During the early days of the coronavirus pandemic, the U.S. Centers for Disease Control and Prevention and World Health Organization made it clear that, unless you're sick or are a medical professional, you do not need to wear a face mask.
On February 29th, U.S. Surgeon General Jerome Adams tweeted: "Seriously people- STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!"
Adams' message comes with good intentions. With COVID-19 cases soaring, doctors, nurses and other frontline health-care workers confront a severe shortage of masks — and cautioning people against buying them can help offset the problem.
Last week, George Gao, director-general of the Chinese Center for Disease Control and Prevention, told ScienceMag.com that the "big mistake in the U.S." is that people aren't wearing masks. "This virus is transmitted by droplets and close contact. Droplets play a very important role," he said. You've got to wear a mask, because when you speak, there are always droplets coming out of your mouth."
Gao has done significant research on viruses that have fragile lipid membranes called envelopes — a group that includes SARS-CoV-2 (the virus that causes COVID-19) — and how they enter cells and move between species.
"Many people have asymptomatic or presymptomatic infections," he continued. "If they're wearing face masks, it can [help] prevent droplets that carry the virus from escaping and infecting others."
In recent days, it appears that U.S. authorities are realizing they should have encouraged mask-wearing during the early stages of the outbreak.
Scott Gottlieb, former Food and Drug Administration Commissioner, said on Sunday in an interview with CBS News' "Face the Nation" that "people should be contemplating wearing masks. We should be putting out guidelines from the CDC on how you can develop a [cotton] mask on your own."
And on Wednesday, Adams told NBC's "TODAY" show that he has asked the CDC to investigate whether his earlier recommendation should change. (Current CDC guidance is that healthy people don't need masks or face coverings.)
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While homemade masks aren't as effective as medical-grade masks (like N95 respirators, which filter out at least 95% of airborne particles), researchers studying respiratory illnesses — including SARS, which is another form of coronavirus — have found that a simple mask can help lower the risk of infection.
It's important to note that wearing a homemade mask alone will not guarantee protection against COVID-19. But its effectiveness is better when combined with basic safety precautions, such as regular hand-washing and social distancing.
So far, U.S. health officials have not offered guidelines or regulations around homemade masks — and since commercially made ones are almost impossible to find, your last resort is just starting making your own.
Researchers analyzed 2008 studies from Public Health England (which evaluated a range of household materials that, in the event of a pandemic, could be used by the general public to make masks) to create a D.I.Y. guide.
"These studies found that T-shirts and pillowcases made into a mask using the design [below] may act as a barrier against influenza, or help limit spread by a person with symptoms," according to the study's authors. "We have no data on COVID-19, but it's not unreasonable to assume similarity."
They also stressed that "the wearing of face masks will only offer limited protected, and should not be considered as sufficient protection. Additional preventative measures need to be adopted."
Face mask template:
- Cutout of mask template above (sizing should be adjusted based on individual face measurements)
- Two washed 100% cotton T-shirts (or any tightly-woven, but breathable, fabric) in contrasting colors. Using two colors will help you remember which side of the mask is facing outwards (contaminated) and which is facing inwards (non-contaminated).
- Pen or marker
- 1.10 meters of flat elastic
- Needle and thread (or sewing machine)
Simplified version of step-by-step instructions:
- Place the template on a single layer of the T-shirt. Use a pen to trace and cut around the rectangle. Repeat with the second T-shirt.
- Place the two rectangles on top of each other. Using your needle and thread, stitch them together at each end, as indicated on the template by Seam A.
- You should now have a rectangle that is stitched at both ends, forming a loop. Turn the loop inside out and iron the seams flat.
- Stitch the fabric together at both ends, where indicated by Seam B. This will create two "tubes" at both ends of the mask.
- Cut the elastic in half, creating two lengths, each approximately 55 centimeters. Each length should be long enough to go around your head, from the bridge of your nose to the back of your head.
- Tie a loose knot at one end of the elastic to help feed it through the tube. Repeat for the other tube.
- To create the pleats, fold the fabric as indicated on the template (unevenly-dashed lines backwards, evenly-dashed lines forward).
- Iron the pleats flat and stitch both sides, as indicated by Seam C.
- Fit the mask so that it sits on the bridge of your nose and under your chin. Hold the elastic at the back of your head at a comfortable length so that it stays on. Mark the correct length and stitch the ends of the elastic to finish the mask.
- Wear your mask in the same orientation each time you use it (i.e., always wear the same side facing outwards).
- Masks should be machine-washed frequently using hot water and regular detergent. Dry at a hot setting.
- Remove your mask by taking the straps from the back of your head and pulling it forward.
- Wash your hands with soap and water before and after touching your mask.
Most people have the basic materials to make a mask right now. It's time to call forth the "can do" American spirit and encourage people stuck at home to start sewing.
Doing so can save existing stock for healthcare professionals as manufacturers ramp up production in the coming months. If you're healthy have any unused commercial or medical-grade masks lying around, consider donating them to local hospitals.
Instead of obsessing over ill-conceived mixed messages, let's starting viewing mask-wearing as an act of solidarity — and make it the new norm (at least until this pandemic over).
Nir Eyal is a behavioral psychology expert and instructor at Stanford's Graduate School of Business. He is the author of the best-selling books "Indistractable: How to Control Your Attention and Choose Your Life" and "Hooked: How to Build Habit-Building Products" and has written for Harvard Business Review, TIME and Psychology Today. Follow him on Twitter @NirEyal.