I know this is completely off topic but I am hoping this could be helpful to some of my readers.
It has been interesting albeit very frustrating to watch North American’s disdain towards the idea of wearing masks. Now, I really can’t blame them when you have government officials left and right telling people to NOT wear masks and that it will only hurt instead of help if they do. To be clear, I myself have spent most of my life in the West and really has no habits of wearing masks either…but I figure when you have a bunch of Asians who has first hand experience of battling SARS (2002) and H1N1 (2009) requiring their citizens to wear masks then it should get our attention.
I have spent a bit of time the last week researching this topic and was overwhelmed by how much information that is out there from Asia. Hong Kong and Taiwan are two places that took this virus very seriously from the getgo since their citizens all know the drill. In the last couple of days, with the news of a few select hospitals that are asking people to help make cloth masks, there has been a surge of interest on how to make them. There are TONS of diy videos on youtube from Asia (from how-to videos to discussions on how to disinfect them, and their actual usefulness in protecting you from the virus) so there is really no need to reinvent the wheel when so many people have already done the work.
Anyhow, here are a few things from Chinese sites, youtube videos and articles that I am hoping might be of some help to you guys.
How to properly wear a mask
- There has been a lot of talk in US on how wearing a mask is actually harmful because it encourages a person to touch their face…um…so don’t. Asians see masks as a way to discourage you from touching your face, kinda like wearing glasses because there is a physical barrier to remind you why you wore the mask in the first place. Another reason given of masks being ineffective is that they often have large gaps allowing the virus to get in anyway…so, get a mask or better yet, make a mask that will fit you without those gaps.
- A Hong Kong doctor explaining how to wear a mask HERE (By the way, if your glasses fog up then that’s a sign that the mask is not properly fitted to your nose).
- When you walk into the door, take care to not touch the front part of your mask but take it off from the back by the straps then either throw it away if it is the disposable kind or take the proper steps to make sure it can be worn again later (spray with alcohol that is at least 70%, set out to dry for a couple of days or wash it then dry in the dryer on high heat.) Wash your hand immediately.
Are Cloth Masks Even Effective?
I will just summarize my personal take away from my own research which of course has no authority whatsoever so please do some of your own as well.
- The Covid19 virus is very small and most masks we can get our hands on now won’t be able to stop it. However, the virus is not just floating in the air on its own when one would encounter it but it is often coated with whatever body fluid (via cough, sneeze) they hitched a ride on. And in THAT form, with a cluster of them together, it is quite a bit larger and a mask with a filter would have a good chance of trapping it.
- Research on the effectiveness of cloth masks is fairly sparse since we really can’t morally expose a group of people to danger purposefully without giving them masks. We do have some evidence they could help to a certain extent and no evidence that they would do harm.
- My personal opinion is that this is a rather silly question. Are we honestly arguing if no barrier at all is preferred over a cloth barrier? That’s like saying I know candy A is poison for sure but I have no proof candy B is really all that good…although I know it won’t kill me, so I should just choose candy A? A cloth barrier’s effectiveness might be unknown but I do know I would take it any day instead of having someone’s saliva or snot landing on my bare skin.
DIY Cloth Videos
- A Taiwanese doctor’s DIY Cloth Mask: HERE I really like this doctor’s take on masks especially since he used common everyday accessible items as the filters (dried wet wipes, feminine pads, tissues). He is honest in saying these masks are not as good as N95s but these should also be pretty good bets for ordinary citizens who are being careful.
- A silent video of a Chinese lady making cloth masks with a pocket for inserts HERE. It’s pretty self-explanatory if you have some sewing experience. Her masks differ from others in that she uses a ribbon for the nose wire piece (she used grocery bag ties. I have seen suggestions that you should double up on them to make them a bit sturdier) and sew on snaps for the sides.
- This guy’s video HERE is probably the most creative one I have seen on how to make your own surgical mask. He is using a sealer (the kind that could seal clear bags) but supposedly if you have a hair curler that might work as well. This particular method might be difficult to reproduce since depending on where you are (esp. since some are specific to Asia) the materials might be hard to get. They are a few things that were pretty useful though: 1. the inner filter he used was air conditioning filter (I don’t think we have the same sort of filter in N. America and you will have to make sure it doesn’t have fiber glass in it. Plus it seems to be the general consensus that it is difficult to breathe through these. ) but he also suggested disposable dust cloths like Swiffer that cleans with static as a good replacement. 2. The water proof layer he used is something I am not familiar with but the alternative he suggests is disposable massage table liners or the liners you see at doctors’ office. I think dental bibs would work too.
