Fabric Face Masks for the Coronavirus Pandemic

 DIY Surgical-type Face Masks for our Coronavirus PandemicTimes

My day job is as a Medical Librarian.  3 weeks ago, I was ordered to work-at-home (in other words: stay out of the hospital) to help slow the spread of Coronavirus / Covid-19and flatten the curve.  Fortunately the VPN is working, and I have access to our online collections to do my job.

I won't lie: It's been frustrating and distressing to watch the number of cases rise every day, to read about shortages in personal protective equipment (PPE) like surgical masks for health care workers.  I also know that my organization is preparing for a surge and already caring for patients with Covid.

If you're a regular visitor to my blog, you know I sew.  There have been multiple times in the past 3 weeks where I felt I could make a bigger contribution by sewing masks than as a Medical Librarian.  I have the fabric and supplies.  I have the skills ...  There's a whole army of quilters and home sewers willing to do this work, to donate their time and supplies for this worldwide effort, mobilized for the common goal of stopping the spread of Coronavirus.   And we're "safe-at-home" looking for some way to make a productive and positive contribution to this pandemic.

For the record, I did this research and mask-making on my own time, not work time.
I was scouting patterns, tutorials, materials, etc. and made a few prototypes ...

So far, my health care organization * says they have enough PPE, and don't want to go the DIY cotton masks for safety's sake for employees.  It's true -- The home-made cotton masks will offer only limited protection.   Yes-- I've done the research ... and they are correct.  A DIY surgical mask is not the same as an N95 or a power-air purifying respirator (PAPR), but with some adaptations, it can work pretty well ...

These masks tend to follow CDC protocols : Strategies for Optimizing the Supply of Facemasks:  If all other supplies are not available (read that as last resort), handmade masks that meet certain criteria are acceptable with additional protective equipment. 

• Health Care Professional (HCP) use of homemade masks:

• In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.

As I understand it,  these face masks are being used in areas NOT caring directly for Covid-19 patients.  I think we'll be seeing regular people wearing the DIY face masks in public even though it might give them a false sense of  well-being and protection.  At the very least, it keeps people from touching their faces. [CDC's new recommendation on Use of Cloth Face Coverings to Help Slow the Spread of Covid-19 in public settings-- as of April 3, 2020]

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4 Simple Rules to prevent the spread of Covid-19:

1. WASH / SANITIZE YOUR HANDS
2. SANITIZE and KEEP SURFACES CLEAN
3. KEEP YOUR DISTANCE
4. DON'T TOUCH YOUR FACE  

Masks are not a substitute for these simple rules.

A calming video to remind you to keep up the social distancing, hand washing, surface cleaning, and not touching your face.     If you haven't seen this March 22 video that David Price, a pulmonary / ICU doctor in NY, made for his family and friends, it's worth the time.  It's a calm, reassuring and empowering reminder of how these steps really do protect us. [The video is an hour, but his main recommendations and advice are in the first 15 minutes.  You can also Google "Dr David Price video" for several articles summarizing it.]

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The Joint Commission's public statement on the Use of Fabric Masks Brought from Home  (in the context of health care workers)

Read Wirecutter's take on whether DIY cloth masks protect against Coronavirus, or not. 

Testing the Efficacy of Homemade Masks: Would they protect in an Influenza Pandemic?

Cluster randomised trial of cloth masks compared with medical masks in health workers. 

Can DIY Masks Catch Viruses? [Can they protect us from Coronavirus?]

The Face Masks-for-All movement is championed by researcher Jeremy Howard.  See his informative 12-min video and "the 34 scientific papers indicating basic masks can be effective in reducing virus transmission in public — and not a single paper that shows clear evidence that they cannot.”  He makes a good scientific case for the public wearing masks.
 
What are the best materials for making DIY Face Masks?

• Study done by Cambridge Univerity
• Compares different fabrics and layers.
• It also describes the elements we're trying to filter out and compares them by size which explains why a tighter non-woven fabric will work better for a tiny virus particle. 
• Who knew that 2 layers of tightly woven tea towels worked so well? 
• Cotton-T-Shirt fabric is breathable.

Unity Point in Cedar Rapids Iowa is using this evidence-based pattern for their face masks.  They call it The Olson Mask. 

