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Face masks, in general, are scientifically proven to aid in slowing down the transmission of SARS-CoV-2 that causes COVID-19. Furthermore, face masks, together with other preventive measures such as getting vaccinated, frequent hand-washing and physical distancing, can help in reducing the numbers of infected patients. (Source: Pexels.com) Face masks can be categorized as Surgical or Medical face masks, N95 respirators, and cloth face masks. It must be noted that surgical face masks and respirators are usually used as protection against respiratory and other infections. Surgical masks are utilized in both healthcare and community settings to block droplet infections and protect from infectious components such as splashes and sprays of blood and body fluids. It can also serve as a source control for they can be used in order to control the spread of the virus from infected or asymptomatic patients. Respirators, on the other hand, are completely fit around the face and are designed for heavy respiratory protection in healthcare settings. However, as a result of the COVID-19 pandemic, Shortage of supplies in face masks, especially the surgical or medical face masks and N95 respirators, became a global problem.  With that, the Centers for Disease Control and Prevention (CDC), together with the World Health Organization (WHO), recommend the use of homemade, cloth, or fabric masks for the general public. Due to the shortage of supplies, the CDC and WHO strongly recommend  that surgical masks and N95 masks should be reserved for health care providers as well as for anyone who has or may have been infected with COVID-19 or who is caring for someone who has or may have COVID-19. Hence, the question now is how effective are homemade, cloth, or fabric masks in protecting against SARS-CoV-2? This article will provide an insight on the scientific data on the effectiveness of homemade or cloth face masks against COVID-19.  What are Homemade or DIY Cloth masks? (Source: Pexels.com) A homemade mask serves as an alternative to surgical masks or respirators that are designed in order to trap respiratory droplets that are released into the air when the wearer talks, coughs or sneezes. In addition to that, it serves as a protective barrier in order to protect the wearer from inhaling droplets released by other people that may possibly have infectious pathogens. The most effective homemade masks are commonly made of effective fabrics such as tightly woven fabrics like cotton and cotton blends, are breathable, and have at least two or three fabric layers. A homemade mask with several layers will stop more droplets from getting through the mask or escaping from it. Lastly, less effective homemade masks are usually single layers that are made of fabrics that are loosely woven like loose knit fabrics. What does science say about Homemade masks? A study by MacIntyre et al. in 2015 compared the efficacy of locally manufactured and double-layered cotton cloth masks to medical masks. The study showed that the rates of infection were consistently higher among those in the cloth mask group than in the medical mask and control groups. This finding suggests that those who wear cloth masks have higher infection risks. Researchers have concluded that the poor performance may have been a result of the lack of washing the masks frequently or because of the moisture and contamination to the cloth masks. It is good to note that for this study, both surgical and cloth masks were utilized by some participants in the control group, but the findings of poor performance of cloth masks continued in post hoc analysis when the data of all participants who used medical masks from both the control and the medical mask groups were compared with all participants who utilized only a cloth mask from both the control and the cloth mask groups. Several studies also examined the filtration capacity of homemade or cloth masks. This includes the study of Chungtai et al. in 2013 who found out that the effectiveness of cloth masks in filtering out microorganisms is commonly lower compared to that of medical masks and N95 respirators. Furthermore, the same researchers were also able to conclude that the filtration effectiveness of homemade or cloth masks are greatly dependent on several factors including thread count, number of layers, fabric type, and resistance to water or blood. In addition to that, van der Sande et al. in 2008 tested surgical and homemade masks for their ability to block bacterial and viral aerosols. Although less than that of medical or surgical masks, their findings confirmed that homemade masks are able to block microbial and respiratory droplets. Furthermore, their study also showed that homemade masks produced out of cotton give better protection compared to homemade masks made out of gauze. Researchers strongly recommend that homemade masks should fit snugly against the face to increase its filtration capacity and total effectiveness.  