What and how to use or reuse masks during Coronavirus (Covid-19) spread

NOTE: This post is originally published April 11, 2020. It is updated Sep 10, 2021.

UPDATED: What masks to wear and how to wear them in the current Delta-variant outbreak

We collected our free masks that Temasek Foundation is giving away recently – a box of regular surgical masks and a box of N95 masks.

There were only 25 masks in the N95 box. Apparently it’s not for everyday use, but if we were unlucky to contract Covid 19 and self-tested positive, we should don on the N95 masks to prevent spreading to others. Then we should go see the doctor and wait to be transported to the hospital or whatever other facility the government deems we should go to. So yah, at least we know what to do when that time comes. Hah!

With the delta variant being more transmissible, the current advice out there would be to use disposable surgical masks above BFE >95% to be properly protected every time you go out.

The good news is disposable surgical masks are now at a more affordable $8-$12 per box of 50 in Singapore. (It was $30 for a box of 50 last year!!).

Cloth masks alone are (no longer) recommended, but pairing them with a surgical mask drastically increases the effectiveness.

JAIN, R. O. U. N. A. K. (2021, April 24). Double masks FOR Covid-19 – how to wear them and other things you should know. Business Insider. Retrieved September 10, 2021.

To feel even more protected, you can wear a cloth mask over a surgical mask. This is called double-masking. It is also recommended if you live in particularly risky zones where the increasing cases are causing alarm bells in your head.

Double-masking can improve the fit of your mask by closing gaps around the edges, and it creates multiple layers of protection against droplets coming in or out.

Parker-pope, T., & Blum, D. (2021, March 17). How to double mask correctly. The New York Times. Retrieved September 10, 2021.

The key thing here to note is that you should NOT double-mask using two surgical masks.

A standard surgical mask is a blue, rectangle-shaped mask made of paper-like material. While surgical masks are great filters against viral droplets, they tend to fit poorly, leaving gaps on the sides, which reduces their efficiency. Wearing two at the same time doesn’t solve the fit problem. Adding a cloth mask on top of a surgical mask helps close the gaps and creates a more snug fit. 

PARKER-POPE, T., & BLUM, D. (2021, MARCH 17). HOW TO DOUBLE MASK CORRECTLY. THE NEW YORK TIMES. RETRIEVED SEPTEMBER 10, 2021.

Of course, double-masking may make it harder for some people to breathe. If you prefer to just wear a regular surgical mask, you can improve the fit of loose masks using the knot and tuck technique. This video by the CDC shows you how.

To read more about how to choose more effective cloth masks and also how to care for and maintain your reusable cloth masks, you can read my original article below.

Original “What and how to use or reuse masks during Coronavirus (Covid-19) spread” article written April 11, 2020.

I’m writing this post to order my thoughts about mask usage during this period. I have been reading just too much and sometimes conflicting information from “authorities” so it gets overwhelming.

Please understand that I am not an expert. I collate published information about mask usage to better inform my family about how to use our masks. This is to help us use masks as effectively as we can and as best as we are able to.

If there are mistakes in my understanding or in how we are using our masks, let me know in the comments. Please include your source of information so that I can double check and verify for myself. Thanks!

Context of mask usage during Coronavirus (Covid-19) spread

It is generally agreed that there is a shortage of masks in many countries including Singapore. Therefore, it is socially responsible to ensure frontline medical workers are supplied with protective N95 masks and surgical masks.

The regular man on the road like you and I are advised to stay home as much as possible. Since no/minimal contact with direct carriers is the safest.

However with online supermarkets unable to have delivery slots for everybody, it is inevitable that we need to go groceries shopping at some point. Weekly? Biweekly? Or monthly if you are only one person and have enough storage and pantry space to go all Doomsday Prepper mode and be fully stocked. Hah! For a bigger family, it is just too difficult especially in the tiny kitchens of Singapore flats today.

Dog owners need to venture out of the home more frequently since there is the need to walk the dog.

So what is the best practice for mask wearing when we need to get out to get shit done? :P If we have a limited supply of surgical and reusable cloth masks, what are the guidelines to using them to keep us safe?

These are the questions that I have been seeking answers for.

Surgical masks preferred

The Singapore government has advised wearing a mask when going outdoors now that the number of daily coronavirus cases has started to rise rapidly.

One-use surgical masks are currently selling at 50 pieces a box for $30 or more. So reusable cloth masks may be more economical, affordable and environmentally friendly. However, there is a difference in effectiveness between surgical masks and cotton materials used to made reusable cloth masks. (See chart below)

That said, in this family at least, we currently have less than two boxes of 50 surgical masks to share among 3 adults. So reusable cloth masks are definitely something we would have to incorporate into our routines. This is especially if the situation doesn’t improve within a month and we need to make those surgical masks last! To that end, I found the most applicable advice here:

Infectious diseases expert Dr Leong Hoe Nam said that following safe distancing measures takes precedence over mask-wearing, and must be practised even when wearing a mask.