I saw this video and pattern from Unity Point for making The Olson Mask.  It seems they'd seen and done the same research I had testing suitable fabrics, filters -- and figuring out what offered the best protection against viruses (not just dust and particulates).   I'm really impressed that they have an Innovation and Maker Space and the guy who runs it knows how to work  a sewing machine!    It's a little more complicated than some of the other patterns out there.  They plan to add a HEPA filter material between the fabrics that would catch those tiny virus particles, along with a wire at the bridge of the nose and adhesive tapeto make it fit and seal properly to the wearer's face.  This is the pattern I would trust most for health care workers.  It is a little more complicated, and takes longer to make.  They are careful to say that these do NOT replace the N95 masks.

A microbiologist and sewer added the following useful comment under the Unity Point video:

• Couple of extra tips from a PhD Microbiologist (pathogen and air quality experience) and avid sewist. You can use fine men’s shirting or high thread count sheets for fabric. 
• You can use a third layer of cotton fabric in center if you can’t access HEPA quality fabric. 
• Also you could use a non woven interfacing for that interior layer. The idea is that the three layers of woven fabric are offset from one another causing air when it migrates in or droplets when they migrate out to not have a straight path. If you use non woven interfacing even better because it is a complex matrix. The entering particulates collide so to speak with the fibers and are captured. 
• Also you can consider a synthetic fabric for the middle layer since many polyesters and nylon are charged and can better capture charged cells. 
• Instead of the pony holders I’ve used fold over elastic about 28 inches long to bind each short side of the mask. This leaves stretchy tails for tying (makes it easier to fit) as you just zig zag across folded over elastic from one end to the other. 
• Many have also used garbage bag wires and plastic floral stems for the nose piece, you can sandwich it in duct tape so it stays waterproof. I suggest inserting it into a 4” casing made with fold over elastic sewn to the lining side of the mask. This way you can reinsert new wire as needed. Lastly after you turn it consider top stitching around to increase durability. 
• Good work guys!

I'm wondering about the hair ties and elastic-- if those might have some rubber latex that could cause problems with health care workers who might have latex allergy?  String ties would get around that issue -- especially since there seems to be a shortage of elastic now, too.

The Olson Mask

• I made one of these -- just as a prototype.  It has 6 pieces to cut and fit together.  One short cut would be to cut out 2 pieces at once as mirror images by folding the fabric in half.  
• I had a pipe cleaner to use for the nose bridge.  The Maker-Space guy said they just seemed to fit and stay, didn't need to be stitched down.  That was not my experience. I zig-zagged it into the seam.
• So far this is the best fitting mask.  It's work the extra fiddling with the pockets.

The reverse side of The Olson Mask.

The Olson Mask: 

The clear winner of the masks I made so far, with the best fit due to the "boob" shape.

I think I 'll be making more in this style.

MILLION MASK CHALLENGE

There are lots of other mask patterns out there ready to mobilize the masses waiting and willing to contribute to the effort ...  including the Million Mask Challenge, which is the pattern MCW in Milwaukee is asking people to make.   These allow for a pocket to add a disposable / replaceable filter material inside the mask.    That will help ... but does not replace the N95s.

• This lady gives a good sewing tutorial, but she says a few things in the video that make me cringe -- like they plan to re-use the masks by flipping them around, so they want a light and dark fabric for each side.  [Red flag -- If you turn it around to re-use it, you'd be breathing all the stuff you just filtered out.  There were multiple comments about this statement in the video. Not just me ...  ] Perhaps the light and dark just help to differentiate which side is the outside (dirty side)? 

• She does have some ideas for using what you have around the house for the nose bridge wire, or making fabric ties if you don't have elastic.
• They also want a piece of metal wire (about 3 inches) inserted and bendable over the wearer's nose bridge, for a better fit.  She recommended using whatever you have around your house: gardening wire, paper clips, twist ties ...  Pipe cleaners?  To stabilize it, sew a wide zig-zag over the wire on the outside of the seam (closest to the cut edge).  This will fold over into the seam and not be visible on the outside.
• The pattern as printed only shows the LARGE mask.  Perhaps that is what is most needed now?  Hmmh ...  Keep looking for one that will fit other faces better ... 

• I finally made one of the Million Mask masks.  It's very large, and doesn't fit even the men of my family.  Very awkward mask.   Is it supposed to fit OVER an N95?  It might be better if you can get a smaller size?  Or just look for a different pattern ...

Found it!

Craft Passion's Sewing Pattern for a Face Mask -- Make one for your whole family.

• Offered as a dust mask, not as an N95!
• Similar pattern /design to the ones above, with that rounded shape.
• Offers different sizes
• Offers a pocket version
• Offers files for Cricut and Silouette Machines 

Make the Best DIY Fabric Fce Mask, and what to use when you can't find supplies - Fabric Patch Quilt Shop

I haven't made any of these yet, but it's on my to-do list.
This pattern is similar to the Olson Mask, so it should fit as well.   

