The Effectiveness of Paper and Cloth Masks in Preventing the Spread of Covid-19
Has the type of masking and the proper technique of wearing a paper or cloth masks during the Covid-19 pandemic contributed to not spreading the virus to other non-infected people or has the type of mask used and the misunderstanding of the protocol of wearing a mask effectively contributed to the spread of the Covid-19 virus?
Some might feel that paper and cloth masks have prevented the spread of the Covid-19 virus in this past year during the pandemic. Their thought is that if all had put on either a paper or a cloth mask that less people would have died from this virus. Their view is that these people are “anti-maskers” and that they have contributed to the virus lasting longer and people dying because of their action of not wearing a mask.
Others feel that paper and cloth masks have not been effective in preventing the spread of the Covid-19 virus because of the science associated with mask wearing. They also feel that there have been political and media influences pressuring people to wear the masks even if the science does not support it. Others feel that these influences have made people biased as the reasons why masks should be worn instead of using the of the science to justify their validity of needing to be worn.
This research paper will show that two big factors that made mask wearing against the spread of Covid-19 ineffective: 1. Masks which made of paper and masks that were made of cloth were ineffective in stopping or slowing the spread of coronavirus because of their physical properties. 2. The proper mask wearing techniques were not used by the public which contributed to the spread of Covid-19 virus.
Masks have evolved since their history in the 17th century. If you came down with what they called the “buboes” in 1656 then you might have been visited by what they called the “plague doctor.”
The plague doctors’ uniform was designed after a suit of armor. “The most harrowing part of the costume was the long-beaked mask.” (Durn, 2020). The description of this first style of mask was that the mask had glasses and two small holes in the beak. The wearer of this mask would stuff the beak of the mask with herbs like mint, myrrh, rose petals, etc.… This getup was an important moment in our past because it was the advent of the first “medical mask” The beak was the creation of a French Medical doctor named Charles de Lorme. The goal of his mask like the paper and cloth masks worn during the pandemic was to “diminish the spread of the illness”. This mask that Charles de Lorme made was not too effective in prevention of the spread. Their theory was that “foul smells or bad air” like rotting carcasses caused disease so if they did not smell it, they would not catch the pathogen. It was not until the 19th century that the first surgeons wore a face mask during an operation. Dr. Paul Berger was this physician and was familiar with the work of a colleague named “Carl Flugge” who was a bacteriologist, today we would call him a Microbiologist that realized that saliva contained bacteria. Berger had a realization that if he was operating on someone that spitting into someone’s surgical site was not a good idea being that there were bacteria present in your sputum. This realization would probably be one of our key articles in support of wearing a mask in the operating room. Berger wrote a paper called “On the Use of a Mask in Operating” (Durn, 2020). The paper was published on February 22,1899. He was not well received for his view on wearing masks up to this point because most doctors were not wearing them when they operated. It took a long time in history before masks became the accepted practice to operate. By the time of the 20th century, “medical masks” became accepted. Most masks during that time were made of gauze and held in place with a metal frame. The sixties brought about what is called the “disposable mask” or what we call the “paper mask” that we see today being so widely used during the Covid-19 pandemic. We have also seen a rise to cloth masks being hand made some by companies and some by the hands of many men and women dawning their sewing machines with the shortage of personal protective equipment (PPE) during this Covid-19 pandemic. The N95 mask was created in 1972 but this paper is not addressing its use. The N-95’s was set aside for medical personnel to be used in this pandemic and it should be noted it has the highest rating of any of the masks available to the public out there a 75% effectiveness rating. “The history of masks in many ways is a history of epidemiology”(Durn, 2020).
The current way that the public has worn masks throughout this pandemic has contributed to the spreading the virus during the pandemic. There are steps that one should take to effectively wear a mask that would contribute to having some prevention of spread of an illness. Health care professionals who are trained by the Occupational Safety and Health Administration (OSHA) are trained in the wearing of a PPE and a mask is one of those PPE items. The certified safety professional is required to know what type of mask is required, how long they can be worn, how they should be worn properly, and when the mask should be replaced, and the effectiveness of different types and styles of masks. One OSHA health care PPE professional named Gregg Richley that was interviewed for this paper and is the primary source on this paper stated that “In my opinion masks, as they are being used in the public, are not an efficient way to stop the spread . If masks are worn correctly, stored correctly, replaced, or laundered correctly, then yes, they would work to some degree.” (Richley, 2021). He also elaborated on their design and the effectiveness of the mask type. He stated that paper masks were never designed to filter viruses. This is documented on the side of the actual box of paper masks if you take the time to read the manufacturers recommendations. With cloth masks it depends upon the materials, the number of layers, how the mask sits on your face when worn. The same is true of the cloth mask, what material is it made of, how many layers, adding nylon to a cloth mask makes it more effective. Gregg presented a scenario in his interview. The following is a synopsis of what he stated: Most people in the public are not trained in what people in the lab refer to as “aseptic technique”. This is how lab professionals handle pathogens. When you are wearing a mask, you must take this way of handling pathogens into consideration. If you wear a mask into a grocery store, come out and then hang that mask on the mirror of your car you should sanitize your hands. A lot of people do not do this step. Most then either grab the used mask wear it again in another store, or they do not sanitize their hands and touch everything in their care after they have touched the mask, they took off their face and then they sanitize their hands or not. What they should do is dispose of the paper mask or put the soiled cloth mask away since they are contaminated. They should dispose of the disposable before they wash their hands and put on a new one when they go into a new store or they should get a clean cloth mask and put the soiled one in a bag to be laundered. They should not touch any surface after taking off the mask before they sanitize. Hanging them on the mirror and someone touching their gear shift, steering wheel, etc. is what is called “cross contamination” so the amount if any that the mask did protect you now is rendered ineffective because you spread the germs throughout the car and possibly into the next store and to those around you if you picked up any of the Covid-19 virus while you were shopping on the outer surface of your mask. The cycle of spread continues if you wore the same mask.
