Homemade Mask Summit: Masks Unmasked

Transcript: Covid-19 Masks: Dr. Jocelyn Songer of MaskMaker.org joins us – Part 1

June 15, 2020

Transcript edited for brevity/clarity.

Participants: Dr Elizabeth Townsend Gard, Dr. Jocelyn Songer, Whitney, and Alexa

Podcast Introduction

Elizabeth Townsend Gard (ETG), Host: We had a delightful evening with Dr. Jocelyn Songer. She is the founder of MakerMask.org and also a biomedical engineer. She has outdoor experience with backpacking and emergency services and breathing. She has been testing masks and has a strong belief as to what material we should be using for masks. We went for an hour, and then we decided we needed to chat more and chatted for another hour and a half.

So this is part 1 of 2 of a very long, in-depth conversation with Dr. Songer. She is going to be our keynote speaker for our Home-Made Mask Virtual Summit this coming week.

Opening Questions: Dr. Songer’s Background

Dr. Jocelyn Songer (JS): I’m Dr. Jocelyn Songer, and I’m calling from Orange, MA.

ETG: Awesome. We ask everybody this question: Do you have any memory of anyone sewing or quilting in your life? If so, what?

JS: Absolutely. Both my mother and my grandmother sew; my grandmother was a seamstress. She would look after me, and I pestered her forever to let me use the sewing machine, which at eight years old probably was never going to happen. But she did let me use a needle, and she and I did work together to make dolls. She helped me make little patterns, and we would go back to the drawing board a zillion times. But eventually she’d kind of zip one together and then let me do the stitching work. So I have lots of fond memories.

ETG: So what was your life like November, December, six months ago?

JS: Six months ago I was balancing my work on neuromodulation and neuro/biomedical engineering with backpacking.

ETG: Tell us a little more about both. Tell us what that is and a little bit about your path of how you got there.

JS: So my background is biomedical engineering and electrical engineering, and I’ve always been passionate about health and helping other people. I’ve maintained certifications as a first responder. I’m very geeky; I have a very science and engineering mind, so I’ve applied my energies towards developing innovative clinical tools for diagnostics and treatment.

ETG: Very cool. Give us some examples so we can have a concrete understanding.

JS: A lot of the work that I’ve done has been on hearing and balance in the inner ear. So understanding how a hole in your ear can make you lose balance.

ETG: How did you get to that? How did you want to be doing that?

JS: When I was young, I loved health and science. My mom is a nurse, so I was passionate about that. I saw a talk on the brain, and what is cooler than how the brain interfaces with electronics and electrical devices. So that is what nudged me in that direction. Early in my career, I got interested in the ear and the acoustics of sound because cochlear implants was where the brain met electronics the best. Then there were some real-world clinical challenges people were finding where this hearing and balance stuff was interacting. So I studied acoustics of sound and how it’s produced and how you hear it, and that kind of led me into the brain.

ETG: Very interesting. So you’re going along; you’re backpacking; it’s great. Then what happens?

JS: So I am asthmatic, so I have to pay really close attention to when there are respiratory illnesses getting big. I flew to a conference in January and was already concerned about COVID so I had masks that I was bringing with me. I’ve hiked across the US three times now, so I’ve had to have masks with me at all times or to be able to make DIY masks as needed because of forest fire smoke. So hiking across California, New Mexico, Oregon, Washington, Colorado, Montana where there are forest fires 24-7, and you can’t get away from it because you don’t have a house; you don’t have shelter; you don’t have running water. So you have to figure out how you’re going to make traditional and nontraditional solutions come together so you can breathe. For me, breathing is a privilege. Most people don’t think about it very often because they can just do it, but since 2009 I haven’t been able to take breathing for granted.

ETG: Me either. I had a couple of pulmonary embolisms and they didn’t go away. So yeah, not breathing is really awful. If you’ve experienced not breathing, it sucks – gasping trying to get air into your body is not fun.

JS: It changed the whole way I had to interact with the world. I had occupational asthma. I was literally allergic to my job, so my whole life kind of shifted.

ETG: What was your job that was causing that?

JS: I was doing research in a facility that had fuzzy, furry critters, and I became allergic to them over the course of five years. It happens to about 80% of people, and I was from a small subset that went on to develop asthma. But as a vet, I have all this background and real-world experience in particles and what size they are and how they disburse in travel because I wasn’t the one working with the fuzzy, furry critters I was most allergic to but certain sizes of particles travel and distribute more. I had worn an N95 daily for occupational work, so I had some real experience with how they are not always the most fun things to wear or the most comfortable. Similarly, I hiked with N95’s in the desert – reusable ones while I was backpacking. So I watch TV now and I see all these people with masks that are worn improperly just covering the mouth and not the nose, and I’m like: “Oh, I so understand that…”

ETG: It’s too exhausting; it’s awful.