Scientific Recommendation on Usage of Homemade Masks During the COVID-19 Pandemic The primary transmission routes for SARS-CoV-2 are thought to be close contact and inhalation of respiratory droplets. With that, the WHO highly recommends wearing medical masks during routine care and using respirators during aerosol-generating procedures and other high-risk situations. Ideally, all frontline healthcare workers are mandated to use N95 respirators. However, due to shortages during the COVID-19 Pandemic, the CDC later recommended respirator use for high-risk situations only and that healthcare workers could utilize a surgical mask but may be at increased risk if they choose to do so. Therefore, evidence supports that surgical or N95 respirators should be reserved for healthcare workers.  For the general public, the CDC and WHO recommends the usage of homemade or cloth masks that have filters in them. However, they should be utilized only as a last resort when medical or surgical masks are not available for public use. This is recommended because homemade cloth masks can be produced in large quantities in a short time. They can also be reused after being decontaminated by several techniques such as washing in hot water with soap, using bleach, isopropyl alcohol, or hydrogen peroxide, autoclaving or microwaving, and application of ultraviolet radiation or dry heat.  (Source: Pexels.com) Furthermore, as stated above, it must be noted that the protection offered by homemade cloth masks are greatly dependent on proper mask use as well as by selection of fabric and design of the masks for water or blood resistance, filtration, and fit. A study conducted by Konda et al. in 2020 has shown that homemade masks made with multiple layers with water-resistant fabric, high thread counts, and finer weave offer more protection compared to homemade masks that are single-layer with no filters. The CDC and WHO also strongly recommend that fit should be ensured in homemade masks to make sure that it can offer a higher degree of protection. Poorly fitted homemade masks produce gaps on the sides that can cause air to flow through the gaps instead of flowing through the masks. This results in poor effectiveness in blocking possible infectious contaminants in the air.  In social and public settings, the WHO and CDC recommends the usage of homemade masks in two different ways. First, they may be utilized by sick persons in order to reduce the transmission of infection. This is termed as source control. So in areas of high transmission that have low supply of surgical or medical masks, homemade masks can be used as a source control which may prevent spread of infection from persons with asymptomatic, presymptomatic, or mild infections. Second, homemade face masks may be utilized by healthy individuals in order to protect them from being infected with respiratory droplets that may possibly carry infectious pathogens. A randomized controlled trial conducted by MacIntyre in 2015 actually has shown masks in general to be effective in closed community settings, with and without the practice of hand hygiene. With that, universal face mask use, whether medical or homemade, may be beneficial especially in settings where differentiating asymptomatic from healthy persons in the community is challenging. At the end of the day, the general public should be educated about homemade cloth mask use because such masks may provide users a false sense of protection. Wearing a face mask, staying at home if possible, observing social distancing, practicing hand hygiene, and taking a vaccine  are still the best ways in order to protect oneself from being infected with SARS-CoV-2. Hence, wearing a homemade mask is only one of the strategies that can help all of us to end this pandemic once and for all.  References: Centers for Disease Prevention and Control. 2021. Guidance for Wearing Masks. Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html. Retrieved on 13 May 2021.  Chughtai  AA, Seale  H, MacIntyre  CR. Use of cloth masks in the practice of infection control—evidence and policy gaps. Int J Infect Control. 2013;9:1–12. Konda  A, Prakash  A, Moss  GA, Schmoldt  M, Grant  GD, Guha  S. Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano. 2020;14:6339–47.  MacIntyre  CR, Chughtai  AA. Facemasks for the prevention of infection in healthcare and community settings. BMJ. 2015;350(apr09 1):h694 MacIntyre  CR, Seale  H, Dung  TC, Hien  NT, Nga  PT, Chughtai  AA, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open. 2015;5:e006577 Mayo Clinic. 2020.How Well Do Face Masks Protect Against Coronavirus?. Retrieved from: https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449. Retrieved on 13 May 2021.  University of California San Francisco. 2020. Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus. Retrieved from: https://www.ucsf.edu/news/2020/06/417906/still-confused-about-masks-heres-science-behind-how-face-masks-prevent. Retrieved on 13 May 2021.  van der Sande  M, Teunis  P, Sabel  R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One. 2008;3:e2618 World Health Organization. 2020. Coronavirus Disease (COVID-19) Advice For The Public: When And How To Use Masks. Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks. Retrieved on 13 May 2021. 

