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How effective are cloth masks in preventing COVID-19?

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How effective are cloth masks in preventing COVID-19?

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The outbreak of the novel coronavirus has made wearing masks an integral part of everybody’s daily lives. Read further to learn about the effectiveness of masks.

Medically reviewed by

Dr. Jagdish Singh

Published At October 18, 2021
Reviewed AtJanuary 20, 2023

What Is the Role of Cloth Masks in the Pandemic?

Healthcare workers and people in the community use masks to protect themselves from several kinds of respiratory infections, especially COVID-19. Medical-grade masks, cloth masks, and respirators are available to protect against these infections. Both medical and community people use medical masks to prevent the spread of respiratory diseases from asymptomatic persons and sick people. On the other hand, respirators are primarily used by healthcare professionals and are designed to fit into the face and protect respiratory function.

Early in 2020, when the pandemic hit the world, there was a great demand for surgical masks or medical-grade masks and respirators. Therefore, the Centers for Disease Control and Prevention (CDC) of the United States recommended people manufacture cloth masks from readily available household items and start using them. This led the medical professionals, affected individuals, and those in close proximity to them to use surgical masks to a greater extent, who are the high-risk group for contracting the disease. Also, speculation about extending the use or employing the reuse of disposable masks, sterilizing the respirators, or resorting to using cloth masks took over.

What Is the History of Cloth Masks?

Even before the pandemic, hospitals employed masks made from various materials like gauze, cotton, and other fabrics in the twentieth century. The medical staff who used two to three layers of masks made from gauze showed fewer cases of respiratory infection. Cloth masks, in particular, were used for protection against scarlet fever (a contagious infection that mostly affects children) and diphtheria (a serious infection of the nose and throat). After the advent of surgical masks, the use of masks made from cotton or gauze rapidly declined; however, their use was still prevalent in the Asian population. After the outbreak of COVID-19 in China, the use of cloth masks by healthcare workers and the common people gradually increased.

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What Do Studies Say About the Use of Cloth Masks?

A randomized control trial performed by the Centers for Disease Control and Prevention (CDC) in 2015 depicted that the spread of infections was higher in people who used cloth masks. It was performed by comparing the efficacy of the cloth mask with surgical masks and a control group that followed the standard practice method. During this study, four weeks were taken into consideration, and five cloth masks were given, which were made locally and had two layers.

The participants were asked to wash the masks with soap and water. It was attributed that the poor protection offered by cloth masks might be due to infrequent washing or using moist and contaminated cloth masks. The CDC has conducted a series of studies to determine the efficacy of cloth masks. The results of all tests indicated that the efficacy of cloth masks was less as compared to that of surgical masks and respirators. The filtration effectiveness of cloth masks depends on several factors, which include the following:

  • Number of layers.

  • Thread count.

  • Type of fabric.

  • Water resistance.

A study was conducted to determine the ability of household cloth masks against viral and bacterial aerosols. It was found that although the efficacy was reduced in cloth masks as compared with surgical masks, the cloth masks made from household cloths, cotton, and towels had better protection than gauze masks. The use of nylon stockings in cloth masks variably increases filtration effectiveness. On the other hand, a wet and moist mask has decreased filtration effectiveness.

CDC gave out updated guidelines on cloth mask usage in January 2022, stating that loosely worn cloth masks do not provide enough protection against COVID-19 like the surgical masks and N95s do.

What Are the Factors to Be Considered While Wearing Cloth Masks During the COVID-19 Pandemic?

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is mainly transmitted by close contact with the infected person and respiratory aerosol inhalation. The World Health Organization (WHO) has advised using respirators in high-risk situations and during procedures that involve the production of aerosols. Respirators are highly recommended for frontline workers. In case of a shortage of respirators, medical professionals can use medical masks; however, the rate of infection increases in such cases. The decontamination and reuse of respirators are also considered in some countries. Due to the shortage of surgical masks or respirators, cloth masks are used by some medical professionals. In these circumstances, the use of multilayered, water-resistant masks with a more delicate weave and a high number of threads highly recommended to prevent the risk of infection spread. Also, the fit of the mask should be ensured so as not to allow the flow of air through the gaps.

In areas where the risk of infection transmission is high, the use of universal face masks should be advised. To prevent the demand for surgical masks, the general public can use cloth masks as an alternative. Also, the removal and decontamination procedures while using cloth masks play an important role in preventing the spread and increasing the efficacy of cloth masks. Improper removal of cloth masks may result in self-contamination and may increase the risk of infection spread. Cloth masks can be decontaminated by washing with soap and hot water, applying dry heat, ultraviolet radiation, bleach, hydrogen peroxide, isopropyl alcohol, autoclaving, or microwaving. It is advised to wash the mask once it becomes wet or dirty, or atleast after a day’s use.

What Are the Advantages of Cloth Masks?