JS: It’s too exhausting, and it can be uncomfortable. So you kind of shift it; in the desert I did that with the smoke because I would be hot and sweaty but I needed something, and it helped. It sort of highlights some of the differences between when you’re wearing a mask for infection control, essentially in a pandemic where the things that you do to treat with forest fire smoke or other things where you’re like, “well, if it’s preventing me from breathing through my mouth, but all that stuff is coming out of your nose…” So every time I see it on TV, I’m like: “if you can’t wear the mask…” The most important thing about a mask is your willingness and ability to wear it when you need to be wearing it. So if it’s an N95 and it isn’t perfect, that’s okay if it’s a mask that you’re willing and able to wear for the amount of time that you need to wear it.

So I feel like some of those human factors are things that don’t get talked about very much. I make my masks, and I know the science really well, which helps. I have experience as a first responder, so I’m used to thinking about these things.

Mask Research

ETG: So we’ve been doing research; we’ve been talking to different people: industrial hygienists and all kinds of other people. We’ve learned about big particles and tiny particles and electrostatic fabric versus cotton and all this stuff that tells us where we’re at.

For those that want to follow along, go to makermask.org.

You’ve got a science-based resource on creating masks. We’re doing a summit next week, and the goal is to gather everything. There’s so much science out there, and we really want to be able to make masks for our friends and family and communities – first responders if they need them again. But there’s too much science out there; it’s chaotic. So tell us about your science. You design water-resistant, non-woven, polypropylene. We just got some polypropylene that’s latex-free and can be machine-washable or disinfected by boiling or autoclaving. So tell us what that is and why that’s important and how you make your masks.

JS: I initially started from the infection control standpoint. What we know most about COVID-19 and the transmission of SARS-COV-2 — which is the virus associated with it – is that it’s mostly transmitted through droplets. There’s a whole long dialog about the different forms of transmission, but for droplets in hospital settings, it means that they wear surgical masks, gloves and gowns. The surgical masks in those cases provide droplet protection, which means they prevent water-based droplets from coming through and those masks are water-resistant. So they’re designed to block bigger particles and especially particles that are in water. That’s why I started looking for water-resistant materials is to block droplets so that you can contain your droplets to you and keep other droplets out.

Polypropylene

ETG: It’s a great website because you’re also suggesting what is polypropylene on there, right?

JS: Yeah. I was used to thinking about polypropylene from backpacking because all of these synthetic fabrics and high-tech materials are really popular there. But most of those materials are woven, so the big stuff goes right through it. The challenge is finding something that’s water-resistant so it provides a barrier to droplets; that’s breathable; and that you can wash, clean, sterilize, disinfect. So you have to have the trifecta there. Reusable grocery bags are nonwoven polypropylene. It’s really hard to talk about because people are like: “I’m not going to put a bag over my head!” Absolutely, don’t put a bag over your head. The key is it’s got to be breathable; if it’s not breathable, don’t use it. That’s rule number one.

It turns out that these reusable, nonwoven polypropylene bags, which I shorten to NWPP, are designed to be touching food, which is good because they meet some standards; they’re designed to be washable so they can be disinfected; and it’s water-resistant because you don’t want the wet stuff from your food soaking into the bag. So it met all those criteria, so that’s how I ended at nonwoven polypropylene from reusable bags. It’s because of that food-grade component that made me select that relative to other things. It feels like fabric, and you can find it in all sorts of sources around the house like with the food grade but in other things like interfacing, which sewists are much more familiar with.   There are lots of variations, but you can get nonwoven polypropylene in interfacing. The caution there is that most of the interfacing that people are used to is fusing interfacing.

ETG: Right, so you want non-fusible?

JS: Right, because fusible has adhesives. Breathing in adhesives is usually bad.

ETG: And stabilizer? They have stabilizer that’s not fusible.

JS: Some of the stabilizer if it’s backing that’s tear-away for some embroidery projects, a lot of that is also nonwoven polypropylene. They’re different weights. I feel like I’ve been down the rabbit hole on nonwoven polypropylene and looking at all the different kinds with different safety and engineering features because when you’re making something, you want to make sure you’re not doing more harm than good.

Whitney: I think that’s why we’re trying to do the summit is because there are so many sewists and quilters out there who want to help and make masks, but there’s so much information and some of it’s conflicting, and it’s like what do we do because we just want to do the best thing.

JS: I want people to wear the masks that they’re going to be comfortable with and that they can get or create. A lot of people have been focused on making a zillion masks and getting them out as quick as possible. As a scientist, engineer and researcher, the thing I can do is take a deep dive on all the science and come at it from the health perspective, too. But there’s so much information that figuring out how to communicate it to people who are sewing masks, wherever they are, more effectively is the thing I struggle with.

ETG examined some nonwoven stabilizer.

JS: The polypropylene in particular that I’m looking for is called spunbond. That gets into the details of how it’s made. But if you look closely at the bags, they have this little pattern to them that looks almost woven.

ETG: This one is flat.

JS: I think what you’ll find is that if you go to tear it, it tears more easily than if you had some of this other stuff.

ETG: This tears really easily. You want it to tear easily, or you don’t?

