Should you wear a homemade mask in public?


Source: @jperla (Twitter)

In order to slow the spread of the coronavirus, should everyone out in public be wearing a homemade mask?

In recent days, a growing legion of global voices is saying a resounding “yes.”

One of the most influential voices is the head of the Chinese Center for Disease Control and Prevention, George Gao, PhD. He warned the west on March 27 that to control viral spread everyone, sick or not, should wear a mask in public.

“The big mistake in the US and Europe, in my opinion, is that people aren’t wearing masks. This virus is transmitted by droplets and close contact. Droplets play a very important role — you’ve got to wear a mask, because when you speak, there are always droplets coming out of your mouth.” Gao said in an interview in the pre-eminent journal Science.

“Many people have asymptomatic or presymptomatic infections,” said Gao. “If they are wearing face masks, it can prevent droplets that carry the virus from escaping and infecting others.”

Here are six key developments pushing this emerging consensus, links to current evidence and opinions, and our conclusion: yes, masks can help.

But, we recommend using homemade masks. At the bottom of the article are easy DIY ways to make your own mask with common items at home — no sewing required!

“Leave the medical-grade masks to the health providers. But homemade masks can protect other people,” said Dr. Andreas Eenfeldt, founder and CEO of Diet Doctor, who has been following the mask issue closely. “Evidence is showing that many people without symptoms are spreading the disease. Wearing a mask reduces these silent transmissions.”

Why is Diet Doctor taking a stand about this non-dietary issue? Because the coronavirus pandemic is the most important public health issue of our time.

As a company whose mission is to dramatically improve health, we are compelled to relay knowledge that may prevent more people from acquiring a potentially lethal illness that is swamping health systems.

This is also especially relevant because many of our readers have underlying health issues like diabetes, pre-diabetes, hypertension, and cardiovascular disease. These underlying conditions, as Dr. Bret Scher noted in his recent guide, put people at higher risk of more severe COVID-19 complications and even much higher rates of death.

Aren’t masks in short supply? Yes, that’s why we’re stressing that surgical and N95 masks should be reserved for frontline health workers or those with compromised immune systems like cancer patients, especially since there is a current global shortage.

We are focusing this discussion on homemade masks. Are they good enough?

Yes. Research shows that any barrier — tea towel, pillow case, vacuum cleaner bag — provides some protection and is better than nothing. The layer of fabric, or even paper, across the nose and mouth creates an obstacle to respiratory droplets, helping reduce the viral load that you either exhale upon someone else or they exhale upon you.

New research has also found that spikes on the coronavirus attach extremely strongly to cells on the upper respiratory tract. That means very few virus particles are required for infection to start.

Combined with other measures, like strict hand washing, not touching your face, social distancing and staying at home, the DIY masks can add yet another layer to prevent coronavirus spread.

So, let’s dig into the six recent developments that have led to the increasing call that DIY masks should be universally promoted to flatten the curve of coronavirus spread.

1. Differences between Asia, Europe and North America

Universal mask wearing in public is the cultural norm in Asia. It is seen as being hygienic and the sign of a good, conscientious citizen. It is seen as common sense.

But in Europe and North America mask-wearing is currently rare, even stigmatized. It is seen as being done only by those who are sick — who should not be out in public but rather home in bed.

Most Western public health officials have been strictly advising the general public to avoid masks and leave them for health care providers. In fact, on February 29, US Surgeon General Dr. Jerome Adams, sent a scolding tweet: “Seriously people — STOP BUYING MASKS!”

The US FDA and the Center for Disease Control have continued to stress that only people who are sick, or caring for someone who is sick with the coronavirus, need to wear a mask.

Some health authorities have even been warning that wearing a mask potentially increases the risks for coronavirus spread because a mask could give “a false sense of security”, improper use (such as touching them with your hands) can increase the chance of inadvertent infection, and wearing them may reduce public commitment to good hand hygiene, self-isolation, and social distancing.

However, in mid March, a map created by San Francisco tech engineer Jo Perla, went viral when it compared the spread of coronavirus between Asian and Western countries. Everyone was handwashing and social distancing, but Asian cultures that normalize mask-wearing had flattened the coronavirus spread while all other regions had not.

The map, of course, shows an association only (correlation is not causation, remember), but it sparked a world-wide debate.

Why were Western nations so entrenched about not wearing masks, compared to Asian countries? How did recommending that only those who are knowingly sick wear masks make any sense when people can shed the coronavirus without feeling sick at all?

In fact, evidence from China shows  almost 80% of the transmission of the coronavirus may be from those who did not know they were infected.

The consensus was building: the time to wear masks, obviously, is not only when you are sick, but before you show any signs of being ill at all!

2. Pro-mask experts’ voices build

In recent days, more and more expert voices have been building to counter the official claims that universal masks are not required. Dozens of articles are being published showing this emerging consensus. Some of the high-profile ones include:

  • The New York Times: Why telling people not to wear masks backfired (March 17): Written by columnist Zeynep Tufekci, PhD, an information science professor at University of North Carolina, she deconstructs how the authorities have seriously erred when they shaped the message around managing the scarcity of masks rather than confronting the reality of how wearing them might help. “Slowing this epidemic with masks is how we will ultimately protect our medical workers,” Tufecki has tweeted.
  • The Lancet: The rational use of face masks in the COVID-19 pandemic (March 20): Written by six infectious disease experts from the UK and Hong Kong, it surveyed policies towards masks by a number of organizations and countries. It notes: “As evidence suggests COVID-19 could be transmitted before symptom onset, community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wear face masks.”
  • The Washington Post: Simple DIY masks could help flatten the curve (March 27): Written by Jeremy Howard, a San Francisco tech entrepreneur who is leading the global #masks4all movement, the piece notes: “When historians tally up the many missteps policymakers have made in response to the coronavirus pandemic, the senseless and unscientific push for the general public to avoid wearing masks should be near the top.”