The data shows that paper and cloth masks are ineffective in preventing the spread of the Covid-19 virus. There are issues with the design of the masks because they allow air leakage around the edge or sides of a paper or cloth mask. Therefore, you see such a drastic difference when you study the data between a paper or cloth mask vs.an N-95 mask that seals around the face. Data from testing revealed that “overall performance results suggested that cloth masks provided marginal protection to the wearer from particles less than 2.5 μm”(MacIntyre). The actual Covid-19 virus is 0.125 μm. That is a lot smaller than what the manufacturers of the paper and cloth masks say they can filter! Paper and cloth masks are designed to filter 0.3 μm. One needs to ask can a paper or cloth mask filter a virus half its size if the manufacturer made it to filter something bigger? A big issue with cloth masks is that they retain moisture, people reuse of cloth masks instead of washing them at every use, they have poor filtration may result in increased risk of infection. Medical mask or paper masks offer somewhat more protection than do cloth. There is also question that the outside of the mask may transfer pathogens to the hands of the wearer in both types of masks. The key factors in a mask protecting you are filtration, effectiveness, fit, and performance of the material that the mask is made of. The effectiveness of both the paper and cloth mask range from 30-60% when they are worn as a “loose-fitting mask.” This is how most people wear them in public. Their nose sticks out, it is half-way down their face. If the mask is tight fitting it raises the percentage of coverage to 60-80%. At this stage in the pandemic rarely do you see someone wearing a paper or a cloth mask tightly fitting their face unless your President Biden who wears one even after he was vaccinated. It is not sure if he practices the hygiene related to mask wearing though.
The biggest counterargument for wearing a mask is that if you do not wear them that you can kill someone if you are not wearing one. People that support the wearing of cloth or paper masks feel that they are causing the percentage of people dying and those being infected to decrease. People stare down someone like they are the problem if someone is not adhering to mask wearing policies. “Pro-maskers” will even go up to people in the grocery store to correct their mask wearing to make someone compliant. People that are “pro-maskers” say that wearing them helps the economy.
The fact is that paper or cloth masks do not offer the protection that people think that they do. They only protect in the range of 30-60% when they are worn loosely or have areas for air to get in on the sides or if hygiene is not practiced in addition to the mask wearing. The design of the current mask that people wear during the pandemic is really the culprit. It allows leakage around the mask and could potentially allow someone that has the virus to leak those airborne droplets outside to others. People do not follow the guidance that the CDC gives on the way to properly wear a mask. They do not wear one mask every time they enter a store. They hang masks on their mirrors, and they do not always sanitize their hands when they take the mask off and go from the car to the next store. People ride with their mask on in the car sometimes up and sometimes down which means that they have cross contaminated if it is down. The other fact is that there is not a lot of current studies on the use of masks in a scientific setting. A lot of the research now is in the form of an “observational study” because of the mortality” associated with the virus. The data on different masks was there before the pandemic but the media and others like Dr. .Anthony Fauci a long-time immunologist and the CDC have politicized the wearing of masks they are ignoring the statistical evidence on paper and cloth masks that existed even before this pandemic which discussed mask performance and materials used to make them based on the manufacturer’s recommendations. The CDC started this pandemic stating that masks do not work and that is because they were using the science and not the politics involved in the pandemic.
Masks could have more bearing on this pandemic provided that the people in the public wearing them followed the best practices that the CDC and other health agencies have put forth for wearing them. The guidance of single use wear, washing or sanitizing your hands between use. Not hanging them in your car on the mirror. Being mindful of what cross-contamination is. Ways to improve would be to educate the public more on how to properly wear them and the other parts of prevention that goes along with their use. As a country people need to consider having medical supply companies work on researching a better mask for pandemics in the future that gave more coverage, are cost effective, and filtered a virus size that the Covid-19 one is.
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Chughtai, A. A., Seale, H., & Macintyre, C. (2020). Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(10), 1-5. https://dx.doi.org/10.3201/eid2610.200948.
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Richley, Gregg CSHM Personal Interview 11 April 2021
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