JS: You don’t want it to tear easily. If it tears easily, it’s not going to hold up as well to washing.

ETG: So for single use, it would be okay. It’s just the washing factor that you’re concerned about, is that right?

JS: Right, the durability. If you’re going to wash it and try to disinfect it to use it multiple times – especially if you’re putting it in the middle layer of a mask, you don’t know how it’s holding up.

ETG: So you just want the basic one that doesn’t have any extra bells and whistles.

JS: Right. If you’re on the webpage, there’s a section called Research Blog. If you page down in there, there’s a place called Big Four: Criteria for Community… That one dives into all of that…

Water Resistance

ETG: Tell me a little bit about the fluid resistant test.

JS: In the US, for something to be called a surgical mask, it has to be fluid resistant. The FDA has really strict conditions for what that means. There’s one specific test that it has to pass which uses synthetic blood. That’s for surgical mask classification. Most of us who are just trying to make masks for community use for friends and family, water resistant is much more easy to check at home to see if it’s going to provide some barrier to water. The simplest version is you just flick water at it and see if it beads up on the surface. If it beads up on the surface, it’s hydrophobic and water resistant, and if it absorbs into it, it’s not; it’s hydrophilic. With the mason jars, you can measure it and quantify it, which makes the scientist in me really happy.

Mask Designs and Layers

ETG: Let’s go back to the masks that you’re making. You have Cover, Surge and Fit. Let’s talk about Surge and Fit because Cover is the N95, and that’s not really where we’re at I don’t think.

JS: Although I’ll mention that WHO has released new guidance on fabric masks. Three layers, including nonwoven polypropylene.

ETG: It’s like they knew you.

JS: One of the things with the Cover is that you could use it over cotton masks if you wanted to have a layer of water resistant over materials that are more water absorbent.

ETG: So, the Surge is the pleaded masks a lot of people have been making. It’s got three layers, and it’s got the pipe cleaner across the top so you can fit it. Do pipe cleaners wash okay?

JS: If you sew them in, they’ve been rewashing fine. It’s on the Surge guidance as two; I find it works better with three because it makes it a little bit stiffer and you get a better fit.

ETG: Three together?

JS: Yeah, I push them together. What I’ve found I love to put in the nose pieces are the ties that go around coffee bags. There are a number of different things you can use to stiffen across the nose as long as it fits.

JS: I forgot to mention that when I wash the ones with pipe cleaners or any other nose bridge, I put them in a lingerie bag because otherwise they get bent a lot.

ETG: So you’re doing three layers and they’re all polypropylene. You’re not doing a cotton layer. How do you feel about cotton?

JS: The nice thing about cotton is everybody has it. For all these other materials, we’ve had challenges sourcing them. Initially, the masks that you could get people wearing as quickly as possible were the best. Cotton tends to be absorbent.

ETG: Which is bad…

JS: I think absorbent is bad for the outer layer of the mask because what I want to do is make sure that I have a water-resistant layer that isn’t going to…

ETG: So one polypropylene layer on the outside.

JS: Yeah, at least one polypropylene layer on the outside. That way if anything with moisture comes at you, it can shed and fall off, and your droplets don’t spread beyond the other side.

ETG: How do you feel about cotton on the inside?

JS: I’m okay with cotton on the inside (against the face). It’s more comfortable for a lot of people because they’re used to it. It absorbs the moisture so it kind of keeps it close to you. If people are worried about the synthetics touching their skin, cotton is good. I still recommend and prefer the nonwoven for all three layers. Part of that gets into the washing and cleaning and drying aspect. Nonwovens dry faster, whether it’s from your own moisture or from washing. It dries really quickly, so that’s less time that you have a warm, moist environment for things to grow in it. So I prefer using different weights of nonwoven polypropylene for the different layers. The default instructions say use three of the same because up until now we haven’t had a lot of variety in where we can get nonwoven polypropylene materials. So if you only have the bags, you can use that for all three. That is not as comfortable as the nonwoven polypropylene in garment bags and other sources. The inner-most layer of the mask for me is mostly about fit and comfort. I rely on those other layers to provide the barrier and filtration and all those other features and factors. I increase the number of layers if I want more particle protection.

ETG: How far do you go?

JS: The very first thing that I did after developing the masks, designing them and proposing them and researching the heck out of them was send them down to ATOR Labs in Florida to get breathability testing done on them. I have been searching for all the other testing ever since. Where I haven’t been able to get professional testing done, I’ve come up with DIY procedures to test all the critical elements. For the professional lab testing, we got ATOR Labs to work with us, and they provided breathability testing: inhalation resistance, exhalation resistance, CO2 accumulation, for all of our mask designs.

ETG: How did it go?

JS: It went well. That was what slowed the initial – I wasn’t willing to put this stuff out there until I had seen that it was at least breathable. We’ve looked at the safety data sheets, and we’ve thought about different potential hazards, and we’re confident that we’re not going to do more harm than good. I tested up to five layers of the NWPP, and they passed the breathability criteria. They also pass the French standard referenced by the WHO. I’ve got some of that data up on the webpage, though I haven’t been able to get it all written up.

