CLEVELAND, Ohio – Wearing masks is now a part of everyday life in Ohio and the rest of the country as we all do our part to get through the coronavirus pandemic.
And health officials said that’s not likely to change for at least a year. Masks will be as ubiquitous as key chains, wallets and purses.
This culture change has led to a lot of questions: What kind of mask should I wear? How many do I need? How do I keep it clean?
Many readers raised these and other questions through our From the Editor Subtext account with cleveland.com executive editor Chris Quinn, which you can find more information on here. So we set about getting some answers and came up with this guide to mask care and etiquette.
What kind of mask?
For starters, it’s important to distinguish which kind of masks are recommended for the public versus which kind are necessary for health care workers and first responders.
Surgical masks and other personal protective equipment, such as N95 masks, should be reserved for people at the highest risk of coming into contact with coronavirus every day – health care workers. There’s a shortage, and hospitals currently don’t have the appropriate amount.
The public has taken to making their own cloth masks at home instead. The Centers for Disease Control and Prevention now recommends the public wear cloth masks when going out in public and even provides crafting and use guidelines on its website.
Other instructions making cloth masks are readily available online. And here’s a handy video.
Dr. Neil Korman, professor of dermatology at Case Western Reserve University and University Hospitals Cleveland Medical Center, said cotton-based materials are the best option for preventing discomfort with masks. The CDC also recommends cotton fabrics.
Elastic bands are the recommended way of securing the mask to the head. But the constant rubbing of elastic against skin can cause some irritation.
Dr. Susan Massick, a dermatologist at Ohio State University’s Wexner Medical Center, said there are several workarounds to make masks fit more comfortably.
“People have been coming up with pretty clever ideas for headband styles with buttons,” Massick said. “You can actually put safety pins on a baseball cap and pin the loop to the cap instead of the ear.”
Prepping your face
We promise some fun stuff is coming in a bit, but first let’s talk about the daily routine.
Putting a mask on seems simple enough, but some basic prep should be undertaken both to minimize the possibility of infection and increase comfort.
People should consider their morning skin-cleansing routine as masks become more commonplace, Korman said. Some medications, particularly for acne, may irritate the skin, which could be exacerbated by having a mask covering the face for a prolonged period of time, he said.
“It might be reasonable for the person to cleanse their skin with gentle soap and water and maybe put a moisturizer on their face that doesn’t clog their pores when they keep it on,” he said.
That applies to makeup as well, which can quickly dirty the inside of the mask. Plus, nobody is really seeing your face anyway, so what’s the point?
“Just don’t wear it,” Massick said. “First of all, if you’re wearing a mask, no one is going to see behind the mask. You don’t need foundation. That residue gets on the mask. Just skip the makeup.”
For the men out there, the biggest hindrance to properly wearing a facemask is facial hair. Full beards can particularly get in the way of making sure the mask fits snugly.
The CDC put out guidelines for health care workers with facial hair for tight-fitting respirators. A cloth mask isn’t the same as those types of masks, but generally speaking, the same guidance can be applied for those beards you’ve been working on. Most mustaches are good to go, and it’s probably time we brought mustaches back anyway.
While wearing a mask, it’s important to make sure the face cover doesn’t get saturated with moisture from your breathing.
“If you’re breathing through it or it gets saturated, you can kind of get an acne breakout,” Massick said. “What we encourage people to do is just take the mask off and let the mask dry out. That’s really important. As it becomes saturated it’s not effective.”
As for filtration, it’s important to realize that these masks will not provide the same protection as the N95 masks. They are to prevent your respiratory droplets that potentially carry coronavirus from transferring to other people – a sneeze guard of sorts.
Two layers of cloth is fine for the do-it-yourself kind of mask, especially since tampering with and trying to customize filters can potentially be dangerous, Massick said. More layers of cloth fabric are perfectly acceptable, but too many layers might make it harder to breathe.
Washing your hands with soap and water for 20 seconds both immediately before putting the mask on and after taking it off is paramount, said Dr. Aaron Hamilton, a hospitalist and interim chief safety and quality officer for the Cleveland Clinic hospital system.
“It feels very basic and coronavirus is complex and has people very anxious and worried and there are some unknowns with it,” Hamilton said. “But one thing we do know is basic hand hygiene – soap and water for 20 seconds – is important to do before you put your mask on and after you take your mask off.”