If you have a supply of surgical masks, you could choose which to use based on the type of activity – wear the cloth one for “low-risk” activities, such as going for a short walk nearby, and the surgical one for “high-risk” activities, such as taking public transport or going to the supermarket.

ASK ST: How effective is a reusable mask and how should I take care of it

Who gets to go out? Who needs to stay home?

Until yesterday (Thursday April 9, 2020), I was still bringing both Donna and Little P out for morning walks. Singapore is currently in partial lockdown (officially called Circuit Breaker period). Individuals or people living in the same household can exercise by themselves in parks as long as we practise social distancing.

However, when I researched further yesterday, I think our group would likely be categorised under “loitering” in the park rather than “exercising” in the park. Oops!

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In any case, the number of cases shot up suddenly from 100+ to 200+ in a day yesterday.

I read before that usually a coronavirus patient can transmit the virus to 2 to 3 other people on average. This average differs by country. In Italy, it was reported that 1 patient can transmit the coronavirus to 6 people.

The 287 cases yesterday is made out of locals and foreign workers already isolated from the general population. Reportedly, 7 out of 10 of the cases were foreign workers. So maybe around 86 cases yesterday were locals like you and me.

If each of these 86 people managed to spread the virus to another 3 people, that would be another 258 carriers walking around with or without symptoms before they are diagnosed as patients. And this is just from 9 April 2020, there are still over a hundred cases on 8 April and 10 April respectively.

And so, one-year-old Little P who refuses to wear a mask and sneezes at will without covering his nose is officially grounded at home. :P

Donna who has low risks from getting the virus gets to go for 2 walks still. But we may cap these walks at a shorter duration if the situation continues to worsen. Or if the government has more advisories about the length of time spent outdoors. On the bright side, Donna finally gets individual and personal attention on these walks with Little P out of the picture. Hah!

What masks do we use?

…For instance, when a person who is sick goes out wearing a mask, the chances of spreading the virus are reduced by 50 per cent. When the person comes into contact with someone who may not be sick but wears a mask, the risk of transmission is also reduced by another 50 per cent.

Ask ST: How effective is a reusable mask and how should I take care of it

Since it is outdoors and we will treat all humans outside like zombies, reusable cloth masks will be the mask of choice on such walks.

Ms Wu ( FDA Taiwan director-general Wu Shou-mei ) said using cloth masks made of non-woven material that can be washed after each use is acceptable only if one is going to open-air, low-risk locations like parks.

CORONAVIRUS: TAIWAN HEALTH AUTHORITIES GIVE TIPS ON HOW TO MAKE MASKS LAST LONGER

Lifts are small enclosed spaces shared with others not unlike public transport.

For apartment dwellers, put the mask on and remove it while inside your home. Elevators and stairwells can be high-contamination areas.

How not to wear a mask, The new York times

At some point, it might be safer to switch to surgical masks because we do still take the lift up and down to go for our walks. If that day comes, maybe we’ll just stop walks at that point, I don’t know. I do hope that day never comes.

In the meantime, we reserve surgical masks for visiting places where it may be hard to keep distanced from others like the supermarket, etc.

Conflicting Information about Reusing Surgical Masks

Ideally it would be good if we can reuse surgical masks but I read conflicting advice about it. For example, this doctor is reported to advise:

… If all four checks are done, the surgical mask can be reused for up to four or five days. (Read the article to know what these 4 checks are.)

Dr Leong (Infectious diseases expert Leong Hoe Nam) said people should not share masks, and masks should be placed in a ziplock bag for personal hygiene reasons.

ASK ST: HOW EFFECTIVE IS A REUSABLE MASK AND HOW SHOULD I TAKE CARE OF IT

But I also read conflicting advice that keeping a mask in a ziplock bag has the potential of making it a breeding ground for bacteria.

“I would advise storing masks you took off temporarily in a dry, airy environment and not store it in a sealed plastic bag; this would cause bacteria to multiply. You can use a plastic folder or a paper bag but avoid touching the mask with your hands,” he (Associate Professor Lai Chane-yu from Chung Shan Medical University’s Department of Occupational Safety and Health) added.

coronavirus: Taiwan Health Authorities give tips on how to make masks last longer

In the end, I found a different article on the South China Morning Post that recommends including desiccating gel in the ziploc bag to keep your mask dry. This advice comes from the same Dr Leong Hoe Nam quoted above.

In general, one should change face masks regularly, usually once its inner lining becomes moist, said Leong (Leong Hoe Nam, an infectious diseases expert at Mount Elizabeth Novena Specialist Centre).

To reuse a face mask, Leong said that one has to keep it dry so that it can last as long as possible. One should take off the mask without pulling it under the chin so germs there will not attach to the mask.

“If dry, and the layers and shape are intact, I would consider putting it in a ziplock bag with a desiccating gel,” he said.

Desiccating gel is a substance that absorbs moisture and can keep a mask dry. If the mask is dry and not torn, it can be reused for two to three days.

Even when one is sick, he can still reuse the mask, provided the mask is not shared.

“No harm [reusing the mask]. Once you have been infected with a virus … It can’t reinfect you,” Leong said.