  • Large quantities can be produced in a short time.

  • Reusable.

  • Degradation of cloth masks is unlikely.

  • Inexpensive.

  • Available in a wide variety of designs (masks have become a part of fashion).

What Are the Disadvantages of Cloth Masks?

  • The filtration effectiveness of cloth masks is reduced as compared to surgical masks and respirators.

  • Improper decontamination of used masks may result in self-contamination.

  • If used in a hospital setting, the extra work of decontaminating the cloth masks is present.

  • Due to the hydrophilic nature of natural fibers, aerosols can get absorbed into the cloth fibers. That is why it is advised not to touch the upper surface of the mask without washing or sanitization.

Are Double Masks Necessary?

According to research by the CDC, the use of double masks, including a surgical mask and a cloth mask (to limit the air leakage and provide contoured fit), or the use of tightly-fitting surgical masks, helps reduce the chance of infection to about 96.5 %.

Conclusion:

Adequate knowledge about the quality, method of usage, and decontamination of cloth masks to the public are necessary to prevent the spread of infection. Also, the public should be taught how to select cloth masks so that they do not have a false sense of protection. When cloth masks are used, it is always advisable to use double masks and properly remove and decontaminate them to avoid self-contamination.

Frequently Asked Questions

1.

Which Face Mask Can Be Reused?

Cotton face masks can be reused but only after proper washing, disinfecting, and drying. Surgical masks can be reused if it remains intact in shape and is dry. The surgical masks can be stored safely in zip-lock bags and reused for not more than three days. N95 masks can be reused after drying for three to four days or after sterilization of the respirator. N95 masks may be reused a maximum of five times.

2.

Which Is the Best Mask Against COVID?

N95 and KN95 masks provide the highest levels of protection as recommended by the Center for Disease Control and Prevention (CDC). The N95 respirators are capable of filtering out both larger and smaller particles. Ideally, National Institute for Occupational Safety and Health (NIOSH) approved respirators are the best for regular use.

3.

Which Facemasks Are a Safe Choice for the Older Population?

Masking for the older population brings them a lot of discomfort, respiratory restriction, and depression. It is advisable for them to use loosely woven cloth masks. This can be combined with surgical masks, if possible. The elderly are an at-risk population; hence they require protection.

4.

Which Mask Is Superior to N95?

N95 respirators are the most widely available masks that provide optimal protection when worn correctly. Another mask type, KN95, practically offers the same protection as N95. Other respirators available for use are N99, N100, P95, P99, P100, R95, R99, and R100. These masks provide equal or better protection than N95. Also, it is advised to purchase and use only NIOSH-approved masks.

5.

Is It Okay to Double Mask With Surgical Masks?

Double masking creates a better fit and improved filtration, but it is inadvisable to combine two masks of the same kind. For example, two surgical masks or even N95 with KN95. The real goal of double masking is to enhance filtration and eliminate gaps rather than adding layers of fabric. It is best to layer with a surgical mask over a cloth mask.

6.

Is It Okay to Double Mask With KN95 Masks?

The Centers for Disease Control and Prevention (CDC) stands against double masking with KN95 or N95, nor should these masks be combined with the same or other types of masks. The real benefit comes from double masking with a cloth and surgical mask, which provides a better fit, eliminates gaps, and improves filtration.

7.

What Is the Consequence of Using Face Masks for Too Long?

Healthcare and frontline workers (shopkeepers, cops, media professionals, etc.) need to wear masks for extended periods of time, which makes one sweat intensely. This, in turn, leads to skin inflammation, causing acne, colloquially known as ‘maskne’. Additionally, constantly reusing masking without ensuring proper cleaning and sanitization protocols can also cause similar problems.

8.

What Is the Benefit of Masking Every Day?

Weaning a mask every day or regularly not only prevents one from acquiring unwanted infections but also protects one from several components of air pollution. Wearing masks keeps one away from airborne pathogens and particulate matter. N95 or KN95 masks denote that they are capable of filtering out 95 percent of airborne particles.

9.

Is It Okay to Use Two Face Masks in a Day?

It is okay to use multiple masks in a day. If one intends to reuse any masks, they should be properly stored, cleaned, and disinfected. Double masking is also advised but only in case of cloth and surgical mask combination.

10.

Is It Possible to Use Disposable Masks More Than Once?

Disposable masks may be reused only if they are not soiled, damaged, or disfigured. Disposable masks should be stored in airtight ziplock bags and should be reused for not more than two to three days. N95 and KN95 masks also fall under the disposable category. They should be stored to dry for four days before reusing and should not be reused more than five times.

11.

What Is the Lifespan of a Face Mask?

The life of a face mask depends on its use. The user must keep a watch on the wear levels of the mask. Surgical masks should not be worn again if they are soiled or damaged, and N95 respirators should be discharged if they lose their shape and do not offer a tight fit.
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Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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