Mask up: the hows and whys of wearing a non-medical mask

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Get used to wearing a mask. And make sure you wear it properly.

Last month, two friends of mine in different cities reported being mask-shamed for wearing clearly non-medical masks in public (one homemade and one bought from a convenience store). They said they were accused of keeping much-needed medical supplies from front-line workers.

The reactions were ridiculous then. They are nearly unthinkable now.

Over the last month, the conversation has shifted. Slowly, the idea that we should be wearing masks when we go out is starting to gain normalcy.

How did we get here?

On April 6, during the federal government’s daily briefing, Canada’s chief public health officer, Dr. Theresa Tam, cautiously endorsed wearing masks in public as a way to cut down the possibility of spreading novel coronavirus infection. Citing recent studies on viral load and asymptomatic transmission, she said:

“We have to take the evolution of the evidence as rapidly as possible. So the viral load studies show that yes, people just before they develop symptoms have high viral loads, and that tells us there is the possibility they can transmit…

And so we very rapidly tried to integrate that latest science on the area of wearing masks to protect others. What we are talking about is non-medical masks…

Canadians can take this additional measure in instances where social distancing is difficult to maintain… This may add a layer of protection to protect you from transmitting to others before you know you have the illness.”

As André Picard wrote that same day in the Globe and Mail:

“The advice about masks is changing because our knowledge of the coronavirus and how it spreads is evolving. That’s how science works.”

This was all too much for some pundits, who took to their keyboards to excoriate Tam. Picard’s Globe and Mail colleague, columnist Robyn Urback, led the way, accusing Tam of flip-flopping on this important issue:

“Dr. Tam has backtracked before – on the risk posed to Canadians by COVID-19, on the usefulness of travel restrictions and, now, on the efficacy of masks for asymptomatic individuals. And while we can’t expect health authorities to be omniscient, we can expect them to be direct, to explain their work, to produce their evidence and to offer some humility when they get things wrong. That can go a long way in establishing, or repairing, trust. Dr. Tam has some work to do.”

On April 8, Picard, perhaps the country’s top health reporter, took to Twitter to argue Tam had not flip-flopped on masks. Saying he usually reserves his opinion for columns instead of tweets, he went on:

“On masks, Dr. Tam has said the same thing since day 1: They do not protect wearers from infection, they can provide a false sense of security and, because of short supplies, surgical masks and N95 respirators should be reserved for medical personnel. All this remains true…

“Critics of Dr. Tam argue there were reports of asymptomatic transmission back in January. True, but you don’t change policy based on a single study. And imagine what those same critics would have said if @CPHO_Canada had called for mask-wearing 12 weeks ago? ‘Hysterical…’…

“Changing your mind in changing circumstances is not flip-flopping and not a lack of leadership. It’s how you do good science, and how we should shape public policy going forward – being nimble, not rigid. And recognizing #COVID19 is as humbling as it is challenging.”

Now, some six weeks later, it seems like many of us have come to accept that wearing a mask in public is the right thing to do. On social media, people are changing their profile pics to ones in which they are wearing non-medical masks — a subtle but powerful message. Mask-wearers no longer stand out on the street, or behind the wheel of a car.

Last week, I wrote in the Examiner about a New Yorker story on the importance of proper pandemic communications. I quoted a section in which a politician and a public health officer discussed what measures to adopt in Seattle, during the earliest days of the COVID-19 outbreak in North America:

“He said if we advised social distancing right away there would be zero acceptance. And so the question was: What can we say today so that people will be ready to hear what we need to say tomorrow?’ In e-mails and phone calls, the men began playing a game: What was the most extreme advice they could give that people wouldn’t scoff at? Considering what would likely be happening four days from then, what would they regret not having said?”

I think this applies handily to masks. Would you have worn one back in early March?

Yesterday, Tam strengthened her position on masks, from saying Canadians “can take this additional measure” to directly recommending it:

“In addition, where COVID-19 activity is occurring, use of non-medical masks or face coverings is recommended as an added layer of protection when physical distancing is difficult to maintain. And staying home when sick is a must, always and everywhere.”

On Twitter, she went on to say:

“However, non-medical masks or cloth face coverings are not appropriate for everyone, such as young children < age 2 or anyone who has trouble breathing, is unconscious, incapacitated or otherwise unable to remove the mask on their own.”

(So don’t go piling on people not wearing a mask, because they may have good reasons.)

Yesterday, Strang also urged Nova Scotians to wear non-medical masks as a matter of course. During his afternoon briefing, after reiterating the importance of hand-washing, not touching your face, and coughing into your sleeve, he said:

“Lastly, I want to talk in detail about masks. The appropriate use of masks is part of this personal protective measure. There has certainly been lots of debate about the general public using masks, the evidence on masks has evolved, and essentially now we are at a place that we weren’t several weeks ago… When worn properly, non-medical masks can reduce the spread of the virus, the same way coughing etiquette and hand-washing is all part of a package.”

But Strang cautioned:

“It’s important to understand two things. Wearing a mask doesn’t protect you, it protects the people around you… But masks also need to be worn properly. They need to be fitted, so they feel comfortable,[and]  they allow you to breathe easily, but they need to fit securely over your mouth and nose. And it has to be mouth and nose. I’ve seen lots of pictures, of examples, where people pull the mask down so it’s only over the mouth, and it’s not over the nose. Or they pull the mask aside.

“I’ve seen pictures of people eating or smoking a cigarette, pulling the mask aside. The mask has to be covering your nose and mouth and stay there firmly. Otherwise there’s no point in wearing it. It certainly needs to be of a material that is washable and can keep its shape after being washed. So things that are made out of cotton or linen. It’s important that people don’t share masks. In a household, everyone should have their own individual masks.”

