Cloth face mask

{{see also|Face masks during the COVID-19 pandemic}}

File:Use of Cloth Face Coverings to Help Slow the Spread of COVID-19.pdf on using and making cloth masks during the COVID-19 pandemic{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html|title=Use of Cloth Face Coverings to Help Slow the Spread of COVID-19|date=April 4, 2020|website=U.S. Centers for Disease Control and Prevention|language=en-us|access-date=April 5, 2020}} {{PD-inline}}]]

Prior to the COVID-19 pandemic, reusable cloth face masks were predominantly used by healthcare workers, and in the community, in developing countries and in Asia. Cloth face masks contrast with surgical masks and respirators such as N95 masks, which are made of nonwoven fabric and contain a layer or layers formed through a melt blowing process. Melt-blown materials have a fine, random, structure, which leads to excellent filtration properties. Respirators are regulated for their effectiveness based upon filtration efficiency of sub-micron sodium chloride particles (count median diameter 0.075 ± 0.020 μm; mass median diameter 0.26 μm),{{Cite web |title=42 CFR Part 84 -- Approval of Respiratory Protective Devices |url=https://www.ecfr.gov/current/title-42/chapter-I/subchapter-G/part-84 |access-date=2025-02-21 |website=www.ecfr.gov |language=en}} along with other criteria such as outer splash/spray protection, inner splash/spray absorption, contaminant accumulation and shedding, breathability (or pressure drop across the mask), and inflammability.{{Cite book|url=http://www.nap.edu/catalog/11637|title=Reusability of Facemasks During an Influenza Pandemic: Facing the Flu|date=July 24, 2006|publisher=National Academies Press|isbn=978-0-309-10182-0|location=Washington, D.C.|pages=6, 36–38|doi=10.17226/11637}} Like surgical masks, and unlike respirators, cloth face masks do not provide a seal around the face, and prior to the 2019 COVID-19 outbreak were generally not authorized by institutions for protection from diseases recognized as airborne (e.g., tuberculosis).

In healthcare settings, they are used on sick patients as source control to reduce disease transmission through respiratory droplets and respiratory aerosols and by healthcare workers when surgical masks and respirators are unavailable. Cloth face masks are only recommended for use by healthcare workers as a last resort if supplies of surgical masks and respirators are exhausted. They are also used by the general public in household and community settings to reduce the risks of both infectious diseases and particulate air pollution and to contain the wearer's exhaled virus-laden droplets and aerosols.{{Cite journal|last1=MacIntyre|first1=C. R.|last2=Chughtai|first2=A. A.|date=April 9, 2015|title=Facemasks for the prevention of infection in healthcare and community settings|url=http://akkie.mods.jp/2019-nCoV/images/c/c0/%E3%82%B5%E3%83%BC%E3%82%B8%E3%82%AB%E3%83%AB%E3%83%9E%E3%82%B9%E3%82%AF%E5%8C%BB%E7%99%82vs%E5%B8%82%E4%B8%AD%E6%84%9F%E6%9F%93%E4%BA%88%E9%98%B2%EF%BC%9A%E7%B7%8F%E8%AA%AC_%282015%2C_MacIntyre%29.pdf|journal=BMJ|language=en|volume=350|issue=apr09 1|pages=h694|doi=10.1136/bmj.h694|pmid=25858901|s2cid=46366687|issn=1756-1833}}{{Cite journal|last1=Shakya|first1=Kabindra M.|last2=Noyes|first2=Alyssa|last3=Kallin|first3=Randa|last4=Peltier|first4=Richard E.|date=May 1, 2017|title=Evaluating the efficacy of cloth facemasks in reducing particulate matter exposure|url=https://www.ceh.org.in/wp-content/uploads/2017/08/1-Shakaya-Face-Masks-JESEE-2016.pdf|journal=Journal of Exposure Science & Environmental Epidemiology|language=en|volume=27|issue=3|pages=352–357|doi=10.1038/jes.2016.42|pmid=27531371|bibcode=2017JESEE..27..352S |s2cid=8794360|issn=1559-064X}}

