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COVID-19
PANDEMIC

Use of Cloth Earlier this year I hosted a foreign exchange high school student from Thailand.

As concerns about Coronavirus in the US started to increase, she asked if she should
Masks by the wear a mask to school. I informed her that, unlike parts of Asia, we in the US didn’t
wear masks in public except in rare circumstances and that the other kids at school
Public: would think her either very ill or strange. Fast forward 2 months and the use of masks
is not only recommended but required in some settings as the COVID-19 pandemic
sweeps the US. What evidence is there to support this change?
Most of our pre-COVID-19 virus respiratory disease pandemic planning focused
Good, Bad or on controlling a novel influenza virus and the use of face masks was considered.
CDC recommended that persons who had flu-like symptoms use surgical face masks
just Ugly? as a non-pharmaceutical intervention during severe, very severe or extreme flu pan-
demics, but noted little evidence supporting the use of face masks by well persons in
By Diane Simpson, MD community settings. (Qualls et al, 2017). The situation we are in now, the use of cloth
face masks by the general public, was not addressed in the planning document.
A few studies around the time of the H1N1 2009 influenza pandemic did try to
assess the ability of cloth facemasks to prevent respiratory virus transmission either
from the standpoint of infected persons wearing a mask to stop virus transmission
or non-infected persons wearing a mask to prevent virus acquisition.
One study conducted prior to the 2009 influenza pandemic compared FFP2 masks
(N95 equivalent) with surgical masks with tea cloth (a flat, woven linen or cotton
cloth). FFP2 masks provided 28 adult and 11 child volunteer wearers 50 times more
protection than tea cloth and 25 times more protection than surgical masks in an en-
vironment containing at least 10,000 particles per cm3. Particles ranged in size from
0.02-1 micron. Surgical masks provided about twice as much protection as the home-
made masks. Evaluation of the different types of masks, capability to prevent particles
from passing from an adult-sized artificial, head into the environment showed similar
protection capability between the FFP2 masks and the surgical masks and only mar-
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