What I learned about face masks

Not a stranger to the surgical  mask, the last six months have been pretty taxing in terms of extreme caution. Throughout this time, I have used medical-grade FFP3, FFP2 and surgical face masks as well as made  homemade masks. From my first feeble attempts of mask sewing to making batches of them. And here is what I learned about face masks.

Masks mean protection!

This post is not about why and when you should wear a mask.  There is plenty of information about this already! This post about is what I learned about face masks – and which ones worked best in everyday life. Even the WHO has now recognized face coverings are crucial in preventing spread of the SARS-CoV2. They recommend you wear one to protect others. Most information published online focuses on wearing face masks to reduce transmission from oneself to others,  but I also firmly believe they protect the wearer significantly.

The grip of mask fatigue

Why am I writing this? Where I live, there is a severe mask fatigue going on right now. This means masks are not worn at all, or not properly. My heart sinks every morning when I open the door  and see at least 30% of people in the waiting area not wearing their masks correctly.  This is in a hospital area with very little natural ventilation. And in a specialty that sees disproportionate numbers of upper airway infections. I see mask-free faces looking at me, and as much as hate to admit it, compassion sometimes goes out of the window.

You cannot imagine how tired  I get of the blank looks or stupid excuses of the mask-free. This is happening again and again and again every day for the last four weeks.  All I manage is a tired “Please can you make sure you wear your mask correctly.  It is required by law!” I have even been verbally assaulted, and no doubt will get some complaints sooner or later.

I admit I try to see  mask-free patients faster, thinking they are probably lax with their hygiene. And therefore more prone to carrying the virus.  Having neither the time nor the energy to explore the reasons for their mask-free faces, I have somewhat given up.

And I do not want to quote paper x,y, and z.  And explain every single time why the masks are important. Sometime it should be just enough to say the masks protect others  – and the wearer, too.  So just please wear one where it is required?

But okay, that little rant just wanted to see the light.  Here is  what I learned about face masks…

What I learned about face masks: Medical Grade Masks

When we had the first cases in early March, all we had was surgical masks. Oh, and very low test capacities. It was really scary.

However, I unwittingly had close contact at work with someone who had the test at the insistence of his employer and tested positive for COVID-19 three days later. I was performing an endoscopy in someone who had symptoms not consistent with COVID-19, but obviously the endoscopy was necessary, the alternative option being a CT scan and in these early days, we knew so little about the virus, we wanted to be careful but not neglect our patients, either.  That was my last endoscopy for months, as soon after the data from China came out how our specialty was among the most affected with COVID-19… call it plain luck, call it good breath holding…

Since then, I have become less scared, knowing that  my surgical mask protected me. There are other anecdotal cases like mine. Anyway, Neither myself nor some of my colleagues fell ill or became infected even when using suboptimal protection – the only protection we had at the time, combined with meticulous hand washing.

Surgical Face Masks

Usually have no FFP grading but effectively keep bacteria and some viruses away. They are effective in most medical activities. After years in medicine, I only became accustomed to the FFP high-filtering masks during the swine flu epidemic some years ago. They do have their place in healthcare, but you absolutely do not need them in everyday life where masks are called for. Besides, they create some completely new waste issues – cotton buds, single use coffee cups and cutlery are now so yesterday when it comes to bad waste candidates.

However, there are now exceptions. Some airlines demand you wear them on flights. Air France is one example. I was made to wear one during  a course in a hospital – no cloth masks here! Sometimes I  prefer them on full public transport, as cloth does not have a filtering certification. I have no doubt that they will protect  from virus entering your airway way more than any flimsy piece of loosely woven T-shirt material will. So in situations that feel a bit crowded, I will wear a surgical face mask. And I always carry one or two spares. It is not recommend but I wash mine and re-use them. The average mask survives 2-4 washes before it gets too ragged to wear.

Because I always wear mine with the same side inside, I also re-use them after drying them. Again, this is not recommended practice especially if the inside and outside can easily become confused – you do not want to unwittingly wear the masks outer side against your face!

FFP2 Masks

FFP stands for “Filtering Face Piece” and is a commonly used standard in Europe. FFP2 is the minimum recommended filtering grade for working in close contact with SARS-CoV-2, and I may have gone through ten different brands and manufacturers as masks were supplied in small batches whenever some could be bought. In the meantime, you can purchase them freely in Germany and parts of Europe. They need to sit tight to work, too, and a leakage of up to 8% is permitted to classify them as FFP2. They filter oil- and water- based particles, but not radioactive particles, enzymes or category 3 agents.