Several types of cloth face masks are available commercially, especially in Asia. Homemade masks can also be improvised using bandanas, T-shirts, handkerchiefs, scarves, or towels. Depending on the design and materials, reusable cloth masks with incorporated filters can block particles as well as surgical masks.{{Cite news |date=2022-01-06 |title=The Best Reusable Face Masks |language=en-US |work=The New York Times |url=https://www.nytimes.com/wirecutter/reviews/best-cloth-face-masks/ |access-date=2022-03-28 |issn=0362-4331}}{{Cite web |title=Mask Hierarchy |url=https://maskevidence.org/mask-types |access-date=2025-02-18 |website=Mask Evidence |language=en-CA}}{{Cite journal |last1=Drouillard |first1=Ken G. |last2=Tomkins |first2=Amanda |last3=Lackie |first3=Sharon |last4=Laengert |first4=Scott |last5=Baker |first5=Allison |last6=Clase |first6=Catherine M. |last7=De Lannoy |first7=Charles F. |last8=Cavallo-Medved |first8=Dora |last9=Porter |first9=Lisa A. |last10=Rudman |first10=Rebecca S. |date=2022-03-22 |editor-last=Hashim |editor-first=Suhairul |title=Fitted filtration efficiency and breathability of 2-ply cotton masks: Identification of cotton consumer categories acceptable for home-made cloth mask construction |journal=PLOS ONE |language=en |volume=17 |issue=3 |pages=e0264090 |doi=10.1371/journal.pone.0264090 |doi-access=free |issn=1932-6203 |pmc=8939836 |pmid=35316263|bibcode=2022PLoSO..1764090D }}

File:How to wear a non-medical fabric mask safely - Do's & Don'ts.png showing the do's and don'ts of wearing a fabric mask to prevent the spread of COVID-19]]

File:Deux masques grand public.jpg. The white mask is made of polypropylene and the black one is made of cotton.]]

The World Health Organization (WHO) continues to recommend that masks be used as part of a comprehensive strategy of measures to suppress transmission and save lives; the use of a mask alone is not sufficient to provide an adequate level of protection against COVID-19. The US Center for Disease Control, along with Johns Hopkins University School of Medicine, The Mayo Clinic, and Cleveland Clinic all concur with this recommendation.{{cite news |url=https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html |title=Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission |date=3 April 2020 |work=CDC}}{{cite news |url=https://health.clevelandclinic.org/5-myths-about-coronavirus-and-face-masks-debunked/ |title=5 Myths About Coronavirus and Face Masks, Debunked. Are you wearing yours the right way?|date=4 June 2020 |work=Cleveland Clinic }}{{cite news |url=https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449 |title=COVID-19: How much protection do face masks offer? |date=28 May 2020 |work=Mayo Clinic}}{{cite news |url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-face-masks-what-you-need-to-know |title=Coronavirus Face Masks & Protection FAQs |date=25 June 2020 |work=Johns Hopkins School of Medicine}} The World Health Organization also recommended that those aged over 60 years old or with underlying health risks require more protection and should wear medical masks in areas where there is community transmission.{{cite news |date=6 June 2020 |title=Coronavirus: WHO advises to wear masks in public areas |url=https://www.bbc.com/news/health-52945210 |work=BBC}}

The World Health Organization recommends using masks with at least three layers of different materials. Two spunbond polypropylene layers offer useful increases in filtration with acceptable breathability.{{Cite journal |last1=Laengert |first1=Scott E. |last2=Kwon |first2=Yae Ji |last3=Corbin |first3=Joel C. |last4=Sipkens |first4=Timothy A. |last5=Morkus |first5=Patrick |last6=LaRue |first6=Ryan J. |last7=Latulippe |first7=David R. |last8=Clase |first8=Catherine M. |last9=de Lannoy |first9=Charles-François |date=2023-09-01 |title=Aerosol charge neutralization and its impact on particle filtration efficiency of common face mask materials |url=https://linkinghub.elsevier.com/retrieve/pii/S002185022300054X |journal=Journal of Aerosol Science |volume=173 |pages=106189 |doi=10.1016/j.jaerosci.2023.106189 |bibcode=2023JAerS.17306189L |issn=0021-8502|url-access=subscription }} When producing cloth face masks, two parameters should be considered: filtration efficiency of the material and breathability.

The filter quality factor known as "Q" is commonly used as an integrated filter quality indicator. It is a function of filtration efficiency and breathability, with higher values indicating better performance. Experts recommend Q-factor of three or higher. The usefulness of this ratio in selecting materials for masks has not, to our knowledge, been demonstrated.