Masks should be washed after every use to remain most effective, Hamilton said. Taking the mask straight from your face to the laundry machine is the most effective method, though it can also be sequestered for later wash.
Hamilton said running a mask through a washing machine and dryer might not be practical for some. In lieu of that, hand-washing a mask can be effective (coupled with washing your own hands before and after, of course).
“Just soap and water and agitation is probably enough,” Hamilton said. “But also, five minutes in boiling water in addition to soap and water can help. That’s kind of a throwback to the old days before washing machines.”
Widely shared online posts recommend different ways of sterilization that are either ineffective or outright dangerous.
Some of those posts advocate microwaving the masks to clean. This is probably inadvisable for a number of reasons.
“I would not advocate for microwaving masks for a whole host of reasons,” Hamilton said. “It doesn’t include the soap and water aspect. Sometimes even cloth masks will have a little metal nose bridge in them that can cause a problem in a microwave.”
That little metal part on the nose bridge might literally set your house on fire. Metal and microwaves simply don’t mix. And certain types of cloth are very combustible.
“I can say from the fire perspective that microwaving cloth isn’t a good idea,” said Cleveland Fire Department spokesman Mike Norman. “We would be concerned that is a fire hazard.”
Beyond potentially burning your house down, there’s also a question over whether a microwave would even do the trick.
Technically speaking, high heat can kill coronavirus. But microwave settings are not standard. It’s the same reason why cooking times for microwave popcorn vary from microwave to microwave. Uneven heating patterns could damage that mask you worked so hard on.
Antibacterial cleaning wipes or sprays are also a bad idea, Hamilton said. Those products are made for surface cleaning and with cloth masks having two surfaces and an internal pocket, products like Lysol simply aren’t going to do the trick.
“An external wipe just doesn’t do everything you need, whether it’s whatever brand,” Hamilton said.
Using any chemical besides soap and water also puts your skin at risk for irritation, Massick said.
“The problem with spraying Lysol all over a mask and then putting it on your face, there’s a potential to cause some irritation to the skin with some antibacterial components of the Lysol,” she said.
Instead, it’s probably best for you to treat your mask like it’s one of your favorite pieces of clothing when washing it.
Should you have more than one?
You wouldn’t – or at least you shouldn’t – wear the same pair of underwear every day. It’s prudent to apply that logic to cloth touching your face as well.
“It’s good to have backups,” Hamilton said. “In my house we have a couple cloth masks for every household member. They don’t have to be the fanciest things. They have to fit snugly but comfortably. They have to be secured with elastic bands or ties.”
Having multiple masks allows you to get into a routine as well, Hamilton said. When you take a dirty mask to the wash, you can then replace it with a clean mask in a place where you’ll remember to have it on your person out in public. Hamilton leaves his clean masks in his car so he knows he has them when he reports to work, but what routine people undertake is really up to them.
There is no set number for how many masks a person should have as wearing them more often becomes the norm. It’s really up to how many a person feels are necessary to make sure they’re consistent and safe with their mask wearing.
How long a mask lasts can depend. Functionally, they’re protecting other people from your germs, not so much protecting you from their germs.
The basic guidelines essentially say that so long as the mask fits correctly and snugly on the face, it’s good to go, according to the CDC.
The easiest way to think about masks is as another part of your wardrobe. Everyone owns a certain number of shirts that they cycle through. They wear shirts they like more than ones they don’t, but there’s still a set amount of shirts they have to be both comfortable and clean.
Protecting your skin
Your face includes some of the touchiest skin on your body (but don’t touch your face).
“Facial skin is more sensitive in general,” Korman said. “The epidermis, the top layer of the skin, is thinner and more sensitive.”
That can lead to skin irritation caused by the snug fit or the elastic bands.
Luckily, there are already several remedies for any number of these problems, Massick said.
“There are quite a few products out there that can help prevent pressure sores and pressure wounds,” she said.
Massick listed several, such as DuoDerm patches and Mepilex dressings, which can be shaped to cover the afflicted areas of the skin. Moleskin bandages, which are used for blister prevention and protection, and silicone gel sheets used to treat scars are other options, Massick said.