Mask Fit

ETG: Tell me about fit because we’ve heard that the fit is really important; if it doesn’t fit right, the percentage of protecting goes down real fast. What are your thoughts about that?

JS: The challenge here is you have to know what it is that you want your mask to do for you. Masks are like shoes: sometimes you wear sandals, sometimes you wear sneakers, and sometimes you wear mountaineering boots. You wear them to do different things, and the same shoe doesn’t fit everybody.

ETG: We saw with the Olson masks and these other masks that are flat, they didn’t fit very well and you had to have the right face and the right mask. So we went back to surgical because we didn’t know who was going to be wearing them. We wanted my husband who has a big head and my daughter who has a small head to both fit.

Filter Pocket? Yes or No

ETG: I’m curious what your thoughts are on the whole filter pocket thing.

JS: That ties into the fit of the mask in terms of acoustics and airflow. Essentially, the air is going to follow the easiest path. So if you have a really good filter in the middle of the mask and it doesn’t go all the way to the edges of it, the air is just going to go out and through the edges. And if it doesn’t fit well on your face, the air is just going to go out the sides or up through the nose around the eyes. The nose piece is super important in that respect because if you don’t have that nose piece, the air is preferentially going to be going in and out through the space by your eyes. Pulling all the air you’re breathing past your eyes is a bad idea for infection control. All these people show these videos of them with a mask on and trying to blow out a candle, and they’re really excited because they can’t blow out the candle with the mask on. I just do a facepalm on that because I can watch the air going out the sides as they breathe because now the air is going through the mask. So if the air isn’t going through the mask, where is it going? What it means is it’s found an easier path out the sides or down the bottom or around the eyes.

ETG: So do the polypropylene ones allow the air to go in and out and not the particles? Is that the idea that it’s keeping the little particles out but the air back and forth in and out?

JS: Right, and the water out. Because the droplets contain the particles, if you’re keeping those droplets out and you have water resistant, you’re keeping the water out but allowing the air to go through. That’s your balancing act. Same thing with particles: Keeping the particles out, allowing the air to go through.

Ear Loops or Head Ties

ETG: You’re using straps and not elastic. We did, too, because it’s a better fit. The elastic was a chaotic mess in our house with big head, little head. But the straps work really well.

JS: and you can individualize straps as well so you can adjust for different head sizes. And elastic stretches, so as your face moves, the mask moves and shifts. Having the ties helps prevent that. The other issue is latex; most elastic you get contains latex. The first reason why we moved away from using elastic was because so many people in healthcare settings have latex allergies.

One of the challenges with all these masks from alternatively-sourced materials is that if you say “cotton” that describes a huge range of things; same thing for polypropylene.

Material Sourcing

ETG: There was a study that came out. They went to Joanne’s and Wal-Mart, which is totally weird. From a sewing point of view, there was not enough specificity for us to really be able to use it. This whole thing with electrostatic, man-made fabric, cotton – how do you feel about all that?

JS: I agree. One of the challenges with all our mask-making efforts regardless of which materials you’re using is standardizing so you know the material you’re using is the same as the neighbor down the street and if the guidance is applicable and useful.

ETG: I was so frustrated with the dataset.

JS: Part of that is because the scientists are doing what everybody else is doing, which is finding the materials they have now available at home.

 

ETG: I felt like there was a discourse disconnect. Why aren’t you asking the sewists? We could tell you. They found a flannel that had a percentage of – it wasn’t a 100% cotton flannel, but we all have 100% cotton flannel. Try to find one that has some percentage of a man-made thing, that’s bad flannel!

JS: As a backpacker, I’ve done a whole bunch of research into fabrics and materials to make my own gear. So I have a stack of all these high-tech fabrics that are ultra-light and water resistant and wind-proof and all these different things. That gets you into the language people use to describe fabrics. That is a real challenge. How do I translate thread count to grams per square meter? I translate everything to GSM because that’s at least a thing I can weigh at home and test and verify where my 400 thread count and your 400 thread count are still…

ETG: The New York Times Article said “batik.” So we bought a bunch of batik and we used it, but we want a little more science in the material for us.

Balancing Material Properties

JS: I think that’s a great dialog to have, though, because the important features are the weave, thread count or fiber density, and the GSM is a weight that at least allows you to normalize things. There are some studies that say denim is great, but they put a little asterisk next to it and say that you can’t breathe through it. But the take-home message is that denim is the best mask material.  But if you can’t breathe through it, it’s useless.

ETG: We had a study come out that said one layer cotton and one layer flannel. So we made these, and we sent them out, and we’re in New Orleans; people are like, “you’re trying to kill us!” There’s no way you can have flannel in the South in the summer.