A peer-reviewed summaryClase, C.M., Fu, E.L.F., Ashur, A., Beale, R.C.L., Clase, I.A., Dolovich, M.B., Jardine, M.J., Joseph, M., Kansiime, G., Mann, J.F.E., Pecoirs-Filho, R., Winkelmayer, W. C. and Carrero, J. J. Forgotten technology in the COVID-19 pandemic. Filtration properties of cloth and cloth masks: a narrative review. Mayo Clinic Proceedings 2020; https://www.mayoclinicproceedings.org/article/S0025-6196(20)30826-0/fulltext of the filtration properties of cloth and cloth masks concluded that, pending further research, evidence is strongest for 2 to 4 layers of plain weave cotton or flannel, at least 100 thread count. A plain-language summary of this review is available.{{Cite web |title=Narrative Review of Filtration |url=https://maskevidence.org/filtration-efficiency-of-masks-and-mask-materials |access-date=2025-02-20 |website=Mask Evidence |language=en-CA}}

Cloth face masks can be used for source control to reduce disease transmission arising from the wearer's respiratory droplets and respiratory aerosols, and also to reduce risk for the wearer by filtering incoming aerosols, thereby reducing disease transmission, but are not considered personal protective equipment for the wearer in regulated or health-and-safety contexts{{cite journal |last1=Matuschek |first1=Christiane |last2=Moll |first2=Friedrich |last3=Fangerau |first3=Heiner |last4=Fischer |first4=Johannes C. |last5=Zänker |first5=Kurt |last6=van Griensven |first6=Martijn |last7=Schneider |first7=Marion |last8=Kindgen-Milles |first8=Detlef |last9=Knoefel |first9=Wolfram Trudo |last10=Lichtenberg |first10=Artur |last11=Tamaskovics |first11=Balint |last12=Djiepmo-Njanang |first12=Freddy Joel |last13=Budach |first13=Wilfried |last14=Corradini |first14=Stefanie |last15=Häussinger |first15=Dieter |last16=Feldt |first16=Torsten |last17=Jensen |first17=Björn |last18=Pelka |first18=Rainer |last19=Orth |first19=Klaus |last20=Peiper |first20=Matthias |last21=Grebe |first21=Olaf |last22=Maas |first22=Kitti |last23=Gerber |first23=Peter Arne |last24=Pedoto |first24=Alessia |last25=Bölke |first25=Edwin |last26=Haussmann |first26=Jan |title=Face masks: benefits and risks during the COVID-19 crisis |journal=European Journal of Medical Research |date=12 August 2020 |volume=25 |issue=1 |pages=32 |doi=10.1186/s40001-020-00430-5 |pmid=32787926 |pmc=7422455 |doi-access=free }}{{Cite web|title=FAQs on the Emergency Use Authorization for Face Masks (Non-Surgical)|url=https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-emergency-use-authorization-face-masks-non-surgical|date=2020-04-26|website=U.S. Food and Drug Administration|language=en|access-date=2020-05-21}}{{Cite web|title=Meat and Poultry Processing Workers and Employers|url=https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/meat-poultry-processing-workers-employers.html|date=2020-04-26|website=U.S. Centers for Disease Control and Prevention|language=en-us|access-date=2020-05-08}} Filtration efficiency of the material is typically low compared with non-woven materials used in surgical masks and respirators.{{Cite web|title=Using face masks in the community - Reducing COVID-19 transmission from potentially asymptomatic or pre-symptomatic people through the use of face masks|url=https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission|date=2020-04-08|website=European Centre for Disease Prevention and Control|language=en|access-date=2020-05-21}} However, a well-designed cloth mask may fit very well, with little edge leak. In contrast, surgical mask material is an excellent filter, but surgical masks typically fit poorly, with visible gaps and large edge leaks. This explains why cloth masks (less good filter, good fit) and surgical masks (good filter, less good fit) perform similarly in tests of protection of the wearer from aerosol-sized particles.

