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Why a cloth mask isn’t adequate healthcare PPE

Well-intentioned homemade cloth masks won’t protect EMS providers from COVID-19 and may increase risk of viral infection


Seamstress Adita Rodriguez sews a surgical mask at Sareh Nouri’s atelier in Rutherford, N.J., Wednesday, March 25, 2020.

AP Photo/Seth Wenig

There is a massive shortage of personal protective equipment right now for the EMTs, paramedics and other healthcare providers caring for COVID-19 patients. Providers are being forced to re-use single-use equipment, like N95 masks and face shields.

There has been a social media-driven surge of civilians making homemade face masks for healthcare providers, though the CDC does not recommend these as first-line PPE, classifying bandanas, scarfs or other homemade masks “as a last resort.”

Can homemade masks protect healthcare providers from airborne virus particles and possible infection? How do homemade masks compare to an N95 respirator?

A 2015 study in the British Medical Journal Open compared how effective cloth masks were to medical masks in healthcare workers. The study randomized hospital wards at 14 hospitals in Vietnam and had 1,607 healthcare workers wear medical masks throughout their whole shift, cloth masks throughout their whole shift, or the “usual practice, which included mask wearing,” for every shift for 4 weeks.

Researchers then tested the healthcare workers with respiratory symptoms for a panel of different types of viruses. The researchers also tested the filtration performance of the different types of masks to determine what percentage of particles the masks filtered.

Cloth masks increase chance of viral illness 13x

Researchers reported that there was a 13 times greater chance of acquiring a viral respiratory illness in healthcare workers who wore the cloth masks, compared to healthcare workers wearing medical masks throughout their shift.

Cloth masks protect from only 3% of particles

Additionally, researchers found 97% of particles penetrated cloth masks, 44% of particles penetrated medical masks, and <0.01-0.1% of particles penetrated N95 masks.

A 2016 study in the “Journal of Exposure Science & Environmental Epidemiology” found similar results, suggesting that cloth masks are “marginally beneficial in protecting individuals from particles <2.5um.”

In addition to these dismal performance results, non-disposable cloth masks place an additional task on providers or support staff to wash the masks between shifts. If providers bring dirty masks home to wash, they are further exposing their home and family to potential viral particles, a further burden in this stressful time.

Healthcare providers have rallied with a social media campaign, #GetUsPPE, and are petitioning The White House for assistance.

Can we still use cloth masks?

The sentiment from those at home making cloth masks to protect healthcare providers is appreciated, and should not go unrecognized, but we need to reconsider how we use these cloth masks. Here are some ideas for further study:

  • Would placing cloth masks on patients or people sick with COVID-19 who are staying at home or being evaluated in the emergency department help reduce droplet transmission?
  • Would placing a cloth mask on top of a surgical mask help extend the life of the surgical mask?

Communicate with your community about how they can best protect themselves and support healthcare professionals. Here are other ideas on how civilians can limit the spread of COVID-19.

  • Be a great social distancer and #FlattenTheCurve
  • Donate blood. Check the American Red Cross for a location near you.
  • Check in with your friends and family who work in healthcare. They are stressed, overworked and on the frontlines of this pandemic. Can you send a takeout meal to the staff at the fire station, EMS agency or emergency department, supporting both those on the frontline and a local business?

Let’s minimize unnecessary risks for our frontline healthcare professionals. They don’t deserve equipment that protects them from only 3% of particles when highly engineered N95 masks will protect them from 99.9%.

Let’s redirect our efforts towards companies who are re-tooling their factories to produce appropriate PPE, or towards advocating for funding this critical and time-sensitive shortage. Sign the petition to #GetUsPPE and save the N95 masks for prehospital and in-hospital healthcare providers to protect them from aerosolized virus particles resulting from invasive medical procedures such as endotracheal intubation.

Emily Pearce, BS, EMT-P, FAWM, DiMM is a paramedic and third-year medical student at the University of New Mexico. Emily has a bachelor’s degree from the University of Virginia and has been involved in EMS since 2008. She has worked as an EMT-Basic in rural Virginia, a search and rescue paramedic for the National Park Service in Grand Canyon National Park, and a prehospital educator and researcher at UNM.