Covid-19: A case for why we all should wear homemade face masks

The spread of the Covid-19 virus will slow down if everyone wears homemade face masks when going out in public or when caring for a potential Covid-19-positive relative in their household.

Homemade face masks will prevent asymptomatic and pre-symptomatic people from spreading droplets containing the virus. When you speak, there are always droplets coming out of your mouth, as reported by Jon Cohen in Science magazine. But mask-wearing should not replace other physical-distancing, hand-washing, self-isolation or lockdown measures.

The World Health Organisation (WHO) has issued information on how, who and when to use a face mask and what to do with it afterwards. At a media briefing on Monday, 30 March, to update the public on the Covid-19 pandemic, the WHO said the sick, caregivers, and front line health care workers should wear masks. But the organisation is reviewing its position on the use of face masks.

There are several misconceptions about face masks that might put everyone at higher risk. Some of these misconceptions are well intended, in that they aim to maximise the availability of medical masks for medical personnel. It has also been observed that nonmedical people do not know how to wear and handle face masks, putting themselves at higher risk. These factors result in the public being actively discouraged to wear all types of masks. This is a fatal mistake. As Jeremy Howard notes in the Washington Post: “There are good reasons to believe DIY masks would help a lot.”

By limiting medical face masks to be used exclusively by medical personnel, the availability problem is addressed, but there are other benefits that are missed out on. Although non-medical people may currently not know how to wear and handle homemade face masks, they can learn to do so. We will soon have a situation where an increasing number of non-medical people will have to care for Covid-19-positive individuals in their households and training everyone in the best practices is imperative.

The primary benefit of wearing a homemade facemask is the protection of others. The secondary benefit is the protection of yourself. My mask protects you — your mask protects me. We should all consider the possibility that we might already be infected, but are not showing any symptoms, and that we might actively be infecting others, as posited by Tomas Pueyo

Any barrier between your hands and your face will have a benefit, according to David Price, an intensive care unit pulmonologist, who is currently treating Covid-19 patients. 

Countries able to contain the virus

Hong Kong, Singapore, Japan and Taiwan have all been able to contain the virus. In all these countries, people have been wearing face masks for weeks now, as noted by James Myburgh. The public Covid-19 posters in Hong Kong prominently display the use of face masks when in public. Taiwan is producing 10-million masks each workday. Taiwan does not have enough cases to appear on the Financial Times’s graph tracking the spread of Covid-19. Mask-wearing among the general population was not adopted in Italy, the United States, Germany, Spain, France and South Africa. In fact, it was actively discouraged in the US, United Kingdom and South Africa.

Wearing masks in public has been mandatory in the Czech Republic since March 18 2020, and the effects of this directive should be studied closely. Now more than a week later, the country has a high level of compliance. As of March 29, the known cases were growing at an average of 14% a day since March 23. As of March 29, there were 2 743 known Covid-19 cases and 16 deaths in the country, making the death rate by known cases 0.58%.

Should the general public wear masks?

According to a medical expert, “The evidence is that, as masks dampen with prolonged wear, they become quite good at conveying viral particles deposited onto their surfaces (both inside and out). Also, based on observation, most people do not use masks effectively. They also tend to touch the mask more often, to adjust it or for eating and drinking, potentially depositing virus onto the surfaces. 

“Consequently, the [authorities’] view is that members of the public should not use masks because they will derive no benefit from them. They may even increase their own risk. Therefore, masks out in public really aren’t that helpful, unfortunately,” he said. “You are right to highlight the dangers of transmission in a care setting. The close and prolonged contact that such care necessitates results in significant risk escalation. We estimate that 80% of transmissions occur in the household settings.”

One way to practice to not touch your face would be to wear a homemade face mask at home, seen in David Price’s video. The face mask will make you more aware of when you touch your face. This behaviour needs to be practised long before you wear a homemade facemask in public, or long before you need to care for a Covid-19 patient in your household.

Making masks

During the lockdown, the intention is for you to go out only to buy food or medicine. This should be a short mission, during which you can avoid the risks of wearing a mask for a prolonged period. There should be no eating or drinking during this mission. When you go out, put on a clean, homemade mask and focus on not touching your face. When arriving home, take off the mask and wash both your mask and your hands with soap and water.

Masks can be made from a variety of readily available materials. T-shirt and pillowcase material have been shown to adequately filter droplets and have good breathability, according to a 2013 research paper by Anna Davies et al. In poorer countries, where physical distancing is more difficult, people still have access to T-shirts. 

Anyone can wear a T-shirt as a mask. A T-shirt head opening can be worn at eye level, with the sleeves tied behind the head. Make sure that you cover your chin with the mask. There is also a proliferation of DIY face-mask solutions on the internet. 

Comparing individual and group benefits

Although there is a benefit to the individual wearing a homemade mask in public, one should really consider the benefit if everyone followed this practice. If everyone wears masks in public and everyone practices rigorous hand hygiene, fewer surfaces will be contaminated and the likelihood of hand-to-face contamination will be reduced. As more people take these measures, the benefit will be compounded. This benefit should be modelled mathematically in the same way that lockdown measures were modelled in The Washington Post article by Harry Stevens.

By making it compulsory for everyone to wear homemade masks in public and by creating awareness of proper mask-wearing practices, the growth in Covid-19 infections will be slowed down, without putting medical staff at risk due to a shortage of medical masks. 

Piet Streicher has a PhD in Engineering and is the managing director of BulkSMS. 

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