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 Table of Contents  
REVIEW ARTICLE IN MEDICAL EDUCATION
Year : 2022  |  Volume : 3  |  Issue : 3  |  Page : 269-272

Defeating the deficits: Mask banks offer a promising solution


1 Medical Students, AIIMS, Rishikesh, Uttarakhand, India
2 Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission26-Dec-2020
Date of Decision02-Jun-2022
Date of Acceptance29-Jun-2022
Date of Web Publication22-Nov-2022

Correspondence Address:
Dr. Santosh Kumar
Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_200_20

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How to cite this article:
Mehta T, Jain P, Garg A, Kant S, Kumar S, Kumari R, Bhadoria A. Defeating the deficits: Mask banks offer a promising solution. J Med Evid 2022;3:269-72

How to cite this URL:
Mehta T, Jain P, Garg A, Kant S, Kumar S, Kumari R, Bhadoria A. Defeating the deficits: Mask banks offer a promising solution. J Med Evid [serial online] 2022 [cited 2023 Feb 1];3:269-72. Available from: http://www.journaljme.org/text.asp?2022/3/3/269/361736




  Introduction Top


The COVID-19 pandemic has swamped the entire world and has caused numerous adversities sparing none. India is one of the widely affected countries which have endured massive losses of human resources as well as the economy. With a drop of 23.9% in the Gross Domestic Product and a shrink of 7.3% in 2020–2021,[1] with the higher number of COVID-19-infected cases ranked us second in globally[2] and a sky-high unemployment rate of 20%–25%,[3] which has now come down to 8% as of December 2021 indicting the improvement in conditions as the country has battled this deadly virus.[4] There are in total 10 vaccines, which have been approved for use in India, among which the two most commonly used are Covaxin and Covishield. With over 190 Crore doses administered, 64% of our population has been successfully vaccinated.[5] Along with successful vaccination drive the use of face masks, adhering to social distancing norms and avoiding social gatherings is the only way to defeat this virus which is merely biding its time, waiting for us to let our guard down.[6]

Studies have shown that cloth masks can block droplets and aerosols, and layers add efficiency. It has been shown that single layers of different types of cotton cloth show filtration efficiency ranging between 43% and 94%, compared with 98%–99% for fabric from disposable medical masks. In experiments using viruses, a single layer of T-shirt fabric has an efficacy of 51%, compared with 90% for a medical mask.[7] A recent 2020 study also confirms that multiple layers of fabric have greater efficacy.[8] A study conducted in a research laboratory from June 2020 to August 2020 demonstrated that the fitted filtration efficiency of consumer-grade masks is nearly equivalent to or better than their medical mask counterparts.[9] Cloth masks were found to be effective in controlling the spread of the virus, especially when made of hybrid fabrics such as cotton/chiffon, cotton/silk and cotton/quilt having filtration efficiency of around 80%–90%.[7] The cotton/silk hybrid is particularly presented with a filtration efficiency very similar to surgical and N95 masks.[10] The efficacy of cloth masks can substantially be increased by enhancing the fit of the mask. A well-fit mask along the contours can prevent leakage of air, thereby increasing the efficacy of the mask and providing better protection to the wearer. A recent experimental study conducted by the Centres for Disease Control and Prevention (CDC) showed that double masking and improving the fit of the mask reduced aerosol exposure by more than 95%.[11]

Keeping in mind the gravity of this pandemic, the marginal benefit obtained by the use of face masks supersedes any possibility of harm.


  Mask Etiquette Top


The CDC recommends wearing the mask after cleaning your hands with soap and water or a hand sanitiser with clear instructions of not touching the mask when wearing it. If at all the mask needs to be adjusted quite often or it does not fit properly one should choose a different mask. A proper mask should cover the nose and the mouth and should be able to fit snugly against the sides of the face while being secured under the chin. The public should choose masks made up of two or more layers of washable, breathable fabric and should strictly avoid the use of ones with exhalation valves or vents or those that are intended for health-care workers, including N95 respirators. The mask should not be placed around the neck, forehead, dangling from one ear or under the nose. Care should also be taken to not touch the eyes, nose or mouth when removing the mask, followed by immediate hand washing. The CDC also recommends that a mask not be put on children under 2 years of age.[12]


  Government Regulations Top


The Indian government has mandated the use of face masks in public places. In the current scenario, a fine of up to INR 1000 is being imposed upon going to a public place without wearing a face mask. Furthermore, in many states, the government has announced a fine of INR 1000 for people in urban areas and a fine of INR 500 in rural areas for violating the mask-wearing guidelines. One of the states in India named Jharkhand has imposed a penalty of up to Rs 1 lakh (∼$1300) and a jail term of up to 2 years against violators of preventive measures such as not wearing masks in public places.[13],[14]


  Need for Mask Bank Top


The COVID-19 pandemic has disrupted working life with negative consequences around employment and pay.[15] With our health-care workers and frontliners facing a dire shortage of personal protective equipment, people were discouraged from buying medical-grade masks and instead promoted to make masks at home. Just any household fabric from a bandana to an old T-shirt was touted as a protective face covering.[16] The lower-income group of the society has especially been hit hard by this pandemic and to them, buying a new mask or feeding their families is one dilemma they are facing. Mask banks here can play a crucial role. Mask bank, as the name suggests, collects masks in the form of donations and then distributes those fresh, clean masks among the needy. Government and health authorities should step up their efforts to set up mask banks, especially in areas where people of lower socio-economic strata reside. Such places have a lot of overcrowding and an inability to afford masks for all the family members adds a layer of complexity to the already woeful situation. Mask banks can also educate these communities on the proper usage and disposal of masks and inculcate in them the essentiality of wearing one. Awareness coupled with adequate supply can help us better grapple with the crisis.