As of 2015, there had been no randomized clinical trials or guidance on the use of reusable cloth face masks.{{Cite journal|last1=Chughtai|first1=Abrar Ahmad|last2=Seale|first2=Holly|last3=MacIntyre|first3=Chandini Raina|date=June 19, 2013|title=Use of cloth masks in the practice of infection control – evidence and policy gaps|url=http://www.ijic.info/article/view/11366|journal=International Journal of Infection Control|volume=9|issue=3|doi=10.3396/IJIC.v9i3.020.13|issn=1996-9783|doi-access=free}} Most research had been performed in the early 20th century, before disposable surgical masks became prevalent. One 2010 study found that 40–90% of particles in the 20–1000 nm range penetrated a cloth mask and other fabric materials.{{cite journal |vauthors = Rengasamy S, Eimer B, Shaffer RE |journal = Annals of Occupational Hygiene |pages = 789–798 |volume = 54 |publisher = Oxford University Press |number = 7 |year = 2010 |title = Simple Respiratory Protection—Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20–1000 nm Size Particles |issn = 0003-4878 |doi = 10.1093/annhyg/meq044 |pmid = 20584862 |pmc = 7314261 |doi-access = free }} The performance of cloth face masks varies greatly with the shape, fit, and type of fabric, as well as the fabric fineness and number of layers. As of 2006, no cloth face masks had been cleared by the U.S. Food and Drug Administration for use as surgical masks. A Vietnamese study of healthcare workers compared influenza-like illness outcome among those wearing cloth masks versus medical masks.{{Cite journal|last1=MacIntyre|first1=C. R.|last2=Seale|first2=H.|last3=Dung|first3=T. C.|last4=Hien|first4=N. T.|last5=Nga|first5=P. T.|last6=Chughtai|first6=A. A.|last7=Rahman|first7=B.|last8=Dwyer|first8=D. E.|last9=Wang|first9=Q.|date=2015-04-22|title=A cluster randomised trial of cloth masks compared with medical masks in healthcare workers|journal=BMJ Open|volume=5|issue=4|pages=e006577|doi=10.1136/bmjopen-2014-006577|pmid=25903751|pmc=4420971|issn=2044-6055|doi-access=free}} They concluded that cloth masks were ineffective at preventing transmission in high-risk clinical settings. Although discouraged in clinical settings, cloth masks may still serve a useful role in reducing disease transmission in public settings according to a systematic review.{{Cite medRxiv |last1=Mondal |first1=Agnibho |last2=Das |first2=Arnavjyoti |last3=Goswami |first3=Rama Prosad |date=2020-05-11 |title=Utility of Cloth Masks in Preventing Respiratory Infections: A Systematic Review |medrxiv=10.1101/2020.05.07.20093864}}{{Cite journal |last1=Greenhalgh |first1=Trisha |last2=MacIntyre |first2=C. Raina |last3=Baker |first3=Michael G. |last4=Bhattacharjee |first4=Shovon |last5=Chughtai |first5=Abrar A. |last6=Fisman |first6=David |last7=Kunasekaran |first7=Mohana |last8=Kvalsvig |first8=Amanda |last9=Lupton |first9=Deborah |last10=Oliver |first10=Matt |last11=Tawfiq |first11=Essa |last12=Ungrin |first12=Mark |last13=Vipond |first13=Joe |date=2024-05-22 |title=Masks and respirators for prevention of respiratory infections: a state of the science review |journal=Clinical Microbiology Reviews |volume=37 |issue=2 |pages=e00124–23 |doi=10.1128/cmr.00124-23 |pmc=11326136 |pmid=38775460}}

One role of masks worn by the general public is to "stop those who are already infected broadcasting the virus into the air around them" or source control. This is of particular importance with the COVID-19 pandemic, as transmission from people who are asymptomatic is a key feature of its rapid spread.{{Cite journal |last1=Almadhi |first1=Marwa Ali |last2=Abdulrahman |first2=Abdulkarim |last3=Sharaf |first3=Sayed Ali |last4=AlSaad |first4=Dana |last5=Stevenson |first5=Nigel J. |last6=Atkin |first6=Stephen L. |last7=AlQahtani |first7=Manaf M. |date=April 2021 |title=The high prevalence of asymptomatic SARS-CoV-2 infection reveals the silent spread of COVID-19 |journal=International Journal of Infectious Diseases |language=en |volume=105 |pages=656–661 |doi=10.1016/j.ijid.2021.02.100 |pmc=7908846 |pmid=33647516|hdl=2262/98543 }} For example, of the people on board the Diamond Princess cruise ship, 634 people were found to be infected—52% had no symptoms at the time of testing, including 18% who never developed symptoms.{{Cite news|url=https://www.economist.com/science-and-technology/2020/04/11/how-important-is-silent-spreading-in-the-covid-19-epidemic|title=How important is "silent spreading" in the covid-19 epidemic?|newspaper=The Economist|access-date=2020-04-20|issn=0013-0613}} Best practice is to implement multiple prevention techniques to reduce risk, for example, increasing the proportion of outside air used in ventilation, filtration systems built into HVAC, stand-alone filtration systems such as HEPA filters and Corsi-Rosenthal boxes, avoiding crowded spaces, and practicing staying home while sick and for the period of probable infectiousness following illness.{{cite web |title=Advice on Reopening Business: Frequently Asked Questions |url=https://my.clevelandclinic.org/-/scassets/files/org/employer-solutions/covid-19-workplace-safety-faqs.ashx |website=clevelandclinic.org |publisher=Cleveland Clinic |access-date=14 June 2024 |date=4 May 2021}}