KN 95 MAsks

KN95 is a standard from China which is similar to the American N95 standard of the National Institute for Occupational Safety and Health. They use a polypropylene filtering fleece and in terms of protecting from the SARS-CoV-2, are considered equal to the US-American N95 Standard but use slightly different certification criteria. KN95 is now the most widely available high filtering mask here in Germany.

FFP3 Masks

They are really hard to wear for more than a few hours, and I admire every one who puts up with them. When I started my work on a hot site, they were all we could get, and there was some re-usage. They must sit very tight and after a few hours, you will inevitably sweat, and if you have sensitive skin, you may well get the mask stigmata which seemed so fashionable on Instagram for a short while. IN addition to filtering particles of the FFP2 category, they also filter enzymes, radioactive particles and Category 3 agents. Their leakage is up to 2%.

What I learned about face masks: Cloth  Masks (“Community Masks”)

I started to make them early using fabric I already had and some knicker elastic I got from my colleague. Basically I made three types: The pleated surgical style mask, the 3D mask and the muzzle type mask. I haven’t bought  a single mask yet, so I have no experience with anything shop bought. I made all my masks on a deadstock Bernette “Happy Stitch” machine that I bought for 75Euro, as my sewing machine decided to have a motor failure just in time for the pandemic.

Pleated surgical mask style

The first mask I made was fusing the JoAnn tutorial  . It is the fastest one  – if you cut a cardboard template and pin the pleats freestyle. The 6x9in (15x23cm) measurements looked a tad on the small side for me. I wanted a big old face covering that would take care of my double chin, too, so increased it to 18x24cm which is a bit too big. The problem with this one is that the elastic/ties are sewn in and cannot be replaced/adjusted easily.

So I changed to a different style and video tutorial  where I used an 18x25cm outer and 18x19cm inner layer, which makes for a really good-sized adult mask. The video is in Thai  – but it doesn’t matter as it is excellent and the video is pretty self-explanatory

The 3D Face mask

This one folds up really nicely. I initially made it because I wanted to make something with an easy filter pocket. I used this video tutorial. It is in Thai but really well made and the instructions are self-explanatory.

The “Muzzle”

I’ve shied away from them because they looked too Hannibal-Lecter-y but at the request of certain people, I had a go. I used this video tutorial and the measurements are just right for an adult size. It also makes a two-layered adjustable mask and is very easy to make, but take a few steps more than the pleated style. I still don’t like the look much and don’t find them comfortable when speaking, but they do leave more room around the mouth and allegedly there’s less lipstick smearing – if anyone bothers with lipstick under a mask?

Adjustments

I made some size adjustments to the pleated style and for me, an 18x25cm piece of fabric works fine if I make tunnels for elastic on each side, otherwise 18x23cm might suffice. At first when shops where closed here, elastic was to be had at astronomical prices online, so I used whatever I had at home (gift ribbon, knickers elastic, thin elastic, you name it) and I am switching to “ear fluff” special mask elastic which has magically appeared in fabric shops here in Germany and online.

With the patterns I use, I had very little issue with my glasses misting up. I did make one mask where I incorporated a pocket for a nose wire, then inserted one of those freezer bag wires. The mask sits more snugly round the nose, but that wire pocket really messes with the pleating. I wear rather large glasses, it might be advisable to trial nose wires if your glasses are very small.

Also, I find style where you create a tunnel for the elastic more practical. You can shorten the elastic and replace it. I found that most useful as I used pretty much anything elastic at first and replaced it with proper fleecy ear loop elastic once it became available.

Materials

Fine, densely woven cotton works best. Like  quilting cotton, high thread count bed sheets or high quality shirting.

You can purchase quilting cotton in fat quarters (50x55cm). This will make one  generous  sized mask. I usually buy a half metre, which makes at least four masks.  I used a new, nice looking fabric for the outer  and one of my husbands shirts  for the inner layer.

Some of my masks are made from Dutch wax fabrics which has a dense weave it it is good quality – like the Vlisco used in the orange masks.

Usually I try to use off-cuts and smaller pieces of what I already have. I have also used  thick cotton  from  old work trousers where I  loved the fabric. But it is rather thick and less easy through breathe through than a cotton lawn. If you make a two-layers mask with a finer cotton inner, that might work, but for a four-layer mask (two layers plus filter pocket) you want to test that you can still breathe comfortably through the four layers.

I am sewing some home stuff in  linen so I will use the off-cuts for outer mask layers as well but still use a densely woven cotton for at least two layers of inner, as linen is quite loosely woven and in this case, purely decorative.

Man made fabrics?  Forget them. You want natural fibres  in your face only. I was given a mask by work from thick polycotton, similar to work wear trouser material. I only keep it in my work bag for emergencies, as I really do not like the feel of the fabric on my face. Also, its a tie style, and my already not great hair always looks a mess under it.