The Covid-19 has halted the world. Other than causing deaths of millions and draining the economy, the pandemic also changed the way our daily life activities go. From being able to enjoy the outside and see the world, we had to stop and stay in our spaces inside our homes.  After more than a year since the Covid-19 health crisis started, we are now accustomed to the fact that we have to wear face masks in order to be protected against the infectious pathogen. However, even after all this time, there are still debates on what face mask one should wear in order to be provided with adequate protection and comfort both at the same time. While one would argue that it should be surgical masks, another would disagree because he thinks it should be home-made or cloth masks.  So to put an end to this debate, here is the difference on the effectiveness of surgical masks and home-made or cloth face masks.    (Source: Pexels.com)   A surgical mask is a loose-fitting, disposable device that produces a physical barrier between the mouth and nose of the wearer and possible pathogens in the direct environment. Surgical masks are heavily regulated by organizations such as the American Society for Testing and Materials  (ASTM). If worn properly, surgical masks can help in blocking almost all large-particle droplets, splashes, sprays, or splatter that may contain contaminants, keeping them from entering the wearer's nose and mouth. Also, surgical masks are effective barriers for retaining large droplets released from the wearer's mouth and nose.   Surgical masks are produced using a variety of materials with different thicknesses and different abilities in protecting you against contact with respiratory droplets. Most surgical masks are manufactured through the combination of three various layers of nonwoven fabric with each layer having a vital function. The outermost layer is the waterproof layer which helps in keeping out fluids including mucosalivary and respiratory droplets. The middle layer is the filter. The middle layer has the ability to block particles or pathogens above a specific size from penetrating in both directions. The innermost layer is the absorbent layer. Absorbent materials are utilized in order to confine mucosalivary droplets from the user. The innermost layer also improves comfort through absorbing the moisture from exhaled air. When combined together, these three layers effectively protect both the user and the surrounding people by reducing the penetration of particles and pathogens in either direction. The comfort, breathability, and filtering capacity of surgical masks are greatly dependent on the properties of these materials that were utilized in manufacturing the mask. It must be noted that due to the materials used, surgical masks are not intended to be reused and should only be utilized once. With that, if your surgical mask is soiled or damaged, or if breathing through the surgical mask becomes hard, you should remove the face mask, discard it safely, and replace it with a new one. Unlike Home-made or cloth masks, surgical masks undergo the scrutiny and testing of the ASTM. The ASTM is responsible for setting the standards for surgical masks. The ASTM F2100, the current standard for surgical masks, reviews 5 basic criteria. These include: Bacterial Filtration Efficiency (BFE) - the ability to filter bacteria; Particulate Filtration Efficiency (PFE) - the ability to filter sub-micron particles Fluid Resistance - the ability of the surgical mask to prevent fluid penetration from the mask to the wearer; Delta P (Pressure Differential) - the measurement of how comfortable, light, and breathable a mask feels; Flame Spread - the ability to withstand exposure from flame. In addition to these criteria set by the ASTM, skin sensitivity and cytotoxic testing for surgical masks should also be done by the ISO (International Organization for Standardization). This is important for it makes sure optimal comfort is achieved and the risk of adverse reaction from surgical mask materials and surgical mask usage is greatly minimized. If the surgical masks passed these quality checks, certification will be provided by the ISO. The filtering capacity, which depends significantly on the materials and engineering design utilized for making the mask, dictates the level of protection that the surgical mask can offer against pollutants and pathogens. With that, surgical masks are greatly effective in filtering out viruses such as SARS-CoV-2 that has a size of approximately 60 to 140 