  Mask Banks in India Top


Keeping in mind all of this, various states in India have established mask banks. Kolathur neighbourhood in Chennai, with the help of non-government organisation Goodwill has set up a mask bank and has been running campaigns around slum tenements to ensure residents wear masks.[17] The city of Jodhpur, Rajasthan, has also set up the City's first mask bank and has announced a distribution of around 5 lakh masks in view of figures stating that around 15% of the city's population is still not wearing masks.[18] With the slogan 'One mask, Several lives'- the Madhya Pradesh government also acknowledged the importance and need of mask banks and is encouraging the use of face masks.[19] In an initiative to help the poor, Lucknow University has set up the Mask Bank, wherein masks will be distributed to the needy.[20] Along similar lines, a mask bank has also been established by the All India Institute of Medical Sciences Rishikesh, Uttarakhand, on the auspicious occasion of Dussehra, highlighting the concept of victory of good over evil, shaping this initiative with the socio-cultural event. It is a multidisciplinary coalition between governmental and non-governmental agencies, which aims at providing masks to every segment of the community at a terminal level. Poverty percentage among the population ranges from 6.3% to 15.7% in the districts of Uttarakhand, during the COVID-19 pandemic, the reported job loss was around 63% and more than 73% of employees belonging to Uttarakhand have not paid due to the lockdown put them into livelihood crisis that forced migrant to rush to their native place.[21],[22] This social and economic crisis might reflecting the inability of the underprivileged to buy a face mask. Establishing a mask bank and distributing free clean masks to these families is therefore indefensibly the need of the hour.


  Efficacy of Cloth Masks Top


A study at the University of Illinois took into consideration several factors determining the effectiveness of a fabric mask-like construction, fibre content, weight, thread count, porosity and the water-absorption rate they found that even a single layer of all the ordinarily available household fabrics, were to some extent effective at blocking the 100 nm particles carried by high-velocity released by speaking, coughing and sneezing.[23] In another analysis conducted at the University of Oxford's Leverhulme Centre for Demographic Science, data compared the protection that masks can afford versus not wearing a mask at all and it was observed that wearing a cotton mask can lower the risk of getting infected by 54% compared to the no mask group.[24] Because one of the routes of spread for the coronavirus is by infected respiratory droplets suspended in the air, a study at Florida Atlantic University further delved into the fluid mechanics of the droplets. The research ascertained that without a face mask, droplets from cough or sneezing can travel up to 12 ft (more than the safe distance of 6 ft recommended for social distancing). The team also noted that simple homemade masks can reduce the forward projection but they had considerable side and top leakages.[25]

According to a study, a sheet of tightly woven cotton - of 600 threads per inch - plus two sheets of chiffon, made from polyester and spandex, were the most efficacious combination, filtering out 80%–99% of the particles, depending on their size. University of Cincinnati biologists have opined that silk works better than polyester or cotton as it is water repellent, easily washable, and has a better moisture barrier than the two.[8] At a household level, quilted cotton with two to three layers of fabric also presents as a good alternative. Even though homemade masks will not be as effective as medical-grade masks in filtering out the particles, they still offer adequate protection by trapping incoming particles in a fabric matrix and reducing the forward projection by the way of cough and sneezes as compared to thinner ones.

A key recommendation by the WHO suggests using readily available materials such as cotton blends, a thick woven fabric like batik, quilting cotton, thick interwoven tea cloth/towel and/or gauze and making sure that the fabric is layered so that particle penetration can be kept at the lowest possible.[26] Other than the right material, correct mask coverage should also be ensured. The homemade mask should fit snugly over the nose and cover the sides of the face, coming all the way down to the chin to prevent side and top leakages and breathing without restriction should be possible through the layers of fabric.

While disposable face masks are supposed to be discarded after a single use, cloth masks are inexpensive, reusable and can be washed several times, making them an affordable as well as an eco-friendly option. Cotton face masks, besides being super comfortable, are relatively easier to breathe in making it convenient for people to wear them without craving to remove or adjust it for better respiration, thereby avoiding self-contamination or transmission onto other surfaces.[27]

CDC has issued guidelines for making simple, breathable masks at home (both sewn and non-sewn) and their proper usage and disposal. It recommends wearing a mask in public settings and especially in situations where it is difficult to maintain social distancing measures.[28]


  Conclusion Top


While it is true that no face covering can offer us absolute protection against the virus, a widely masked population that maintains social distancing is our best chance at slowing the rate of spread. Generating awareness about mask-wearing can only go so far if we do not provide masks to the needy and underprivileged population. This especially holds true in a country such as India, where campaigning and sloganeering will only fall on deaf ears if we do not put money where our mouth is.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Introduction
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Need for Mask Bank
Mask Banks in India
Conclusion
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