"many people say that it is Patriotic to wear a face mask"

Jul 21, 2020

Welcome to Something Still Bugs Me! Today’s deep dive is about face masks for the general public.

Man, we’ve really been through the wringer on masks this year. First we got two months of blatantly contradictory advice from the CDC; then we got an infestation of monkey-paw worshiping chaos-agents who think being asked not to spit in other people’s mouths is basically slavery.

There’s so much room for back and forth because, before February, there wasn’t a lot of research into whether imperfectly-worn homemade masks could slow the spread of a respiratory pandemic. Why would there be? We only had a century of warnings that a respiratory pandemic like COVID-19 was a “not if but when” scenario, including this report HHS commissioned in 2006. It recommended the agency develop standards for cloth masks the public could wear in the event of a PPE shortage.

Now, answering the big question -- “do masks prevent the spread of SARS-CoV-2?” -- has been a nightmare in part because it’s actually two different questions. Whether masks work in a lab has to do with fluid and aerosol dynamics and viral properties. Whether they actually work has to do with us.

Even with effective materials and fit, proper use is the only way a mask can protect the wearer. Think of it as the ‘front-is-lava’ rule: act like the front of the mask is covered in virus at all times.

Thankfully, a decent mask seems to make you less likely to infect other people -- even if you put it in your pocket while you eat lunch and then put it on again, possibly without washing your hands (a.k.a. real world use). So at the very least, please cover your mouth and nose when you’re near me, dirtbag.

Excellent street art near our place in Oakland, CA

Before we dig in, I want to say one thing about masks and oppression: While unmasked morons have been LARPing “insurrection against tyranny” as they protest mask rules, some actual mask-related tyranny has gone largely unnoticed by the national press.

Since March, cops have killed at least two men of color by forcing them into ‘spit hoods’ (which do not prevent disease transmission): Manuel Ellis, March 3 in Tacoma, and Carlos Ingram-Lopez, on April 21 in Tuscon. Both told officers they couldn’t breathe before dying.

When the richest country in the world treats health security as a luxury and human rights as a privilege, it’s on all of us to take care of ourselves and one another.

With that in mind, today’s burning question:

What’s the best mask I can make out of cheap materials, without taking anything away from frontline workers?

(Spoiler: There’s better options than a folded t-shirt, and no matter what “scientists have figured out,” a mask made of chiffon and cotton is not as good as an N95.)

A quick recap

In January, staring down the barrel of the above-mentioned inevitable PPE shortage, public health officials told the general public not to wear masks. (Perhaps they believed “cloth masks for you, N95s for healthcare workers” was too nuanced a concept for American minds.) Regardless, officials claimed wearing masks wouldn’t help healthy people, despite acknowledging reports of asymptomatic transmission. Some officials actually doubled down and said masks might increase your risk of getting the virus.

But places like the public-facing page “How Covid-19 Spreads” made it clear from the jump that CDC believed the primary route was respiratory droplets going directly into people’s mouths and noses, not indirect transfer from surfaces. Pretty frustrating we were stuck with “wash your damn hands” campaigns!

Meanwhile in hell, the culture war was building steam.

On March 9, Rep. Matt Gaetz (R-FL) had to go into quarantine for COVID-19 exposure less than a week after shoehorning his enormous head into a gas mask to mock people for being scared.

On March 31, the same day news broke that the CDC was considering a general mask recommendation, Surgeon General Jerome Adams went on Fox and Friends and said wearing a mask made it more likely you’d get coronavirus. How shocking Fox News viewers are so resistant to masks 🙃

After CDC’s April 2 mask recommendation, Adams walked his position back with this video, where he makes a mask out of a t-shirt that says “got naloxone?” Love to be reminded of the other deadly epidemic our leaders let fester through corruption and incompetence, then told us to solve ourselves.

While some politicians are still working hard to make it to the Hague -- like Georgia governor Brian Kemp, suing Atlanta’s mayor over a mask mandate -- there are now mandates in 28 states.

But the poison of anti-mask sentiment is still killing us. In Michigan, two people have died in separate attacks on essential workers who told customers to wear masks.

(We’re not the only country having a literal culture war over face covering. Some shitheads in France beat a bus driver to death for asking them to wear masks, and Brazilian president Jair “somehow says Trump’s quiet parts out loud” Bolsonaro called masks “a fag thing” before testing positive for the virus.)

Thank god Trump’s account finally Tweeted something incoherent but seemingly pro-mask yesterday. We’re saved.

How do we know masks work?

Masks aren’t a panacea, and they’re not the only way a country can keep an epidemic in check. The U.S. absolutely cannot throw on a mask and call it job well done. But. BUT. There is good evidence public mask wearing can help slow transmission, as one part of a balanced breakfast.

Mathematical models suggest face masks and lockdowns together result in “vastly less disease spread, secondary and tertiary waves are flattened and the epidemic is brought under control” (Proc R Soc A, June 10)
A CDC team looked at sailors on the USS Theodore Roosevelt (the one where the captain was fired by the Navy after begging for help to contain the virus) and found face masks were a better predictor of who got the virus than social distancing (MMWR, June 12)

Researchers at the Beijing CDC found people wearing face masks at home reduced asymptomatic transmission by 79 percent (BMJ, May 28)
”Although the non-medical masks tested in this study experienced varying degrees of flow leakage, they are likely to be effective in stopping larger respiratory droplets” (AIP Physics of Fluid, June 2020)

So...what kind of mask should I wear?