nm. Unlike those masks made of materials with larger pore sizes such as those made from cotton and synthetic fabric, surgical masks are tested and proven to have filtering capacity for matter smaller than that of viruses and other microorganisms. The effectiveness of surgical masks can be categorized as ASTM level 1, 2, or 3. Level 1 Surgical masks are ideal for scenarios where low amounts of fluid, spray and aerosol are produced. Level 2 Surgical masks are for procedures where moderate amounts are produced and Level 3 Surgical masks are ideal for surgery. Home-Made or Cloth Masks (Source: Pexels.com) Unlike surgical masks that undergo standard checks to provide maximum protection against airborne pathogens, home-made masks do not undergo the scrutiny of internationally recognized quality assurance bodies. Hence, cloth masks are the most permeable and offer the least protection. A home-made mask acts as a reusable barrier to protect the wearer from inhaling droplets released by others. It is intended to trap respiratory droplets that are released when the wearer talks, coughs or sneezes. Cloth masks are commonly retained long term and reused a number of times, with a variety of cleaning methods and widely different intervals of cleaning. There are many materials to utilize in order to make home-made masks. These include cotton and silk, among others. The most effective home-made masks are those that have multiple layers of tightly woven fabric like cotton. A home-made mask with several layers is better in preventing the respiratory droplets from getting through your mask or escaping from it. Other people also make cloth masks that have filter slots so that it can have an additional protective layer. Furthermore, home-made masks are made of flexible material. Hence, they can tightly cling on to your face which removes gaps, such as those in the side of your face, which reduces the risk of pathogens possibly entering these spaces. Cloth masks are frequently utilized in resource-poor settings because of the reduced cost of a reusable option. Several types of cloth masks, including those made of cotton, gauze and other fibres, have been tested in many in vitro studies in the past. Findings show lower filtration capacity compared with disposable surgical masks. However, it must be noted that studies also showed that the protection offered by home-made or cloth masks increases with the fineness of the cloth and the number of layers, indicating potential to develop a more effective cloth mask, for example, with finer weave, more layers and a better fit. The Verdict Findings of studies showed that all types of masks reduced aerosol exposure, relatively stable over time, unaffected by duration of wear or type of activity. Many studies conclude that any type of general mask, whether surgical or home-made cloth masks, is likely to decrease viral exposure and infection risk on a population level, despite imperfect fit and imperfect adherence. This is because it is always better to have some form of protection than have nothing at all. However, multiple evidence show that the filtration, effectiveness, fit, and performance of home-made masks are significantly inferior to those of surgical masks and respirators. With that, the scientific body does not recommend home-made or cloth masks for use in healthcare settings, whose workers should as a priority be given proper respiratory protection through surgical masks or N95 respirators. Therefore, cloth mask use in the community is only advisable in certain situations such as when surgical masks are unavailable. If the supply of surgical masks are low, one can improve the protection provided by home-made masks through selecting appropriate material, adding a number of layers, and utilizing those with a design that offers better filtration and fit. References: Howard, J. (2021, January 26). An evidence review of face masks against COVID-19. PNAS. https://www.pnas.org/content/118/4/e2014564118 Chughtai AA, Seale H, Macintyre CR. Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(10):e200948. doi:10.3201/eid2610.200948 Seongman Bae, Min-Chul Kim, Ji Yeun Kim, et al. Effectiveness of Surgical and Cotton Masks in Blocking SARS-CoV 2: A Controlled Comparison in 4 Patients. 2020. Ann Intern Med. 173; W22-W23. Doi: 10.7325/M20-1342. U.S. Food And Drug Administration. 2021. N95 Respirators, Surgical Masks, and Face Masks. Retrieved from: https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks. Retrieved on 26 April 2021. Popular Mechanics. 2021. Cloth Masks, Surgical Masks, or Double Masks: Which Are Safest?. Retrieved from: https://www.popularmechanics.com/science/health/a35290705/which-face-mask-is-best-for-covid-protection/. Retrieved on 26 April 2021. Johns Hopkins Medicine. 2021. Coronavirus Face Masks & Protection FAQs. Retrieved from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-face-masks-what-you-need-to-know. Retrieved on 26 April 2021.