Compared with bacteria recovery from unmasked volunteers, a mask made of muslin and flannel reduced bacteria recovered on agar sedimentation plates by 99%, total airborne microorganisms by 99%, and bacteria recovered from aerosols (< 4 μm) by 88% to 99%.{{cite journal | last1=Greene | first1=V. W. | last2=Vesley | first2=D. | title=Method for Evaluating Effectiveness of Surgical Masks | journal=Journal of Bacteriology | publisher=American Society for Microbiology | volume=83 | issue=3 | year=1962 | issn=0021-9193 | doi=10.1128/jb.83.3.663-667.1962 | pages=663–667| pmid=13901536 | pmc=279325 }} In 1975, 4 medical masks and 1 commercially produced reusable mask made of 4 layers of cotton muslin were compared. Filtration efficiency, assessed by bacterial counts, was 96% to 99% for the medical masks and 99% for the cloth mask; for aerosols (< 3.3 μm), it was 72% to 89% and 89%, respectively.{{cite journal | last=Quesnel | first=Louis B | title=The efficiency of surgical masks of varying design and composition | journal=British Journal of Surgery | publisher=Oxford University Press (OUP) | volume=62 | issue=12 | year=1975 | issn=0007-1323 | doi=10.1002/bjs.1800621203 | pages=936–940| pmid=1203649 | pmc=7161878 }}

An experiment carried out in 2013 by Public Health England, that country's health-protection agency, found that a commercially made surgical mask filtered 90% of virus particles from the air coughed out by participants, a vacuum cleaner bag filtered out 86%, a tea towel blocked 72% and a cotton t-shirt 51%—though fitting any DIY mask properly and ensuring a good seal around the mouth and nose is crucial.{{Cite journal|last1=Davies|first1=Anna|last2=Thompson|first2=Katy-Anne|last3=Giri|first3=Karthika|last4=Kafatos|first4=George|last5=Walker|first5=Jimmy|last6=Bennett|first6=Allan|date=2013-05-22|title=Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic?|journal=Disaster Medicine and Public Health Preparedness|volume=7|issue=4|pages=413–418|doi=10.1017/dmp.2013.43|issn=1935-7893|pmc=7108646|pmid=24229526}}{{Cite news|url=https://www.economist.com/science-and-technology/2020/04/11/should-the-public-wear-masks-to-slow-the-spread-of-sars-cov-2|title=Should the public wear masks to slow the spread of SARS-CoV-2?|newspaper=The Economist|access-date=2020-04-20|issn=0013-0613}}

