Abstract
Despite numerous masking recommendations from public health agencies, including the World Health Organization, editorials, and commentaries providing support for this notion, none had examined different homemade masks or demonstrated that perhaps not all cloth masks are the same. This article aims to provide evidence-based recommendations on cloth-mask materials, its design, and, importantly, its maintenance. Articles were obtained from PubMed and preprint servers up to June 10, 2020. Current evidence suggests that filtration effectiveness can range from 3% to 95%. Multiple layer (hybrid) homemade masks made from a combination of high density 100% cotton and materials with electrostatic charge would be more effective than one made from a single material. Mask fit greatly affects filtration efficiency, and adding an overhead knot or nylon overlay potentially provides the best fit for cloth masks. There is a paucity of evidence for masks maintenance as most studies are in the laboratory setting; however, switching every 4 hours as in medical masks and stored in dedicated containers while awaiting disinfection is recommended. Outside of these recommendations to improve the effectiveness of cloth masks to reduce infection transmission, there is a need for countries to set up independent testing labs for homemade masks made based on locally available materials. This can use existing occupational health laboratories usually used for accrediting masks and respirators.
Highlights
Despite numerous masking recommendations from public health agencies, including the World Health Organization, editorials, and commentaries providing support for this notion, none had examined different homemade masks or demonstrated that perhaps not all cloth masks are the same
W orldwide, face masking has become a global phenomenon associated with the coronavirus disease (COVID-19) pandemic
The World Health Organization and the US Centers for Disease Control and Prevention (CDC) have reversed their recommendation to advocate for universal masking with the public recommended to use homemade cloth masks and not medical masks.[4,5]
Summary
Despite numerous masking recommendations from public health agencies, including the World Health Organization, editorials, and commentaries providing support for this notion, none had examined different homemade masks or demonstrated that perhaps not all cloth masks are the same. The World Health Organization and the US Centers for Disease Control and Prevention (CDC) have reversed their recommendation to advocate for universal masking with the public recommended to use homemade cloth masks and not medical masks.[4,5] The use of cloth masks to prevent infection is nothing new It had been used for decades in surgical theaters before being replaced by the more effective medical masks and are still in use in many low-resource settings.[6] Prior to the current public masking recommendation, the CDC had provided recommendation for health professionals on the use of homemade masks (scarfs, bandana) as a last resort in settings where face masks are not available.[5] Even so, despite numerous masking recommendations from public health agencies, editorials and commentaries providing support for this notion, none had examined the different homemade masks or demonstrated that perhaps not all cloth masks are the same.[7,8]. This article aims to examine current evidence on cloth masks and, with theoretical rationales, provide some recommendations on what might be an effective cloth mask for the public
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