemade masks. The study suggested that “homemade mask should only be considered as
a last resort to prevent droplet transmission from infected individuals” [4]

McIntyre et at. (2015) conducted a randomized trial of cloth masks compared to medical masks in Vietnam, and concluded that there was a significantly higher risk of infection with cloth masks resulting from moisture retention, reuse of cloth masks, and poor filtration. The researchers reported an almost 97% penetration of particles versus 44% penetration with medical masks. [5]

The analytical paper by Chughtai et al. (2013) cites historical research, including that of Weaver in 1918 (during the Spanish influenza), Greene and Vesley (1961) and Quesnel (1975). The general findings of research (as qtd. in Chughtai et al., 2013) indicated that masks fashioned from four-layer cotton, two layers of woven cambric with a piece of paper in between, and a paper mask surrounded by cellulose wadding, were indeed useful in the reduction of disease transmission. [6]

Additionally, Chungtai at el. (2013) also cites more recent studies that found that certain types of cloth provide better protection than other; e.g. fine muslin (loosely-woven cotton fabric) was better than the gauze, gauze padded with cotton were better than simple gauze or paper masks and towels were more effective than other fabrics. [6] The conclusion drawn was that the number of layers in cloth masks increased the filtration capacity. This effectiveness was tested by Van der Sande et al. (2008) and found that homemade masks provided a level of protection, but outward protection was less effective than inward protection. [7]

A limitation in most of the above studies was in the type and size of pathogen used to measure the filtration capacity of cloth masks. None of the studies utilized the COVID-19 (SARS-CoV-2) as the pathogen during experimental trials. It is necessary to understand that the size of the particles/pathogen affects the filtration capacity of different types of materials and in the case of the COVID-19 pathogen, the size is in the vicinity of proximately 60–140 nm. [8] Rengasamy and colleagues (2010) tested cloth masks made of different materials (sweat shirt, t-shirt, towel and scarf) for efficacy in filtering particles in the size range of 20-1000 nm and found that the penetration was between 74 and 90%. [9] With the COVID-19 pathogen falling within particle parameters (60-140nm) of the above study, homemade masks leaves the wearer with about 10-25% exposure level based on the above data.

Understanding that this has been a limitation in most of the studies, Larsen (2020) analyzed existing data similar to Rengasamy et al. (2010) and understood that while the usage of the specific pathogen COVID-19 was a limitation, inference can be made based on the size particles used in research that cloth masks were to a certain extent, useful in preventing transmission by providing both inward and outward protection from COVID-19 pathogen, provided that recommendations on specific fabric type and construction of masks are followed. [10]

In the recent days, major news outlets such as CBS and NBC published articles which made reference to an unpublished research study by Scott Segal, M.D. (Anesthesiology) at Wake Forest Baptist Health, which found that certain fabric performed better than others; achieving up to 79% filtration. “The best-performing designs were made of two layers of high-quality, heavyweight “quilter’s cotton” with a thread count of 180 or more, and those with an especially tight weave and thicker thread such as batiks. A double-layer mask with a simple cotton outer layer and an inner layer of flannel also performed well. [11] [12] Segal’s study is yet to be peer-reviewed and published.

While the CDC recently changed its stance on recommendations for face mask use, at the time of this article, the World Health Organization (WHO) does not explicitly recommend the use of mask by the population and limits mask use for persons caring for a suspected COVID-19 case, and if you are coughing or sneezing. [13] There was also no recommendations available for the construction and use of homemade masks.

From this short literature review, the general consensus by the researchers is that there is limited research and empirical evidence into the effectiveness of homemade cloth masks. However, from the existing empirical data, it is possible to make an educated guess to support the use of cloth masks by the general population in instances where social distancing is not possible. Amidst this new pandemic, McIntyre and colleagues [5] wrote a follow-up response to this study as recent as March 30, 2020, in which homemade masks were not recommended for the healthcare setting, but noted that they may be of some use in the general public. The caveat is that one must follow certain guidelines in the construction of masks, and it must be used in conjunction with other measures as are self-isolation, constant hand washing/sanitizing, and social distancing.

As a final thought (on which some researchers agree), wearing of masks may in some ways, produce a false sense of security, and may in fact, increase the spread of the COVID pandemic as it would decrease handwashing, isolation and social distancing practices. Measures put in place by the Government of Belize are for a reason, and masking yourself as a means to circumvent such measures defeats its purpose, resulting in health and human fatalities. The best recommendation is to stay at home, and only use a mask if absolutely necessary and in situations were other measures are not possible. The best bet is to stay home. Stay safe.

References
[1] Center for Disease Control. (2020, April 1). Public Health Recommendations after Travel-Associated COVID-19 Exposure. Centers for Disease Control and Prevention.

https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html

[2] ——————————-. (2020, April 1). Public Health Recommendations for Community-Related Exposure. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/php/public-health-recommendations.html

[3] National Center for Immunization and Respiratory Diseases (NCIRD). (2020, April 4). Coronavirus disease 2019 (COVID-19). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

[4] Davies, A., Thompson, K., 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. https://doi.org/10.1017/dmp.2013.43

[5] MacIntyre, C. R., Seale, H., Dung, T. C., Hien, N. T., Nga, P. T., Chughtai, A. A., Rahman, B., Dwyer, D. E., & Wang, Q. (2015). A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open, 5(4), e006577-e006577. https://doi.org/10.1136/bmjopen-2014-006577

[6] Chughtai, A. A., Seale, H., & MacIntyre, C. R. (2013). Use of cloth masks in the practice of infection control – evidence and policy gaps. International Journal of Infection Control, 9(3). https://doi.org/10.3396/ijic.v9i3.020.13

[7] Van der Sande, M., Teunis, P., & Sabel, R. (2008). Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS ONE, 3(7), e2618. https://doi.org/10.1371/journal.pone.0002618

[8] Cascella, M., Rajnik, M., Cuomo, A., Dulebohn, S. C., & Di Napoli, R. (2020). Features, Evaluation and Treatment Coronavirus (COVID-19). StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK554776/

[9] Rengasamy, S., Eimer, B., & Schaffer, R. (2010). Simple respiratory protection—Evaluation of the filtration performance of cloth masks and common fabric materials against 20–1000 nm size particles. The Annals of Occupational Hygiene, 54(7), 789-798. https://doi.org/10.1093/annhyg/meq044

[10] Larsen, D. (2020). Homemade cloth face masks to fight the COVID19 pandemic; a call for mass public masking with homemade cloth masks. https://doi.org/10.31235/osf.io/grbzj [11] NBC News. (2020, April 3). Sewing your own face mask? Some fabrics work better than others, finds new research.  https://www.nbcnews.com/health/health-news/making-your-own- face-mask-some-fabrics-work-better-others-n1175966

[12] CBS. (2020, April 4). Testing reveals the type of cloth used in homemade masks makes a difference. WFMY. https://www.wfmynews2.com/article/news/health/typeof-cloth-used-in-homemade-masks-makes-a-difference/83-65853bec-8286-4bb1-90ec-5ce1af8de232

[13] World Health Organization. (2020). When and how to use masks. WHO | World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-
public/when-and-how-to-use-masks

 

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