To treat already irritated areas, Massick said a number of products are available to apply directly to the irritation, such as petroleum jelly, MediHoney or antibacterial ointment.
How often should you expect to see masks?
Probably a lot. A vaccine is still a year away and Gov. Mike DeWine this week said he expects masks to be part of everyday life for awhile. And it looks like he’ll be pressing businesses to require masks when they start opening back up.
“I can’t imagine a business that’s going to open up without employees all wearing one of these,” DeWine said.
If Hamilton, the Cleveland Clinic doctor, gets his way, masks will become more culturally acceptable over the course of the pandemic.
“What I worry about is someone that wears a mask is marginalized societally. It needs to be the reverse,” Hamilton said. “I think societally we need to have people feel pressure. Like, ‘Oh, I forgot to wear my mask. I better go home to get it.’”
Matthew Donahue, professor at Bowling Green State University’s pop culture department, said it’s likely that masks will go from being just a public health recommendation to a pop culture phenomenon.
“The other day, Cardi B was in a mask speaking to her fans,” Donahue said. “I think what you’re going to see is a lot of encouragement from fans and these icons to get their fans to go along with the program in terms of masks or staying at home and these other recommendations. That will be an influence upon the public. The public is always influenced by other pop culture icons.”
With the coronavirus a worldwide issue, everyone has been affected by it to varying degrees, whether it’s knowing someone who has been infected or simply missing out on sports that have been canceled.
As such, Donahue foresees a scenario where masks become part of the cultural zeitgeist in the West. Comedy is usually at the forefront, Donahue said, and he expects shows like “South Park” or “Saturday Night Live” will end up commenting and critiquing their daily use to some degree.
Online celebrities figure to be another significant source of making mask-wearing more normal, Donahue said.
“That’s kind of already happening. What you’re finding even now is there are YouTube videos or TikTok videos either encouraging other people to wear masks or they’re in masks themselves, maybe speaking to their fans and that sort of thing,” he said.
It’s safe to assume that masks will figure into cinema and television to a wider degree at some point, Donahue said. Coronavirus storylines are certain, especially because of the shared experience that the audience will be able to relate to.
Masks as fashion
Right now, mask making and wearing is mostly on a need-based or do-it-yourself system, but commercialization is almost certainly coming.
Linda Ohrn-McDaniel, professor in fashion design and merchandising at The Fashion School at Kent State University, said that’s a new concept to Western culture, but the phenomenon has been a part of Asian culture for decades.
“When we look at the Asian cultures where wearing a facemask is not a strange thing, it’s part of your wardrobe for many of them and a pretty normal thing,” Ohrn-McDaniel said.
Many clothing designers have switched their production over to mask-making already in a bid to help with the coronavirus effort. Gucci, Prada, Louis Vuitton, Dior and Balenciaga are just some of the high-end fashion names involved with mitigating the worldwide shortage of masks for health care professionals.
“I don’t know how long it will take, but in a month or so when we’ve filled the immediate need, I’m guessing more companies will be able to look at how they can make money off of it,” Ohrn-McDaniel said.
Commercialization has already started to some degree. Entrepreneurial people on Etsy and Amazon Handmade are already offering their wares. MaskClub, which offers either single-purchase and monthly subscriptions for masks and donates a medical grade mask one-for-one, started on April 4. Custom Ink, which sells custom branded merchandise in bulk, is offering masks as well.
Donahue said it’s likely a cultural industry will pop up around masks if they end up becoming commonplace. Instead of stores that specialize in clothing like T-shirts, shops may pop up offering different masks.
“I think it already transfers into the masks people are making,” Donahue said. “They’re taking their favorite T-shirt or bandanna or piece of cloth and making their own mask out of those things.”
Ohrn-McDaniel’s students are already incorporating masks into some of their portfolio projects. As people return gradually to more public life, they’ll want to have a personal connection to which masks they decide to wear, such as matching it with their wardrobe, she said.
“The more we get used to it, the more it will naturally become part of our wardrobe,” Ohrn-McDaniel said. “But it will also become a statement opportunity as any piece of fashion is.”
That’s not necessarily a bad thing, Hamilton said.
“It’s a public health responsibility that we all have,” he said. “Making it fun and something you enjoy doing is important. I hope it does catch on in that way.”
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