JS: There’s a scale. If what you’re trying to do is get N95, the best technologies in the world for N95s are coming out of 3M, and most people who have to wear them hate them. They wear them for as short a period as they can because they’re hot, humid, and they’re not comfortable. That’s as good as you can get when you’re pouring a lot of resources into this one thing. But to get an N95 that gives you the particle filtration that’s been the focus of the conversation so that you’re blocking 0.1 micron, it is not very breathable, not very comfortable. Most people are not going to wear it well for more than 10-15 minutes before they pull it down or take it off. As soon as they do that, they’re getting 0% particle filtration. So who’s going to wear it? Where are they going to wear it? And how long are they going to wear it? And what’s the relative risk? For a really high-risk environment, you should wear more layers to give you the best particle filtration you can get. I use three layers of NWPP when I go to the grocery store. I have some that’s thicker that gives me a higher degree of protection, but I don’t want to wear that very long. When I go hiking or into the Maker Space that I’ve been helping out, I wear something that’s a little bit more breathable because I can wear that for four hours straight without taking it off and without touching it to readjust it.

ETG: There’s a whole list with chiffon silk, 100% polyester… What are we supposed to do with that? Do we add two layers outside, inside? Are we really spending $40 a yard on 100% silk? Is that better than polyester silk?

JS: It is very different, certainly. When you’re mixing and matching fabrics, the first thing I would say is to make sure that the washing instructions are going to work for all of them. Also, in terms of how it wears out, you that sew a lot, you know along the seams if you sew your chiffon to your canvas denim…

 

ETG: It’s going to pull out if you’re not careful. The weight differential is going to mess it up.

JS: When people are going down these rabbit holes on chiffon versus silk and not giving us any information about which of those materials they’re specifically talking about, a lot of that is thinking about that really fine filtration.

Electrostatic Filtration

EGT: They’re trying to do the electrostatic for the teeny-tiny drops. That’s how you keep them from getting in.

JS: That’s how you get better particle filtration while still keeping breathability.

ETG: And how do you feel about that?

JS: I feel like it’s a challenging thing that’s still very experimental. For me, it worked well because NWPP holds a charge very well like other synthetics. A study that just came out June 2 is like yay, not only do you have your filtration for lower weight and more breathable materials – 43 GSM interfacing in particular – I think that’s kind of light weight. It doesn’t hold up as well. The WHO guidance specifically says non-woven polypropylene interfacing is a good material to use. That’s based on this paper I was just mentioning which shows the particle filtration, and they show that hydrophobic materials are able to store a charge on them which cotton can’t, and unlike other materials like silk, they keep charge for a longer time. It holds a charge overnight at room temperature. They tested it at body temperature and high humidity and found that it held a charge for at least an hour, which is pretty good. That’s where the guidance for using synthetic layers like nonwoven polypropylene and polyester are coming from. If you roll them between your latex gloves and build up a charge and you do that for 30 seconds, it builds up a charge that can last an hour even in humid conditions to give you a bit of a boost on the filtration. That’s interesting and exciting. We’ll take extra boosts if we can get them. It’s specific for hydrophobic materials because if it absorbs water, it doesn’t keep the static charge.

We don’t know how that kind of treatment is going to impact the durability for reusable masks. If you’re sitting there and rubbing the heck out of it for 30 seconds every time you wear it, that’s going to break it down faster. So like many other things, there’s a trade-off there. I’m curious to see how that pans out over time.

ETG: So on Amazon we’re looking for: non-woven interfacing polypropylene, breathable, dust-proof, anti-fog. Then it’s got one that’s waterproof and one that’s not.

JS: So waterproof and breathable don’t tend to go well together. When I think waterproof, I think Saran wrap. It’s waterproof; it does a great job at blocking particles; but don’t put it over your face; it is not breathable. The most important feature of your mask is that it’s breathable and not hazardous.

Burnout

ETG: People have made a ton of cotton masks; most shops are selling those, too. We may not be making them in the crazy way we were; it got political; companies are making them; people think they don’t need to wear them. I don’t feel that way.

JS: And also burnout. I just want to say to all the people who have been sewing hundreds, thousands, no matter how many, I have seen the most heartening thing while the whole world is falling into chaos for so many reasons. I agree that spending 103 hours a week on masks for months at a time isn’t sustainable.

ETG: It was really exhausting. So going forward, polypropylene is going to be hard for people to get, I imagine. What are your thoughts about a layer or two layers of polypropylene plus cotton plus chiffon. If people are out there freaking out because they have all this cotton but no polypropylene, what do we say?

JS: I would say that the best mask is a mask that you can have, you can get, you can make. So I don’t think we should throw out these other masks. We know the science is evolving rapidly around us. For a long time, my thought is if you have some nonwoven polypropylene, if you can just make a layer of it to wear over cotton masks so you get that water-resistant, hydrophobic layer on the outside…

Mask Layering Combinations

ETG: So the outside is key. You wouldn’t want cotton and then polypropylene; you want the polypropylene on the outside?