Liberty Tana Lawn and similar

My absolute favourite in terms of handling and comfort is Liberty (cotton) Tana Lawn. I’ve searched online but was unable to find a thread count, but these fabrics are made from very fine long mercerised cotton yarn and are woven really tightly, making this a great fabric for lightweight clothes and yes, masks. The Liberty website says wash the cotton at 40 Celsius. Now to be honest I only wash work clothes anything higher than 40 Celsius and I do collect my cloth masks for a week or so, by which time most bacteria/virus particles on the fabric should be non-viable, so I do not boil or hot wash them.

The fabric washes beautifully. I remember my first Liberty fabric (red “Ianthe”) which I made into a vest top in 1991 – after many washed, the fabric still looks like new. It is a dream to sew with – lightweight, supple, yet doesn’t slip.

I stocked up on “Second Quality” (which to my eye looked perfectly fine) at 13 pounds per metre at Classic Fabrics on Goldhawk Road on my recent trip to London. They are on 44 Goldhawk Road and are my all-time favourite shop on Goldhawk Road. They will always have  a huge choice of genuine Liberty fabrics as well as some cheaper Liberty-like fabrics. This time O found some cotton lawn from William Morris in superb quality at 9 pounds a metre but haven’t put it through the wash yet.

Antimicrobial finish fabrics

They are around, but I have not used them. The main reason I have stayed away from them is because they are  synthetic fibre. A highly popular one in Germany is Albstoffe Shield Pro . It is made from Trevira-Bioactive. Not even the Trevira website would reveals what fiber that is, but trust me, its man-made and I think its some kind of polyester. It is also not certified as virucidal, and at 30 Euro per metre it is bloody expensive for a man made fabric so I am not gonna buy it. Albstoffe also has an antibacterial organic cotton with Santitized® nanofibre treatment which is antibacterial and dust mite-proof but not antiviral.

Another one is Silvadur by Dupont, which is essentially a silver ion treatment that can be applied to a range of synthetic and natural fibres.

What I use

At work, I use FFP2 masks  90% of the time, which means I spend 8-10 hours a day with an FFP2 mask on. I have suffered no ill effects internally or externally. So I can confirm they are absolutely fine to keep on for a longer period of time.

I wear one of my homemade masks outside work where face coverings are mandatory – in shops, restaurants, public transport, etc. However, there are situations when I prefer a medical grade face mask. Travelling with luggage or walking a lot/changing on public transport is such a situation – I keep the mask on for the entire trip, and I don’t mind if I lose them. I always use repurposed masks from work – instead of disposing mine, I wash them in a hot cycle and reuse them. Mine stand about 2-3 washes before looking so ratty and the nose wires comes off and the elastic fails so then I dispose them. Do this at your own peril as there is no evidence either way whether reused face masks have identical filtering properties as new – they are obviously a single-use product but I hate how much waste they create so I reuse them.

There are some situations where I do not feel safe with a community mask. So I carry an emergency FFP2 mask. I have so far used it on full long-distance trains with shoddy air-conditioning where fellow passengers did not wear masks, on a full airplane, in airports – and on the London Underground initially.

Mask Issues

To be honest: none that keep me from wearing one. I do notice with any thicker mask (FFP3, four-layer thick cotton) that I get slightly out of breath on exertion.

What about the dreaded “Mask Mouth”?

Um, yeah, it is certainly easier to notice if you have bad breath… Exhaling generously through your mouth, then inhaling through your nose.  Ugh, I get it. The answer: try to breathe through the nose, which prevents mouth dryness, drink enough water and perform meticulous dental hygiene. I sometimes joke that people who let their nose hang free probably don’t want to to smell their own breath. The good news: Less garlic/cigarette breath from others!

Mask Acne, Rosacea, Eczema

Another widely reported side effect of mask wearing. Again, most people do fine. There are a lot of professionals who wear surgical masks half the day before the pandemic. Having last had acne in my Twenties, I now tend to get dry skin.  This I keep in check with a good moisturizer. In fact, my moisturizer is quite heavy. I use Aesop Elemental Facial Barrier Cream, Embryolisse Lait-Creme and Weleda Skin Food. Other than my usual dry skin, I have not suffered any ill effects from the mask at all.  I rarely wear makeup and don’t bother my skin much with products other than facial soap, toner and moisturizer. And all my cloth face masks are natural fibers, and I wash with some eco laundry detergent.

I think we are certainly not done with the masks for a long time. now is  the time to choose a mask that is right but sustainable. I hope this post helped. If you have any tips, especially on good fabrics for masks, and good fit patterns, please let me know!

Disclaimer

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