- This is a girl from Hong Kong making her version of DIY mask HERE. I included this one because hers is actually the version I am going to pattern my own mask after. About five minutes into the video you can see that she sewed snaps on the masks itself and a soft sheer fabric (it really doesn’t matter what fabric this layer is as long as it is soft and breathable for your comfort). This particular snap design allows her to easily insert/change out her mask filter. I have tried making a mask using the Taiwanese doctor’s design and found it kinda troublesome when it comes to inserting the filter since you have to play with it to make sure it lays flat and covers the right area so this seems to be a better design.
- Tired of all the Chinese videos yet? Here is a video in English with patterns and all: HERE
- As you can tell by this point, there is a lot of ways you can make the masks but here are a few things I am making sure to include in my own mask: 1. A thin nose piece (grocery bag ties, pipe cleaner, a disposable foil pan you can cut to size) 2. For myself and my family, I am making them custom sizes to ensure the best fit. 3. I am leaning towards the fabric ties behind the head instead of elastic around the ears… but I am going to make a sample first and see how well they stay up.
Can’t I Just Buy The Surgical Masks From China?
For those of you who have poked around on the internet in search of surgical masks lately, you might be wondering what all the talks of surgical mask shortage are about since there seem to be masks for cheap to be bought from China online. A few things to take into consideration: 1. Medical supplies such as masks are probably still under tight control by the Chinese government. They are still unsure if this virus is gone for good so I doubt they are ready to stop stockpiling it for now. 2. Even if there is plenty of masks, with this virus being a global pandemic now, surgical masks are a great international relations bargaining chip/ show of good will for the Chinese government. 3. Condition 1 + condition 2 = Can we really be sure if the masks we are buying is the real thing or just fake ones produced by some shady factory out to make a quick buck?
According to Mama Ninja, my uncle apparently just bought some masks and they turned out to be fake.
If you have already bought some or are planning to buy some masks, here is a video showing you how to tell if there are fake: HERE. In the video, he goes through three steps: 1. Cut it open to see if they have three layers. 2. Put water in them to see if they are waterproofed as they are supposed to be. 3. Burn the middle piece of fabric to see if they melt instead of burn. (The middle piece is for filtering and it’s supposed to be made of nonwoven fabric which melts when burned.)
Stay safe!
All text copyright @ www.Ninja-Reflection.com
Thank you!
Hi Ninja,
I always enjoy following your Novel translations and drama roundups.
I also appreciate your insights about living in Asia and personal protection for the general public.
I just want to point out that surgical masks are still required in high risk environments such as healthcare.
https://bmjopen.bmj.com/content/5/4/e006577
Perhaps cloth masks are ok for lower risk situations, and are a great reminder for people to practise good distancing and hygiene.
Let’s all do our part and stay safe!
Thanks for adding that! The importance of leaving medical surgical masks and N95s for the health professional can’t be stressed enough which is why these cloth masks are a good alternative for us ordinary folks who can isolate ourselves and use them wisely when it is necessary to go out. In certain places in Asia (such as China and Taiwan), the mask situation is actually nowhere as tight as North America since they have enough factories to mass produce them at a short notice so even ordinary citizens can at least buy limited quantities. If that was also the case here, then I would obviously prefer to use surgical masks for myself as well but unfortunately, I can’t see that being an option.
Thank you so much for taking the time to so generously share your thoughts and information. I admire your common sense approach to helping out your virtual neighbors!! Stay safe yourself.