3. #Masks4all and the experience of the Czech Republic

Unlike most countries in Europe, wearing homemade masks has suddenly become the norm in Czechia.

In mere days, it went from being a rare sight — that people sneered or laughed at — to common practice. The movement was led by the citizenry, but was made mandatory by government on March 18.

The story of the Czech experience was released in a short inspiring video March 27, which is being widely shared on social media. It’s an uplifting, motivating message about how Czechs now strongly believe universal mask-wearing is cool, compassionate and conscientious.

According to Jeremy Howard of #Masks4all, that Czech action is now responsible for helping flatten the coronavirus pandemic curve in that country. According to Worldometer, Czechia has one of the lowest rates of infection per million population in Europe.

How did that change occur so fast? According to Howard the credit goes to another data scientist, Petr Ludwig, who travels frequently between the US and Czechia. Ludwig was the only one wearing a mask on a flight between the two countries in early March. He wondered: Why are others were so reluctant to do so? He made a powerful, compelling video, about the use of homemade masks as selfless, pro-social behavior.

Social influencers in Czechia then shared and amplified the message. The catch phrase soon became: “When we both wear masks I protect you and you protect me.”

But does masking wearing truly work to stop spread, or is it just a feel-good community action?

Masks4all has collected and summarized 40 published scientific research papers that show wearing masks work. One 2011 meta-analysis shows, coupled with strict hand washing, masks have the greatest impact on reducing virus spread.

“In summary: everyone should wear masks, which they should make themselves using t-shirts and/or paper towels, whenever they go out in public,” said Howard.

4. Reducing the stigma of mask wearing

Okay, but here’s a significant problem. In North America and most parts of Europe, we are conditioned by the dominant public health message that anyone who wears a mask is sick.

So, if you go out in public sporting one, people assume you are ill and therefore putting them at greater risk. Sometimes they will even sneer or glare: you should have stayed home.

In fact, in the last few months, individuals of Asian heritage who have worn masks in public in the US have been harassed or even attacked.

If you are wearing a medical grade mask, anger can also be aimed at you for supposedly taking much-needed medical equipment from front line workers.

The UK and Hong Kong authors of the Lancet article, speak directly to this issue: “The contrast between face mask use as hygienic practice (as in many Asian countries) or as something only people who are unwell do (as in European and North American countries) has induced stigmatisation and racial aggravations…”

One big advantage of universal use of face masks, therefore, is that if we all do it together no one is singled out. The stigma and discrimination is gone and the altruism dominates.

5. So how do you make a mask?


The author in her homemade mask

Got a spare pillow case, a pair of scissors and hair elastics? You can make a mask. Even paper towel or an old t-shirt will do.

Hundreds of videos now exist showing how to fashion a protective mask from everyday household materials. These include:

  • Top quality hepa mask: If you want to make a mask, complete with hepa filter, that is good enough for a front line health professional, follow this video. Note, you will need hepa-level vacuum cleaner bags, a glue gun and a sewing machine.
  • Fabric surgical masks: Hobby sewers from all over the world are posting their patterns and instructions for simple reusable cotton masks. Some even have a slot for a filter, such as using the lining from a regular vacuum cleaner bag.
  • No-sew masks: If you want fast and simple versions, try any of these:
    • T-shirt: just cut and tie
    • Paper towel: just fold and use elastic bands
    • Handkerchief or bandana: just fold and use hair elastics. (If you don’t have a kerchief, just cut up a pillowcase and fold in the same manner. This is what I did in the picture above.)
    • Coffee filters: use scissors, paper clips, masking tape.

These are not the only versions. There are literally hundreds of videos using a variety of materials to create a physical barrier in a mask. Simplest route? Simply tie a clean scarf or bandana around your head

Explore Youtube for more ideas and materials.

6. How do you avoid contaminating your mask or yourself?

One of the objections from public health officials about the general public using masks is that the mask itself may become contaminated with the coronavirus.

Careless used of a mask, they argue, may infect you or others. It needs attention to putting it on, taking it off and sanitizing it. Health professionals are trained and continually reminded about how to don and doff protective equipment like masks.

That, however, is no rationale to discourage the general public from using a simple mask if doing so could slow the spread. We just need to be careful.

Here are key steps for keeping yourself, and others safe, when using your homemade mask:

  • Wash or sanitize your hands well before making any mask.
  • Wash and sanitize your hands before putting the mask on.
  • When removing the mask, do not touch the front of the mask with your hands; take it off by the ties or elastics. Then sanitize your hands.
  • Immediately after use, do not put the mask on any surface. Put the mask into the washing machine or a sink of hot soapy water and clean well. You can also bake fabric masks at 180F° (82C°) for 20 minutes to sanitize.
  • If you have made a disposable mask out of paper towels or coffee filters, throw it out into a plastic-lined waste bin with a lid.
  • After discarding, or sanitizing the mask, sanitize your hands again.
  • Any time you are wearing a mask, do not touch the mask, your face or rub your eyes.

In summary, wearing any mask in the weeks and months ahead may protect you from passing the virus onto others more at-risk. It may also prevent someone near you passing the virus onto you through respiratory droplets as they speak or cough.

“It is a selfless act that we all should be doing to prevent the spread to more vulnerable people,” says Dr. Eenfeldt.

“It may even protect healthcare workers by reducing the risk they will be completely overwhelmed in two or more weeks time.”