• Uses the Craft Passion Dust Mask Pattern listed above with a few alternations.
• She recommends an extra non-woven later of interfacing for that additional filter later.  Interfacing with fusible is ok.  [Looking through my own stash, I was wondering about that -- Would you want to be breathing through the fusible?]  Fusible webbing is not ok because it does NOT have the interfacing layer.   They also like that non-woven craft fabric used to make those reusable shopping bags -- people also use them for advertising. 
• She also does a good demo of why the non-woven fabric is better than an extra layer of regular fabric.  She showed the relative sizes of the bits - dust to bacteria to viruses and how they are small enough to fall through the woven fibers. 
• They also talk about what materials and supplies NOT to use, including the fusible webbing noted above.  Make sure fabrics are breathable -- some fabrics might be waterproof and excellent barriers, but won't be very helpful if you can't breathe through it.  It also makes a difference in how long you can wear it.
• For the nose bridge metal bit, she recommends using rectangles of aluminum cut from disposable roasting pans for the nose bridge, because you can fold over the cut edges and sew through it for a bendable nose bridge.
• Another alternative might be the snappy metal hair clips. If you break them apart into 2 pieces, you can make 2 nose clips.
• They note that not all hair ties are appropriate for these masks.  Some are too thick, or too small.  She also found hair bands at the local dollar store that could be used.  I have a nice variety of hair bands and hair ties in my stash already. [Great for taming thread tails to keep spools from unwinding.]
•  She also has a good suggestion for stitching the lining just 1/8 smaller than the outer fabric down that curved seam so that they sit together better.
• She also makes a good case for which mask to make in another video: This one which is more fitted around the face vs. a surgical mask with pleats.
• Basically, the surgical mask is meant to keep your stuff spit out of the wound you're working on.
• While the dust fitted dust mask is designed to keep the outside world from getting to you.   In these pandemic times, I think I'd prefer the dust mask type.

So that seems like a good segway to the ...

Surgical Face Masks
This is another pattern I wanted to try for more of a rectangle, pleated surgical-type mask.
This is different from the cupped masks above in that it has pleats.


Deaconess Hospital in Evansville, IN, created a video to demonstrate making the surgical face masks they are asking their communities to make.     Here's the PDF.

• The pdf is confusing, but does list what size to cut the fabric for various sized masks.  
• Be sure to watch the video, then it will make more sense.    It's really pretty easy when it you see it made.
• That said, this looks like the simplest and quickest surgical mask pattern I've seen so far. 
• I'm also impressed that it's a fiance person in the hospital who is doing the demo.  You never know who knows how to sew!
• It was tricky to get the 3 tucks set up on this one.  I probably was using too wide a tuck. 
• This one does not offer a filter pocket.  

Here is my version of the Deaconess surgical face mask. 

Not my favorite, but this is what they asked people to make ...

Providence St Joseph's 100 Million Masks Challenge

• They offer a video tutorial, along with a pattern template and instructions for community members who sew.
• The template seems a little fiddly with all the cut outs, and you'd have to enlarge it.
• From the video, it looked like they were giving out fabric kits using the real surgical mask material.  

DIY FaceMask Tutorial - Froedert & The Medical College of Wisconsin

• Simple surgical face mask pattern with fabric ties (not elastic) 
• The pattern is very clear about where to make the pleats

Erica Arndt's quick tutorial for sewing a medical face mask.

• This one is 3 layers (includes a flannel inner layer), and appears to come together quick! 
• Only 2 tucks.
• This is the one I decided to make.
• No provision for a filter or wire across the bridge of the nose for a better fit, though the wire could be easily added.
•  

Here's my version of the Erica-Made Designs surgical-type face mask.

Fits better than the Deaconess version, which seemed a bit narrow.

Could benefit with a wire nose bridge for a better fit.  

Same fabric as the Olson mask above, but a flat and pleated style.

[Same at the photo at the top of this post.]

I made several of these for family members to go to the grocery store -- or whatever. 

Face Mask Sewing Pattern by Little Stitch Studio Norfolk

• This pattern demos versions of the surgical face mask with and without the filter pocket and the wire for the bridge of the nose.   This could be easily adapted for the EricaArndt version above.
• It does link to the CDC protocols for conserving PPE equipment
• This one does offer  measurements on where to put the tucks -- how far apart, which might be helpful for some makers.

• No words, just the demo.
• 2 layers of fabric plus filter
• Includes a filter pocket.  Would be easy to incorporate into the Erica Ardnt version above.