I am not here to advocate one way or another (but don’t think a mask will replace the advice for distance, minimum 3 feet, don’t touch your face, and understand how to wash your hands at proper times…which is effective when you do all 3 properly)… just some corrections…
(I am an infectious disease PhD that has spent the past 20 years working in the BSL3 with a highly infectious aerosol pathogen. In case you want to know why I know what I know…)
1. Testing of cloth masks…there are plenty of papers on this. Two examples below. No we do not test this by purposely exposing people, there are a lot of ways to do this, and why it is not recommended as a PPD, and why it doesn’t protect you. The only thing it may be useful for is to offer SOME barrier from spreading your own germs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599448/
https://bmjopen.bmj.com/content/5/4/e006577
We can talk about virus size, aerosol particles, and whatnot… if someone really wants to know…
2. Proper fitting (only about the N95) isn’t determined by fogging of your goggles, glasses whatever. It is most likely not probably fitted even if there is no fogging. Unless you work in a BSL3 lab or you work in a hospital that is run by people who knows biological safety, no one is fit tested correctly. And proper fitting will leave marks on your face, kind of like what a lot of pictures that are on the web lately. Fit test is a 15 minute procedure that uses a machine to measure salt aerosols inside and outside the mask. Any man with facial hair will fail. You gain weight, you might fail. Which is why you are tested regularly and repeatedly. And no N95 will fit a child. And there are people who will never fit properly, and they end up having to the entire head gear set in the BSL3.
3. Mask removal… first thing you should do is DECONTIMINATE your hands! Wash them or spray them down with 70% ethanol. You will be surprised at how much is needed. We are talking about drenching. Hence I don’t recommend anyone from reusing masks. And certainly not the surgical ones. Again surgical masks are not to protect you from other people’s germs, it is to prevent you from spreading your germs.
4. Do wearing a mask remind you to not touch your face? I would argue the exact opposite. If you are not used to it, the additional thing on your face will make you adjust that thing more times than you realize.
5. Do not disregard the distancing just because you have a mask.
And also…if the masks really worked, China won’t have needed to lock down their people for what is it now? 3 months? And we all expect that number to go right back up…
Thanks for sharing! It’s always nice to hear from experts. I really have absolutely no background at all in knowing how effective masks are in protecting you in a pandemic situation. My recommendation comes only from my own personal opinion that if a person wants to become rich then he should probably go ask the opinions of those who are rich instead of those who are broke. So in this situation, I figure it would be safer to seriously consider the actions of those who have had past and current experiences. A big thank you for mentioning of washing your hands before taking your mask off, I did forget to mention that in the post as I only mentioned washing hands after. I also completely agree that washing and keeping a big distance are the most important preventive measure.
As for China…well, what landed them in trouble in the first place is simply your good old Chinese government wanting to save face. It has gotten our culture in plenty of trouble before and I am sure this wouldn’t be the last time. In fact, saving face is the very thing the Chinese people themselves are not sure if they can trust the numbers right now. I do think that one should take a serious look at why Taiwan, Hong Kong and even Japan have been able to keep their number relatively low since January when they are the areas that have the most contact with China. Again, no experts here, so I really have no idea why they have been able to keep their numbers low which is why I am picking the most obvious things such as most of their citizens seem to take the social distance thing extremely seriously, tracking their infected cases and they all wear masks.
By the way, I do have a question for you if you don’t mind. There is a lot of talks this week in US about relaxing the shutdowns by mid April to get the economy going. Our experts and leaders seem to be split on either side of this issue with some asserting this would be a terrible idea and some think as long as we can take precautions to protect the vulnerable group then we should be fine. My first instinct is to say this would be a bad idea but then looking at Japan who seemed to have been able to keep their economy going while keeping their numbers low I am not so sure. What’s your take on it?
I’m in Canada. We have our own struggles with containing COVID infection, but by and large there are no major arguments from our leaders or from the business community against shutdowns. It is widely supported. As a healthcare worker I’m very pleased and hopeful.
If you are in the US I’d be feeling sorry for people in general. Not only is there a big scary virus capable of killing millions, but there’s also mixed messaging causing confusion and uncertainty about how to act.
I personally don’t believe the US is comparable to Japan. In Japan there were far fewer infections and much better compliance with infection control strategies, allowing them to contain infection. Whether they are going to be able to continue containing the infection as it rages on throughout the rest of the world remains to be seen, they could get a second wave. I think the US is wayy beyond containment. I can’t see how relaxing shutdowns will work without a massive spike in infected individuals and healthcare crisis or failure.
As for masking and PPE, the CDC considers it the LAST line of defense . Their position is that the infection is spread by droplets so unless you are performing aerosol generating procedures Healthcare Personnel can use surgical face masks. This aligns with what Health Canada is saying to us too.