JS: I want the polypropylene on the outside, absolutely. I think two layers of cotton inside, one polypropylene outside or one cotton, two nonwoven polypropylene; all those are fine. I would advise against the cotton sandwich where you have a water-resistant, non-woven polypropylene with cotton or some other absorbent material in the middle and then NWPP on the other side because of washing and disinfection. If you’re trying to wash something, and you trap all this warm gunky stuff in the middle, how do you make sure that is getting clean when you have two water-resistant layers on the outside? That may be fine for a disposable mask, but for anything reusable, that’s the sort of thing that absolutely needs validated disinfection and cleaning methods because that scares me in terms of what might grow in the middle.

ETG: Can you do the opposite with cotton on the outside but the polypropylene on the inside?

JS: I think that’s okay. I wouldn’t consider it ideal because anything coming from the outside is going to get trapped in that absorbent layer, and you’re holding it closer to the face. That’s the thing that I dislike about that. But you do still have that water-resistant layer in the middle that’s acting as a barrier to hopefully help keep things from going out or going in. But I have to note that the WHO and the CDC and all the guidance out there right now says that you should be using masks for source control. The only thing you’re concerned about is keeping your germs from going out.

ETG: That’s any cotton mask, then, on that level is okay.

JS: Yeah. Some of them are going to be better than others. That’s why they all say use multiple layers because one layer acts as a diffuser potentially; that gets into a longer discussion. But for what the government and regulatory officials say we should be doing, having just that nonwoven layer in the middle serves that purpose; it helps keep your droplets to you and the other droplets going the other way. If you have an absorbent layer on the outside catching everything that’s being thrown at you, and then it’s drying out, once it’s dried out it’s a smaller particle size. So I don’t recommend having an absorbent layer on the outside. There isn’t any science that I’m aware of yet that backs up my intuition and my view and analysis of why that’s concerning.

ETG: You think three layers of NWPP is the best, but if you have the masks that don’t have that, it’s okay; it’s better than nothing. And if you’re trying to do a hybrid, that’s not super key.

JS: Pretty much. I will say that in terms of what that layer is closest to the skin, I’m not sure. Having that be cotton like the WHO recommends may be just as good as having it be all three NWPP. I find it less comfortable and too warm. There are a lot of reasons why I recommend that three layer. Part of it gets into washing and disinfection.

Washing & Disinfection

JS: There’s a whole blog post that goes into way more scientific detail on that. If you have a mixture of materials and fabrics, especially the absorbent ones, when you wash them with detergent you can get skin irritation.

ETG: You have to use detergents that support allergy return. Fragrance free.

JS: The EPA has a whole site that goes into detail. But if you’re going to use detergents, keep that in mind because you’re holding things up against your face for a long period of time in hot, moist environments.

Transcript: Covid-19 Masks: Dr. Jocelyn Songer of MaskMaker.org joins us – Part 2

June 15, 2020

Transcript

Transcript edited for brevity/clarity.

Participants: Dr Elizabeth Townsend Gard, Dr. Jocelyn Songer, Whitney, and Alexa

Elizabeth Townsend Gard, Host: Let’s start with you and what you really want quilters to know as a scientists coming into this as someone who cares and has breathing issues yourself. What should we understand?

Dr. Jocelyn Songer: I think the first thing is how much we appreciate you, because all of these efforts to get masks to as many people as we can as quickly as we can would not be happening without you.

Second is that even though it’s complicated, it’s worthwhile. Keeping breathability in mind is always an important thing because we’re covering the mouth and nose. We want to do that as safely as we can. So it has to be breathable, and it has to be something that people are willing to wear for the entire time they need to be wearing it.

In terms of the science, ask questions. As long as you keep asking questions, it will force people to come up with better answers. We’re all in this together. We’re all working to create better solutions to make our families, friends, community and healthcare providers safer. We’re doing an amazing job at that even if things may not be perfect yet. Don’t let perfect be the enemy of the good.

Alexa Magyari, Host:

We’ve made all these masks. You’ve proposed a couple solutions in Part 1; one if to make a nonwoven polypropylene cover to go over a cotton mask that we’ve made. You’re suggesting that this is superior to making nonwoven poly propylene (NWPP) filters to put in the filter slot?

JS: I would say yes.

AM: Would you say that making those filters is better than nothing?

JS: Yes.

AM: Do you have any other insights into how to modify these cotton masks that we’ve already made to improve them?

JS: What I would do is if you can put one layer of NWPP and have that go over it, that will give you that extra water-resistant boost. A lot of NWPP is pretty lightweight, and one of the advantages is that it’s really breathable. So you can put a layer of it over an N95. N95’s are not the most breathable or comfortable things in the world, and it’s still breathable. We tested that, and it got a big thumbs up.

AM: So we know how we’re going to fix our imperfect masks of the past if we’re so inclined. Moving forward, the gold standard in your opinion is the three-layer NWPP. In an ideal scenario, where are we sourcing that material?