The use of common fabrics in making face masks has been tested.{{cite journal | last1=van der Sande | first1=Marianne | last2=Teunis | first2=Peter | last3=Sabel | first3=Rob | editor-last=Pai | editor-first=Madhukar | title=Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population | journal=PLOS ONE | publisher=Public Library of Science (PLoS) | volume=3 | issue=7 | date=2008-07-09 | issn=1932-6203 | doi=10.1371/journal.pone.0002618 | page=e2618| pmid=18612429 | pmc=2440799 | bibcode=2008PLoSO...3.2618V | doi-access=free }}{{cite journal | last1=Davies | first1=Anna | last2=Thompson | first2=Katy-Anne | last3=Giri | first3=Karthika | last4=Kafatos | first4=George | last5=Walker | first5=Jimmy | last6=Bennett | first6=Allan | title=Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic? | journal=Disaster Medicine and Public Health Preparedness | publisher=Cambridge University Press (CUP) | volume=7 | issue=4 | date=2013-05-22 | issn=1935-7893 | doi=10.1017/dmp.2013.43 | pages=413–418| pmid=24229526 | pmc=7108646 }}{{cite journal | title=Simple Respiratory Protection—Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20–1000 nm Size Particles | journal=The Annals of Occupational Hygiene | publisher=Oxford University Press (OUP) | date=2010-06-28 | issn=1475-3162 | doi=10.1093/annhyg/meq044 | pmid=20584862 | doi-access=free | last1=Rengasamy | first1=S. | last2=Eimer | first2=B. | last3=Shaffer | first3=R. E. | volume=54 | issue=7 | pages=789–98 | pmc=7314261 }}{{cite journal | last1=Konda | first1=Abhiteja | last2=Prakash | first2=Abhinav | last3=Moss | first3=Gregory A. | last4=Schmoldt | first4=Michael | last5=Grant | first5=Gregory D.|author6-link=Supratik Guha | last6=Guha | first6=Supratik | title=Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks | journal=ACS Nano | publisher=American Chemical Society (ACS) | date=2020-04-24 | volume=14 | issue=5 | pages=6339–6347 | issn=1936-0851 | doi=10.1021/acsnano.0c03252 | pmid=32329337 | pmc=7185834 | doi-access=free }} Filter efficiency can be improved with multiple layers, but it is important also to consider breathability. Cotton is the most commonly used material, and filter efficiencies can reach > 80% for particles <. 300 nm with fabric combinations such as cotton-silk, cotton-chiffon, or cotton-flannel, though these filtration efficiencies are not directly comparable with the reported properties of surgical masks and respirators, because of the non-standard methods used in this study, conducted in the early months of the Covid-19 pandemic. The WHO recommended that cloth masks should have three layers with a hydrophilic inner layer (e.g., cotton) to absorb moisture from the wearer's breathing, a filter layer, ideally spunbond polypropylene,{{Cite web |last1=Clase |first1=Catherine |last2=Lannoy |first2=Charles-Francois de |last3=Laengert |first3=Scott |date=2020-11-19 |title=Polypropylene, the material now recommended for COVID-19 mask filters: What it is, where to get it |url=https://theconversation.com/polypropylene-the-material-now-recommended-for-covid-19-mask-filters-what-it-is-where-to-get-it-149613 |access-date=2025-02-18 |website=The Conversation |language=en-US}} and a hydrophobic outer layers (e.g., polyester). The benfits of a hydrophobic outer layer have not, to our knowledge, been demonstrated, and may be a throw-back to the idea of protection from droplets, which is now recognized as not the dominant mode of transmission.{{Cite journal |last1=Greenhalgh |first1=Trisha |last2=Jimenez |first2=Jose L. |last3=Prather |first3=Kimberly A. |last4=Tufekci |first4=Zeynep |last5=Fisman |first5=David |last6=Schooley |first6=Robert |date=2021-05-01 |title=Ten scientific reasons in support of airborne transmission of SARS-CoV-2 |journal=The Lancet |language=English |volume=397 |issue=10285 |pages=1603–1605 |doi=10.1016/S0140-6736(21)00869-2 |issn=0140-6736 |pmc=8049599 |pmid=33865497}}{{Cite journal |last=Lewis |first=Dyani |date=2022-04-06 |title=Why the WHO took two years to say COVID is airborne |url=https://www.nature.com/articles/d41586-022-00925-7 |journal=Nature |language=en |volume=604 |issue=7904 |pages=26–31 |doi=10.1038/d41586-022-00925-7|pmid=35388203 |bibcode=2022Natur.604...26L }}{{Cite web |date=2022-03-24 |title=White House diverges from CDC, focuses on aerosol COVID spread {{!}} CIDRAP |url=https://www.cidrap.umn.edu/white-house-diverges-cdc-focuses-aerosol-covid-spread |access-date=2025-02-18 |website=www.cidrap.umn.edu |language=en}} Masks should be cleaned after each use. They can either be laundered or hand-washed in soapy hot water and dried with high heat.{{Cite web|title=Coronavirus: How to Care for Your Face Mask|url=https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-how-to-care-for-your-face-mask|access-date=2020-08-04|website=www.hopkinsmedicine.org|language=en}}

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| image1 = 19180927 Gauze Mask to Halt Spread of Plague (Spanish flu) - The Washington Times.jpg | caption1= In 1918, the Red Cross recommended two-layer gauze masks.{{cite news |title=Gauze Mask to Halt Spread of Plague |url=https://newspaperarchive.com/washington-times-sep-27-1918-p-3/ |work=The Washington Times |date=27 September 1918 |page=3}}

| image2= Tram operator refuses man without mask detail, from- 165-WW-269B-11-trolley-l (cropped).jpg | caption2 = During the 1918 flu pandemic, a streetcar conductor in Seattle refuses a person who attempts to board without wearing a mask.