I’m going to answer your question first (nothing is simple…) So yes, for an aerosol pathogen that is fairly infectious, you can’t stop spread, the only thing you can do is slow it down. And I fully expect this to circle the globe completely, we might get a downturn, and it’ll come right back up again. So as a public health policy, you have 2 options, let it run or slow it down. There is a reason why the latter is preferred as a public health policy. Just because low risk people are low risk, that doesn’t mean no one gets sick. You will still have people who will be sick enough to be needing medical care. And this is the problem, how much medical resources do you have in a city/region and can it handle if 1% of your population all need intense care all at the same time? China couldn’t do it. Italy and Spain certainly can’t. And we are going to find out that even the major US cities can’t. (I mean even Houston is putting going with the distancing option even though the medical center in Houston is the biggest one in the world.) So what do you do when you can’t treat everyone… you end up doing what Italy have to do, triage. How do you decide who should get care? This becomes an extremely tricky moral question. Do we consider age? Profession? Arrest records? So the result end up being patients who could have survived with treatment, end up dying because of inadequate medical resources. So most countries are going with the slow down method. Yes, it will drag the cycle out, but you won’t subject your health care workers to a nightmare situation (or completely exhaust the workforce. I mean, they aren’t robots. And I’ve been seeing chatter that some in certain places where they don’t feel that they are getting proper PPD to protect themselves… that they will quit..so…) or put your citizens at risk.
The low case numbers in China’s “neighboring” countries… There are actually several reasons for this. The thing that probably made the most difference is that they were aggressive in their screening of travelers (citizens and foreign) very early (in January, when our own who-shall-not-be-named person was still not concerned, despite the experts telling him to be). And they take infectious diseases seriously (we certainly don’t) and built the necessary experts around it. This involved not just screening of people coming into the country, but also aggressive testing and contact tracing. They learned a lot from the last 10 years with SARS-CoV-1. And there are also fundamental difference in philosophy that probably also played a role.
China… no one disputes that the government hides things. Could they have mitigated the issue early? Probably not. The epicenter is densely populated and well traveled. And most people’s symptoms are barely distinguishable from the common flu/cold. And to find a new pathogen, the patient sample needs to be sent for testing. So..how many were missed because most medical doctors don’t look for the unusual. It takes someone to sent out the sample to be tested. So by the time you ID the first patient infected with a new pathogen…how many weeks has this thing been circulating already? How many people have left the city? And most people don’t sound alarms with one patient… they get concerned when they see a cluster. And that again takes…time. My suspicions are that the numbers coming out of China most likely are way under-reported. And the most glaring example of this is the Iran cases. If the Iranian government were the first patients.. Where are their counterparts in China?
And this takes me to the discussion of confirmed cases… The more confirmed cases isn’t to be interpreted as worse in comparison and vice versa, because the more people you test, the higher your cases will be. And if you just bury your head in the sand and don’t bother testing people (or if you miss patients for other reasons), your cases will be lower. If you look at cases per population… South Korea is the highest in Asia at 169 cases/million. But their mortality is 1%. Whereas Japan, if you take the WHO numbers, their mortality is at 3.6%. And this all has to do with the fact that South Korea test so many people. Same thing with Switzerland… per population, they have the highest confirmed cases in the world. Their morality is a little <1%. Whereas Italy, they are close to 10%. Yes, age of the population makes a difference, but so does the total number of confirmed cases.
And I agree with Mimi… Despite the apparent "low" numbers… those countries know that doesn't mean anything. They are actively monitoring for the next cluster.
I’m glad comments are not closed yet.
I wanted to come around to this post because I want to acknowledge recent developments.
Now the CDC is recommending everyone use cloth masks in public. The conversation has shifted from how do I protect me from you, to how do I protect you from me, and that is due to the discovery that there are quite a lot more asymptomatically infected individuals than previously thought.
Now that the US is in crisis in their hospitals and Everyone in the Western world is running out of PPE, you’ll find grassroots movements for homemade cloth masks everywhere, at least in Ontario.
Also some very good epidemiologists and investigative journalists have been recently blowing the lid off WHO and CDC for their actions, or lack thereof. Their investigation show some of the CDC and WHO statements and recommendations appear to serve political purposes. I am now personally more skeptical of their advice and will do more cross referencing.
Anyhow, bottom line:
Avoid contact if you can, 2m distance if you can’t.
Good hand hygiene, don’t touch your face.
Cloth masks in public.
Save PPE and surgical & N95 masks for high risk workers.
Stay safe!