JS: That is the big challenge. The ideal material in an ideal world is medical-grade spunbond nonwoven polypropylene. There isn’t a great, easily-accessible source for that yet. We’ve got people working on that and trying to coordinate with distributors. But moving forward, that’s what we would like to do is to make it so that as this continues, there’s a place that we can point to where mask makers can obtain materials that we’ve tested and know are great.

AM: In the absence of being able to buy it in bulk, is the best thing to do to cut up my bags? Or is it better to start with the interfacing?

JS: I haven’t been using the interfacing, so I can’t personally attest to how well that works. But if it’s a separate layer, you can test that out on your own; see if it’s water resistant; see how it holds up as it gets washed. I recommend boiling or steaming to disinfect.

The reason why I suggested the reusable grocery bags if they’re unused is because if they’re designed to be touching food, that gives you an extra level of safety because those are food-grade material while other materials may not be. So if I could get it, I would go medical grade; if I can’t, food-grade is the next best. From there, I use conference bags because they’re designed to be the same structure as far as fiber density and tensile strength and weight in GSM, they’re very similar. If you’re using interfacing, you just have to make sure it’s not diffusing interfacing and that it’s free of adhesives. A lot of those adhesives are latex-based. Latex allergies and sensitivities develop over time, so the more exposure you have to them, the more likely you are to develop allergies. So breathing that in constantly close to your face…

ETG: Could create a latex allergy even if you didn’t have one because latex is not something you’re supposed to be breathing through. Is that what you’re saying?

JS: That’s what I’m saying. In general, we know there are so many bad things about inhaling adhesives. I’ll look into the latex bit a bit more, but that would be really problematic.

ETG: We had gotten into learning about H600. I think on your site somewhere you say don’t use that.

JS: Halyard H600 is not just spunbond NWPP; it also includes melt-blown NWPP. So that changes your risk profile. It’s really commonly used in clinical settings, so people have a lot of access to it. I haven’t seen breathability data on it yet. I have made some masks out of it with a single layer, and it’s a little hot and humid for my liking.

ETG: So it’s the breathability you’re worried about rather than safety. It seems like the company is freaking out a little bit that suddenly their surgical wrap is being used for a mask.

JS: There are a whole bunch of potential reasons for that, and I don’t have all the answers. I do know that for melt-blown in general when you cut it, it leaches smaller particles into the air. The particle size from the melt-blown is a size that’s really bad to inhale.

ETG: So stay away from those because we just don’t know, and they’re hard to get, anyway. We’ve tried.

JS: It’s hard to get, and in order to get improved performance on the water resistance especially, they often use surface treatments and coatings. Some of those are things you really don’t want to be inhaling. I have no data about whether or not the Halyard H600 uses that. That’s the challenge when you’re dealing with alternatively-sourced materials. You’re using things outside of the normal scope. Before I recommend things, I try to do a hazard analysis to try to determine all the safety concerns. So it’s a cautious world of more good than harm. One of the advantages of cotton is we’re very familiar it; we’ve been using it for over a hundred years; we’re not scared of it. So there are some real benefits to that.

For that spunbond NWPP, I recommend washing it first so you get anything from the manufacturing processes rinsed out at the very least. I’ve done a ton of research into the backgrounds and risks for the materials and the safety data sheets when you can find them. Mostly, you want to find stuff that hasn’t been coated and doesn’t have extra treatments; it’s breathable; it’s going to stand up to whatever your washing/cleaning/disinfection procedures are and that has water resistance and some filtration. Most of the data that’s coming out is on the water resistance of something that you can test at home by flicking water at it. There are all sorts of ways. The cough syrup cups that they give you are a teaspoon of water, which is 5ml. Just put it over a jar, pour the water on, and see if it goes through in 60 seconds. You can make that quantitative, which is nice.

For breathability, I have a DIY at home test for that as well. Some people pick it up, put it to their mouth and breathe through it, but for materials I’m not sure about, I hate the idea of putting it up to your mouth and trying to breathe through it. So I use a toilet paper tube; take an elastic band; put the material over the end; then blow a lint ball or a piece of cotton ball with it and see how far it goes. If you can’t move that lint ball, it’s not breathable.

ETG: That’s such an important component of it. So on Amazon, when I look at the sheets of polypropylene, it’s very confusing. I don’t feel totally comfortable with it. Then I went to the reusable grocery bags. How have you been finding your bags?

JS: My mom found these for me, so I’d have to ask her strategy. I know that we’ve gotten a lot of bags donated from all these conferences that have been cancelled and from grocery stores that aren’t allowed to use them right now. The savings bank in our town had several of them that they were willing and able to donate. Being able to get them on Amazon is a new thing for the past few months. As soon as people realized that they could be used for masks, they were impossible to get.

ETG: There’s a lot of nylon ones, and that’s not what you want.

JS: Right. I can look after we get off the call and see if I can find some search parameters that will help with that. We’re working with some companies to try to get more consistent materials out there more easily. It’s a pain to break down bags and cut them up into masks instead of getting it by the yard.

ETG: That would be the most ideal. I was looking at wholesale companies because you can probably go there and get stuff and just not put the logo on it. I went to one and it said 80 GSM nonwoven polypropylene. What GSM are we looking for?