}}

In Roman times, Pliny the Elder recommended that miners use animal bladders to protect against inhaling lead oxides. Some followers of Jainism, which originated in India around 500 B.C.E, wear cloth masks to avoid accidentally inhaling insects as part of practicing ahimsa.{{cite news|last=George|first=Nirmala|url=https://www.latimes.com/archives/la-xpm-2005-sep-11-adfg-nun11-story.html|title=Jain Ascetics Give It All Up for Their Faith|work=Los Angeles Times|date=September 11, 2005|access-date=2020-10-31}}{{cite news|last=Briggs|first=Kenneth A.|url=https://www.nytimes.com/1975/08/28/archives/a-jainist-monk-brings-ascetic-ways-here.html|title=A Jainist Monk Brings Ascetic Ways Here|work=New York Times|date=August 28, 1975|access-date=2020-10-31}}{{cite web|url=https://people.uwec.edu/ivogeler/w111/articles/jainism.htm|title=Jainism in India|work=people.uwec.edu|access-date=2020-10-31|archive-date=November 1, 2020|archive-url=https://web.archive.org/web/20201101105525/https://people.uwec.edu/ivogeler/w111/articles/jainism.htm|url-status=dead}} In the 16th century, Leonardo da Vinci advised the use of a wet woven cloth to protect against toxic agents{{which|date=August 2020}} of chemical warfare.{{cite web | title= The History of Respirator | date= March 28, 2016 | url= https://cambridgemask.com/blog/history-of-respirators/ | publisher= Cambridge Mask Co | quote = The idea of using respirators was pioneered by Pliny the Elder in the first century A.D. when he recommended the use of animal bladder to protect Roman miners from inhaling lead oxide dust. Early inventions did not stop with Pliny as in the 16th century, Leonardo da Vinci, advised the use of a wet woven cloth to protect against toxic agents of chemical warfare.}} In the early modern period, the plague-doctor costume included a beaked face-mask worn to protect the wearer from infectious "miasma".

Conventional cowboy attire in the American West often included a bandanna, which could protect the face from blown dust and also potentially doubled as a means of obscuring identity.

{{cite book

| last1 = Guttmacher

| first1 = Peter

| title = Legendary Westerns

| url = https://books.google.com/books?id=i_4HAQAAMAAJ

| publisher = MetroBooks

| date = 1995

| page = 17

| isbn = 9781567991727

| access-date = 21 August 2020

| quote = Before Sam Peckinpah ever wore a bandana , before Paul Newman and Robert Redford ever got into western gear, these gentlemen train robbers [...]

}}

In 1890 William Stewart Halsted pioneered the use of rubber gloves and surgical face masks, although some European surgeons such as Paul Berger and Jan Mikulicz-Radecki had worn cotton gloves and masks earlier. These masks became commonplace after World War I and the influenza pandemic of 1918.{{cite book | author=Fielding H. Garrison | title=History of Medicine | edition=3rd | year=1921 | page=761 | publisher=Philadelphia W.B. Saunders | url=http://www.archive.org/details/3edintroductiont00garruoft}}{{cite journal | title=A brief history of medical uniforms: from ancient history to the COVID-19 time | journal=Rev Col Bras Cir | date=2020 | pmid=32520135| last1=O'Donnell | first1=V. R. | last2=Chinelatto | first2=L. A. | last3=Rodrigues | first3=C. | last4=Hojaij | first4=F. C. | volume=47 | pages=e20202597 | doi=10.1590/0100-6991e-20202597 | s2cid=219563013 | doi-access=free }} Cloth face masks were promoted by Wu Lien-teh in the 1910–11 Manchurian pneumonic plague outbreak, although Western medics doubted their efficacy in preventing the spread of disease.{{cite journal |last1=Lynteris |first1=Christos |title=Plague Masks: The Visual Emergence of Anti-Epidemic Personal Protection Equipment |journal=Medical Anthropology |date=18 August 2018 |volume=37 |issue=6 |pages=442–457 |doi=10.1080/01459740.2017.1423072 |pmid=30427733 |issn=0145-9740|doi-access=free |hdl=10023/16472 |hdl-access=free }}