Face Mask: A Picture Tutorial by Button Counter

• This is another popular pattern I see a lot.  
• It uses separate rectangles of fabric to make the casing for the ear loops.  
• Not hard, just an extra step.

The Stitchroom - Make Masks

• If you want to hook up with other volunteers and mass produce masks for health care workers, this organization can help you make the connection.  Comparable to the Million Mask effort above.
  
• Face Mask Instructions (3 types)
• Fabric Suggestions
• FAQ for MakersVideo: Face mask how-to (easiest) 
• Video: Face mask how-to 
• Video: Face mask how-to (no elastic strap)

Make Victory Masks

• I just like the vintage feel of this one, as if it's a war-time effort, and the masses are mobilizing to help.

This one is worth adding just to show the difference between what someone on the front lines really thinks is important in terms of filtration and safety--In this case, an ER Doctor and his wife designed a duck bill mask, using HEPA filters from a common household vacuum cleaner bag.

If you really want to take it further, you can even start up your own program:
Developing a Mask-Making and Distribution Program in Your Area

• Logistics to think about in starting your own program
• Working with Volunteers
• Connecting with people / health care who need your masks
• Includes a section on possible filter materials 
• [Verify these recommended filter materials for suitability in other trusted academic sources, or even the manufacture's documentation.]
• Furnace or air conditioning filters (Make sure there's no fiberglass!)
• Vacuum cleaner filter bags
• Coffee or Tea Bag Filter (may not be as effective)

• Sterilization

So there you have it -- a round up of DIY Fabric Face masks for the Coronavirus pandemic.
There are many other DIY Face mask tutorials out there now.

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Updated as of April 5, 2020

The thinking / evidence for wearing masks in the public has moved ahead very quickly in the last week.  When I started researching for this post two weeks ago, the general thinking was: Make masks for health care workers where they may have no other options, because it's better than nothing.  Now the thinking has moved on to : DIY Masks for Everyone - My Mask Protects You: Your Mask Protects Me. 

An evidence review of face masks against COVID-19.

Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen HM, von Delft A, Price A, Fridman L, Tang LH, Tang V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. Proc Natl Acad Sci U S A. 2021 Jan 26;118(4):e2014564118. doi: 10.1073/pnas.2014564118. PMID: 33431650  Link to article.

 

Coronavirus FAQs: Is a Handmade Mask Effective? And What's the Best Way to Wear One? - NPR

• This article traces the change in public policy.
• It also addresses the question of how to keep them clean, and how often.  
• Regular laundry will do, but "Think of a mask as like underwear: It needs to be washed after each use." 

Should Everyone Wear a Mask in Public? Maybe--But it's Complicated - Forbes

• Very well-researched from a public health standpoint.  Acknowledges that science and circumstances change as we move ahead through the pandemic.
• Asks some questions that are still unanswered ...
• And links to additional articles and studies.

Slate's Comprehensive Guide to Masks

Systematic Review - Best Evidence for Face Masks preventing spread of Covid-19

A review of 172 observational studies published earlier this month in The Lancet also concluded that wearing face masks or coverings can help curb the risk of coronavirus infection and transmission, the Post reports. Holger Schünemann, a co-author of the review and an epidemiologist and physician at McMaster University, said the review indicated that, "[i]n multiple ways … the use of masks is highly protective in health care and community settings."  [Added 6-17-2020]

Yes, Wearing Masks Help.  Here's Why ... NPR.org

This article cites more recent studies on face masks and their ability to prevent transmission of coronavirus.  It also offers a video with 3 tips for making a better DIY mask.   [Added 6/28/2020]

Covid-19 Myths and Realities - UT Southwestern Medical Center

How Face Masks Can Help Prevent the Spread of Covid-19 - The Scientist (July 2019)

Low-cost measurement of facemask efficacy for filtering expelled droplets during speech - Advances in Science (August 2020) - A research article from Duke University.

Cloth Masks do Protect the Wearer - Breathing in Less Coronavirus means You Get Less Sick  -Aug 19, 2020

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Updated as of April 21, 2020:

* Ascension Wisconsin Now Accepting Hand-Sewn Masks 

• In response to new guidance from the CDC, Ascension Wisconsin is now accepting homemade masks of any pattern, and both ties or ear loops.
• Anyone interested in donating handmade masks to any hospital or clinic within Ascension Wisconsin   is asked to send an email to ascensionwifoundations@ascension.org and follow the given instructions.
• Interested donors will receive a response that includes donation requirements and drop-off locations (donations are only received at specified sites), along with a message of sincere gratitude for the support of the community.