Efficacy and Use of Cloth Masks: A Scoping Review

Jain, Mehr; Kim, Sonya T; Xu, Chenchen; Li, Heidi; Rose, Greg

doi:10.7759/cureus.10423

Cited by 22 publications

(22 citation statements)

References 17 publications

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“…This evaluation is supported by the likelihood of observing reduced particle counts by random variation, as determined by Tukey's Honest Significant Difference post-hoc tests in the enclosed box experiments, where the N95T was significantly different in all positions, and the SewnF was different in all particle sizes but the 5-10 μm size bin. This result differs from previous studies that had found that surgical masks were generally superior to cotton, homemade counterparts, though these studies do not sample using 3D printed models and use different particles for measurement [28,45,46]. Depending on the conformation of each facemask relative to the face geometry, gaps resulted from fitting the facemask, and these gaps opened low-pressure outlets for the redirection of particles, as easily visualized by the change in bar height between facemask types across the rows of Cloth facemasks permit more particles to exit at the top of the facemask on our face model, but this effect could be mitigated through the use of a nose clip or filter.…”

Section: Discussioncontrasting

confidence: 94%

Check the gap: Facemask performance and exhaled aerosol distributions around the wearer

et al. 2020

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Current facemask research focuses on material characterization and efficiency; however, facemasks are often not tested such that aerosol distributions are evaluated from the gaps in the sides, bottom, and nose areas. Poor evaluation methods could lead to misinformation on optimal facemasks use; a high-throughput, reproducible method which illuminates the issue of fit influencing aerosol transmission is needed. To this end, we have created an in vitro model to quantify particle transmission by mimicking exhalation aerosols in a 3D printed face-nose-mouth replica via a nebulizer and quantifying particle counts using a hand-held particle counter. A sewn, sewn with pipe cleaner nose piece, and sewn with a coffee filter facemask were used to evaluate current common homemade sewn facemask designs, benchmarked against industry standard surgical, N95 respirator tightly fit, and N95 respirator loosely fit facemasks. All facemasks have significantly reduced particle counts in front of the facemask, but the side and top of the facemask showed increases in particle counts over the no facemask condition at that same position, suggesting that some proportion of aerosols are being redirected to these gaps. An altered size distribution of aerosols that escape at the vulnerable positions was observed; escaped particles have larger count median diameters, with a decreased ratio of smaller to larger particles, possibly due to hygroscopic growth or aggregation. Of the homemade sewn facemasks, the facemask with a coffee filter insert performed the best at reducing escaped aerosols, with increased efficiency also observed for sewn masks with a pipe cleaner nose piece. Importantly, there were minimal differences between facemasks at increasing distances, which supports that social distance is a critical element in reducing aerosol transmission. This work brings to light the importance of quantifying particle count in positions other than directly in front of the facemask and identifies areas of research to be explored.

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Section: Discussioncontrasting

confidence: 94%

Check the gap: Facemask performance and exhaled aerosol distributions around the wearer

et al. 2020

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“…While efficacy (performance in controlled or ideal conditions) and effectiveness (performance in usual or realworld conditions) are not synonymous [450,509], a large consensus and a growing body of literature have moved forward the uptake of community masking as part of comprehensive NPI bundles or "policy packages" aimed at preventing infections caused by respiratory viruses including SARS-CoV-2 [55, 58,261,262,295,464,508,[510][511][512][513][514][515][516]. Importantly, a fact undergirding community mask wearing during the pandemic is the risk of transmission, not only from symptomatic individuals, but also from presymptomatic and asymptomatic individuals (discussed in section 3).…”

Section: Toward a Multidisciplinary Agreement On Actionable Terminologymentioning

confidence: 99%

COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection

et al. 2021

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Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk (“Emmentaler cheese model”), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.

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“…A systematic review conducted by Jain et al (36) showed that cloth masks have protective efficacy, but that penetration of cloth masks is higher than that of surgical masks and N95 respirators N95. Cloth masks may be used in low risk areas and by the community if there are no surgical masks available.…”

Section: Cloth Masksmentioning

confidence: 99%

Mandatory universal use of cloth mask for prevention of coronavirus disease 2019 transmission

2021

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Since the outbreak in Wuhan City, China, in late December 2019, the Coronavirus Disease 2019 (COVID-19) has spread to nearly the whole world, so that it was declared a pandemic by the Word Health Organization. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative organism of COVID-19, is extremely infectious and can adhere to droplet nuclei of < 5 mm diameter and become airborne (aerosol). Since COVID-19 was declared a pandemic, there has been controversy on the use of cloth masks by the public, because of the still inconclusive evidence of the efficacy of cloth masks in protecting against COVID-19 transmission. Universal masking as a healthcare intervention in the community is currently made mandatory by local governments of most countries, since they follow the recent recommendation by the World Health Organization. The issuing of the WHO recommendation on the public use of masks was based on a study demonstrating that COVID-19 transmission does not occur only through droplets but also through aerosols. In addition, there was a study showing that COVID-19 transmission does not only occur from patients with clinical symptoms but also through asymptomatic and pre-symptomatic subjects, so that universal masking is of benefit in providing protection when used by healthy people and as source control to prevent cross-transmission to other people. This review article aims to discuss the mechanism of COVID-19 transmission, the evidence related to the efficacy of cloth masks, and the guidelines related to the selection and use of masks by the general population.

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Efficacy and Use of Cloth Masks: A Scoping Review

Cited by 22 publications

References 17 publications

Check the gap: Facemask performance and exhaled aerosol distributions around the wearer

Check the gap: Facemask performance and exhaled aerosol distributions around the wearer

COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection

Mandatory universal use of cloth mask for prevention of coronavirus disease 2019 transmission

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