Cloth masks were largely supplanted by modern surgical masks made of nonwoven fabric in the 1960s. Peer reveiwed evidence supporting their equivalence appears to be lacking. The use of cloth masks continued in developing countries. They were used in Asia during the 2002–2004 SARS outbreak, and in West Africa during the 2013–2016 Ebola epidemic. Compared with bacteria recovery from unmasked volunteers, a mask made of muslin and flannel reduced bacteria recovered on agar sedimentation plates by 99%, total airborne microorganisms by 99%, and bacteria recovered from aerosols (<4 μm) by 88% to 99%. In 1975, 4 medical masks and 1 commercially produced reusable mask made of 4 layers of cotton muslin were compared. Filtration efficiency, assessed by bacterial counts, was 96% to 99% for the medical masks and 99% for the cloth mask; for aerosols (<3.3 μm), it was 72% to 89% and 89%, respectively.

{{main|Face masks during the COVID-19 pandemic}}

File:Rhode Island National Guard.jpgsmen sew face masks during the COVID-19 pandemic, April 6, 2020.]]

In the early years of the COVID-19 pandemic, most countries recommended the use of cloth masks to reduce the spread of the virus.{{Cite web|title=Which Countries Are Requiring Face Masks?|url=https://www.cfr.org/in-brief/which-countries-are-requiring-face-masks|access-date=2021-01-05|website=Council on Foreign Relations|language=en}}

On June 5, 2020, WHO changed its advice on face masks, recommending that the general public should wear fabric masks where widespread COVID-19 transmission exists and physical distancing is not possible (for example, "on public transport, in shops or in other confined or crowded environments").{{cite web |url=https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak |title= Advice on the use of masks in the context of COVID-19: Interim guidance |date= 5 June 2020 |publisher= World health Organization |page=7 |access-date= 21 August 2020 |quote= Table 2: Examples of where the general public should be encouraged to use medical and non-medical masks in areas with known or suspected community transmission}}{{cite news |url=https://www.bbc.com/news/health-52945210 |title=Coronavirus: WHO advises to wear masks in public areas |date=June 6, 2020 |work=BBC News |quote=[...] WHO director-general Dr Tedros Adhanom Ghebreyesus said on Friday that 'in light of evolving evidence, the WHO advises that governments should encourage the general public to wear masks where there is widespread transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments'.}} The WHO continues to recommend their use: 'Masks should be used as part of a comprehensive strategy of measures to suppress transmission and save lives; the use of a mask alone is not sufficient to provide an adequate level of protection against COVID-19.'{{Cite web |title=When and how to use masks |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks |access-date=2025-02-18 |website=www.who.int |language=en}} The CDC also continues to recommend masking: 'Wearing a mask is an additional prevention strategy that you can choose to further protect yourself and others.'{{Cite web |last=CDC |date=2024-07-14 |title=Masks and Respiratory Viruses Prevention |url=https://www.cdc.gov/respiratory-viruses/prevention/masks.html#:~:text=Wearing%20a%20mask%20can%20help%20lower%20the,the%20spread%20of%20the%20virus%20to%20others. |access-date=2025-02-18 |website=Respiratory Illnesses |language=en-us}}

{{clear}}

• N95 - a mask designed to stop the spread of airborne disease, e.g., tuberculosis and for use in industrial settings
• Nose filter

{{Reflist}}

• [https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html/ CDC Mask Guidance – Help Slow the Spread]
• [https://www.youtube.com/watch?v=r7ywjj6mJGk NPR: 3 Tips for Safer Face Masks] (video on YouTube)
• [https://www.youtube.com/watch?v=gaka1vqYFNs Mayo Clinic expert on nonmedical mask use to prevent public transmission] (video on YouTube)

Category:Cloth masks

Category:History of medicine

Category:Medical masks

Category:Air filters

Category:Infection-control measures

Category:2020s fashion