Wearing a face mask. How to dispose of them safely and can they be reused

Unknowns about reusing masks

Keep in mind, there is perhaps still a gap in knowledge how to effectively and safely reuse surgical masks. This March 20, 2020 article on The Lancet says we need urgent research on this topic.

… urgent research on the duration of protection of face masks, the measures to prolong life of disposable masks, and the invention on reusable masks should be encouraged. 

Rational Use of face masks in the covid-19 pandemic

So if you can afford it, just use surgical masks once and change regularly. That’s its original intended function after all.

If not, then at least the experts above have pointed out 2 ways for you.

(1) Store in ziplock bag with desicating gel or
(2) Store in clean paper bag.

What to do when you are ready to throw your used surgical mask

How to reuse Cloth Masks

As for cloth masks, this 8days article recommends storing your cloth mask in a clean, breathable container like a paper bag. That works if you are outside and need to take the mask off to eat and drink for example. That is not currently allowed.

So what we need to do is to wash it after every use. It’s not like we go out multiple times a day during this #stayhome period. But I do think I need to get a couple more cloth masks so I can take the dog out twice a day. Haha!

There’s quite a lot of different advice given with regard to how to care for your mask, and not destroy it in the wash. Here are some instances:

… Dr Leong said to wash the mask once a day with warm water and soap, and wring it gently to dry. It should be air dried, and not in the sun, as the colour could run and may destroy the fabric and filtering capabilities.

YES, WEAR A MASK BUT WHEN AND WHY? HERE’S WHAT YOU NEED TO KNOW, Channelnewsasia.com

Whether you machine- or hand-wash your mask, drying it properly is just as important. For that matter, sunning or air-drying your mask isn’t your best move as higher temperatures are needed to kill the pathogens, said Dimitar Marinov, an assistant professor in the department of hygiene at the Medical University of Varna – echoing the WHO’s temperature specifications.

Machine wash or hand-wash? Cleaning reusable masks the right way, Channelnewsasia

Machine washing is optimal…. “Fabric masks can be washed in the warmest possible water that the fabric will tolerate,” Emily de Golian, a board-certified dermatologist said.

Dimitar Marinov, assistant professor in the department of hygiene at the Medical University of Varna, advised keeping the World Health Organization’s specifications in mind. “The temperature should be at least 60 degrees Celsius. We do not have studies on SARS-CoV-2, but the similar SARS-CoV-1 dies quickly at temperatures above 60,” he said.

If hand washing is your only option, de Golian suggested lathering the masks with soap and scrubbing them for at least 20 seconds with warm to hot water.

“Washing should be followed by hot air drying,” Almer said.

MACHINE WASH OR HAND-WASH? CLEANING REUSABLE MASKS THE RIGHT WAY, CHANNELNEWSASIA

It’s much easier to clean a fabric mask than a medical mask. The C.D.C. says fabric masks should be “washed routinely.” The mask experts I spoke with wash theirs daily in a machine or a sink, just using regular laundry soap. You can use the dryer or let it air dry. Although it’s not necessary, you can also go over it with a hot iron for a full assault on any germs that might remain.

Just as with a medical mask, chemicals like bleach or hydrogen peroxide will begin to degrade the fabric fibers, making the mask less effective. Dr. Marr (Linsey Marr, a leading aerosol scientist at Virginia Tech who has been studying ways to extend the life of medical masks) notes that a virus can’t replicate outside the body, and if virus particles have been trapped by the mask, they are pretty well stuck there and will decay or be removed during washing.

“Washing with soap and water should work,” Dr. Marr said. “I throw my cloth mask in the washing machine with the rest of the laundry and dry it on low heat. I would avoid bleach because we know that can degrade fibers. The important thing is to avoid damaging the fibers in the mask.”

A user’s guide to face masks, new york times

One thing I haven’t found in my research is how many times can I reuse the cloth mask before I need to replace it. That really depends on how quickly the mask fabric degrades from washing and sanitisation. Which makes if dangerous since we may be walking around thinking we are protected but perhaps the mask has already become ineffective because of the number of washes, heat treatment, bleaching that it has undergone.

Choose surgical masks wisely (if you have that option)

Which is why if and when we do run out of surgical masks at a critical period. I certainly hope we will be able to buy surgical masks of good quality rather than defective ones highlighted in the video below. Check out this video to get a better idea of what to look out for!

Stay safe. Stay Well.

Masks do make us feel safer, but any benefit of wearing a mask will be quickly negated if we lose our resolve about social distancing and hand washing. Don’t start lingering in grocery stores or spending time with friends because you are wearing a mask. A mask alone will not protect you from the coronavirus.

A user’s guide to face masks, new york times

More articles,
– The New York Times: The User’s Guide to Face Masks – recommended!
– Channelnewsias.com: Taiwan expands mask rationing measures, looks into ways to extend mask lifespan
– >99% BFE masks – Assure | Ultraguard
– The Straits Times: Do homemade masks work?
– The Straits Times: How to make your own cloth masks
– 爱做衫 & handmade: C15-口罩套-(成人版+兒童版)–為了增加醫療口罩使用次數

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