I suspect masks are going to be like bike helmets or hockey visors when they were first introduced. People thought you were a weirdo if you wore one, they seemed clunky and uncomfortable (I’m too hot! Why are my glasses fogging up!) and eventually we got used to them and figured out how to make them more comfortable.

The first time I put one on and went shopping, I felt horribly self-conscious. Last week, as I went to pick up our pre-ordered box of vegetables, someone called out “Nice mask!”

Normally, at this time of year, tailor Tatiana Pietrantoni would be working on a lot of prom and wedding dresses. Instead, she’s spent the last six weeks sewing hundreds of non-medical masks. She said, “We need as many sewers as possible doing this, and people wearing masks.”

Using a variety of fabrics can make the prospect of wearing a mask more palatable (maybe even fun?) but, Pietrantoni warned, it’s important to make sure it fits properly so you’re comfortable and don’t wind up fiddling with it.

Looking at the photo of me above, she said, “It’s too long, it’s gathering.” She said to make sure the mask goes “under your chin and over the middle of the bridge of your nose, and pinch it as much as you want to to not allow any fogging of your glasses.” (Many masks include a little piece of metal you can bend to form-fit to your nose.)

If you can’t measure your face before getting a mask made, don’t hesitate to ask for alterations to make it fit your face better.

Iris, the Examiner office manager, is a former professional seamstress and costumer for theatre and film. She said she spent a lot of time researching masks before starting to make them herself (she gives them away and is donating some for an upcoming fundraiser) and that a lot of what she sees about masks online “makes me really angry.”

“For one thing, a lot of them are made of polyester, which is really bad for your skin and really uncomfortable in the hot summer, which we know is heading our way,” she said.

When it comes to masks, more is not necessarily better. Iris said if you pile on too much fabric, or use material that’s not breathable enough, you’ll end up forcing air out the sides of your mask, which defeats the purpose of protecting those around you.

“A lot of them are made of three or four layers of fabric, and then they put a filter in there too — so you’re trying to suck air through four layers of fabric, and what what means is the air is coming in and going out around the edges of the mask. It feels claustrophobic, it makes it hard to breathe, and it’s not effective.”

Design matters too. Those easy-to-make flat rectangular masks? Iris said they are not so great: “People are putting them on and getting a false sense of security. Anything that’s just a flat rectangle is probably not a good idea, because it leaves a big gap around your nose, gaps on the side, and sometimes doesn’t go under your chin.”

There are other considerations too. Elastics? Ties? Over the head or behind the ears? The most important thing is that the mask be comfortable for the person wearing it.

Iris said she’s been alarmed to see YouTube videos suggesting the use of cut-open vacuum bags or furnace filters as an extra layer of protection inside the mask. Of the former, she said, “That stuff is not made to be breathed through! You need a powerful vacuum motor to suck air through those things!”

Her advice: “Unless the mask is going to be completely fitted to your face like an N95, skip the filter.”

For her part, Pietrantoni does leave a pocket inside her masks for those who want to add a filter.

The Pan-Canadian Public Health Network, made up of federal, provincial, and territorial public health officials, notes that

“There is ongoing discussion regarding the best materials or best construction methods for non-medical masks or cloth face coverings, and the website will be updated as new information becomes available.”

Currently, the federal government’s advice on non-medical masks offers a pretty extensive checklist for making and wearing masks. It says:

Non-medical face masks or face coverings should:

• allow for easy breathing
• fit securely to the head with ties or ear loops
• maintain their shape after washing and drying
• be changed as soon as possible if damp or dirty
• be comfortable and not require frequent adjustment
• be made of at least 2 layers of tightly woven material fabric (such as cotton or linen)
• be large enough to completely and comfortably cover the nose and mouth without gaping

Some masks also include a pocket to accommodate a paper towel or disposable coffee filter, for increased benefit.

Non-medical masks or face coverings should not:

• be shared with others
• impair vision or interfere with tasks
• be placed on children under the age of 2 years
• be made of plastic or other non-breathable materials
• be secured with tape or other inappropriate materials
• be made exclusively of materials that easily fall apart, such as tissues
• be placed on anyone unable to remove them without assistance or anyone who has trouble breathing

You know the seemingly old maxim (in reality, just a couple of months old) that instead of worrying about getting sick, you should act as though you are infected? That way, you protect others. The same applies to your mask. You’re wearing it primarily to protect the people around you, but for it to be effective, you need to act as though it’s contaminated too.

Wash your hands, put it on, leave it on until you can get home, carefully remove it, wash your hands again, and then wash your mask. Don’t keep pulling it on and off to talk on your phone, have a smoke, or whatever.

In his briefing yesterday, Strang said:

“It’s really important, if you’re wearing a mask, that you’re not always adjusting. We don’t want people touching their face. So once the mask is on, put it on properly and leave it there, because every time you touch your face you increase the risk of infecting yourself. So it’s important to understand masks can be helpful, but it’s really important to not get a false sense of reassurance… Masks are part of a package.”

Earlier this month, a now-influential article in The Atlantic urged Americans to wear masks, touting the practice as a relatively easy way to dramatically cut the rate of infection:

“Models show that if 80 percent of people wear masks that are 60 percent effective, easily achievable with cloth, we can get to an effective R₀ of less than one. That’s enough to halt the spread of the disease. Many countries already have more than 80 percent of their population wearing masks in public, including Hong Kong, where most stores deny entry to unmasked customers, and the more than 30 countries that legally require masks in public spaces, such as Israel, Singapore, and the Czech Republic. Mask use in combination with physical distancing is even more powerful.”

Find a mask you’re comfortable with. Wear it. Don’t keep futzing with it. Pretty simple.

And for the people who refuse to wear one because it impinges on their God-given liberty, can someone please start sewing Punisher masks?

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