If you’re not into sewing (and don’t have a friend who is), look for the following things in a mask:

Breathable -- doesn’t puff out and force air around the sides
Covers a lot of your face
No stitching up the middle (sewing needles make big holes)
Doesn’t need adjusting once it’s on (remember the ‘front is lava’ rule!)
BONUS: Waterproof outside, to block spit from getting in
Absorbent inside, so your spit can’t get out and doesn’t pool inside disgustingly

If you are into DIY, you’ve got better options than two layers of cotton (if you want them).

No one is going to promise you a DIY solution as good as professional PPE (except scam websites and/or irresponsible journalists and scientists, who I will ADDRESS IN A MINUTE). But if you can get a pretty good fit with well-tested materials, you’ll be much better off than just tossing on a bandana and heading to town.

Cotton is being widely-recommended for good reason: it’s cheap, durable, washable, highly available, and seems to provide relatively good protection against transmission. (CDC’s advice to make a mask out of a t-shirt or bandana doesn’t come close to meeting WHO’s best practices, for the record.)

Unfortunately, cotton also…sucks. Outdoor enthusiasts love to roll their eyes at newbs in cotton socks and say “cotton kills, man.” That’s because cotton absorbs a billion times its weight in water and then just...holds it. If you’re on the Adirondack Trail, it’s a good way to get trench foot or hypothermia. If you’re walking around the city in 900% humidity, it’s a good way to get swamp-face — not to mention, as cotton gets wetter, its breathability goes down.

One way to deal with wet cotton is to carry several masks with you and swap them out when one gets soaked. I love and support you if you follow this path.

But is there a better way??

There certainly seems to be!

A ton of volunteer projects have sprung up recently to fill the gaping void in mask science and supply: the Better Than Nothing mask project; MaskFAQ; Dr. Yang Wang of Missouri S&T’s ongoing filtration tests; and Suay Community Mask Coalition, to name a few.

The WHO recommends homemade masks contain three layers, roughly corresponding to layers in a surgical mask: an outer layer that repels water (or spit); an absorbent inner layer that absorbs your spit; and a middle layer of nonwoven fabric as an added barrier. Nonwoven fabric has synthetic fibers bonded together at random; instead of flying through holes in a cotton grid, particles have to navigate a “tortuous path,” a.k.a. maze, to get out, while gas whooshes through just fine.

Both the WHO and the scientists at MakerMask give high marks to spunbond polypropylene, commonly used as the outer layer of surgical masks. If it survived your quarantine purges, you may even have some at home -- those matte-finished, fabric-y reusable shopping bags.

I can’t even tell you how much more breathable this shit is than cotton. It’s a whole different universe. But its superpower — being water-resistant — means you’ll basically drown in your own spit if that’s all you use. So it’s not a one-and-done solution!

After making a trillion masks using materials and patterns snagged from all over, I’ve finally landed on a system (this is not scientifically validated, not PPE, please be smart, etc etc):

An outer layer of spunbond polypropylene from a shopping bag
A replaceable filter of nonwoven, absorbent shop towel (WypAll X80), based on testing from Suay Community Mask Coalition
An inner layer of something soft and wicking

There’s a lot of personal preference involved RE the inner layer. My favorite is linen from an old shirt, which seems to wick moisture away from my face and into the towel; I also like stretchy wicking fabric I snagged from a gym shirt. My husband prefers plain-woven cotton from a very lightweight button-down.

Yours truly, wearing a space-themed mask and experimenting with iPhone portrait mode

There’s also a lot of personal preference involved in the pattern, i.e. I can never get a pleated rectangle to sit on my face properly.

Filter-pocket patterns:

Suay has a pattern I’m incapable of sewing, but it looks good!
The Better Than Nothing project has two patterns, one pleated and one cone-shaped
My Origami-style mask pattern, really a modified version of the Aplat mask with added filter pocket and neck tie

Well-tested non-pocket patterns:

The French standardizing agency AFNOR has two patterns, a pleated rectangle and a duck-bill (if you make this, you’re legally required to send me a picture)

Via AFNOR

AS FOR THAT FUCKING CHIFFON MYTH.

There are a lot of stories floating around saying a layer of 600 thread-count cotton and a layer of chiffon can rival N95 masks if there are no gaps, based on a paper published by fancy scientists in a good journal. I believed it! I bought some chiffon and spent 100 years learning how to sew it!

Unfortunately, it’s bullshit. (And so is anyone casually suggesting you replace cotton with chiffon in a pattern. It’s like suggesting you remake Titanic exactly the same, except now Jim Carrey plays Jack).

Getting rid of the “gaps” referenced in the cited paper basically means duct taping it to your face. Oh, and…the article was subject to a lengthy correction in June, explicitly retracting the N95 comparison. Apparently the study design (which the primary investigator bragged to NBC Boston only took the team “a couple of days”) didn’t replicate human breathing. Oops!

None of the articles citing the paper, including in the Financial Times, Medical News Today, World Economic Forum, the AARP blog, Vox, PBS, India’s The Hindu, cult-owned international wire service UPI, or the University of Chicago press release have been updated. The N95 claim is still being referenced in new stories, like this one from Fast Company, this in ScienceAlert, this in Harvard Business Review, and this in Zimbabwe’s state-owned paper The Chronicle.

To any journalists reading this who cover COVID-19 science: please keep an eye on Retraction Watch’s list of retracted or withdrawn papers. If something seems too good to be true, push on it. Whether it’s premature to say the retraction rate is exceptionally high for COVID-19 papers, it’s worth it to be overly skeptical when the cost of fucking up could be so high.

Thanks to Joe Cunningham, renowned quilt artist, for fabric advice, and to Grace, Christian, Sulagna, Najib, and Gil for everything else. Mistakes are all mine, of course.