JS: 80 is good for the outer layer. One of the advantages of using something that’s 70 or 80 GSM is that the melting point tends to be a little bit higher. Sometimes lower weights are made differently, so they don’t hold up quite as well. That’s been one of the challenges with some of the crafting materials is that they don’t hold up to the boiling and sterilization techniques. Most of what that tells me is that they probably have polyethylene in them, which shrinks a lot because it melts at boiling temperature instead of 100C higher.

ETG: Tell us about the thickness and GSM. Are there other thicknesses we should be looking at?

JS: I look for 60 to 80 GSM because that gives you pretty consistent properties throughout – mostly 80. If I can get it, I go for food grade and stuff that’s designed to be reusable. There’s been some challenges with olefin, which you can sometimes get by the yard. I haven’t gotten any. But the melting point of it is more like plastic.

AM: What is the set of masks that in your opinion are harmful? We’ve talked about non-breathable masks and the harm in that. You briefly mentioned single-layer masks as potentially harmful. If you could talk a little more about that and then maybe add whatever else to the list.

JS: I definitely have a Do Not Use list:

• Anything that might have fiberglass in it; vacuum cleaner bags because they aren’t breathable. That comes up more than you would think. People think they just need to get the particle filtration to be protected; they don’t try walking up the stairs with it. So anything that you can’t wear for 15 minutes is not going to work.
• Adhesives, latex, materials with coatings. That comes up a lot with metal-infused materials, which may have antiviral properties although frequently they haven’t been tested for that. That’s hard to do with a DIY home test. That’s often achieved with coatings, which are maybe okay to touch your skin; but just because you can have something contacting your skin, that doesn’t mean you should be breathing it in.
• The other consideration is reusability, which means you have to have a way to clean them and you need to know that all the layers are getting cleaned. That part of the conversation I think often gets ignored because it’s not as cool as talking about the particle filtration. But can you clean it effectively?
• So that leads you into bleach, which both the CDC and the WHO say is an okay thing to clean your mask with. All the little caution flags should be going up because you are putting it over your mouth. So if you do use bleach, which I don’t recommend, make sure you rinse it, rinse it, rinse it. One of the challenges with laundering is that if you don’t get even rinsing you can end up with more bleach concentrations than you anticipate. Though you can smell it at levels where it is well below being hazardous, most of us don’t have a good way to tell where on that spectrum things are. I don’t have a DIY test for that yet, so I say no bleach.

For disinfection, boiling works.

Microwaving is not a great idea because the nosepiece usually has metal in it, and you don’t want to put things with metal in the microwave.

AM: How long should you boil it for?

JS: I recommend ten minutes. WHO recommends one minute. That is assuming that the mask is submerged in the water the whole time you’re bringing it up to temperature; you’re boiling it for a minute; then you’re letting it cool down all the way back to room temperature in that same pot of water. If you do that, then one minute may be okay. There are a lot of variables in that. How hot is it outside? How long does it take to cool down? You’re leaving your mask inside the pot of water for this long period of time and it lends itself to forgetting about the mask in the pot of water. Then you’re leaving it sitting in a warm vat of water for some unknown amount of time, which is problematic.

So I recommend just boiling it for ten minutes and then hanging it to dry. Then you know it’s been at that temperature for a minimum amount of time, especially with masks with pleats or seams; you have multiple layers and you want to make sure that you actually get that heat level consistent throughout the entire thing to maximize disinfection.

AM: Can you give us a laymen version of why one layer is harmful?

JS: I wouldn’t say that it is harmful; I would say that it is less good, which I guess is a hedge. With one layer, you don’t get as much of a barrier, and if there are inconsistencies in the material, if there’s a needle hole through it, or there’s a seam down the middle, with a single layer it increases the odds of things just going through the seams. If there’s a little bit of damage, then that’s a failure point. Two layers reduces the risk of any individual imperfection giving you a straight route out.

AM: So it would act as a diffuser.

JS: Yes.

AM: That’s why I was asking that question. If you’re only wearing one layer, it could spread the germs out more?

JS: Not as far in front of you but maybe in a broader area in the meantime. It does depend on the kind of material. That would be my concern with a single layer; it goes to both of those.

AM: But a single layer is better than none.

JS: Yes.

ETG: Can you help us understand that study that came out with the cotton and chiffon? You guys keep chatting while I pull that up.

AM: I come from a school of public health where I was a PhD student. I came into this problem as the person that was putting all the hospital requests together so that people were donating through sanctioned channels. My big concern as someone that is worried about liability is we want to make sure that the masks are going to the administrators who can make sure they’re being used in a clinically-appropriate way. My next set of questions is about how we can start educating healthcare facilities about these masks.

Have you done that? Have you had a good response from healthcare facilities? Do you have any ideas about how we can continue to do that?

JS: Yes, I’ve been working on that and I have some ideas. One of the things I’ve been doing is keeping up with the regulatory side of things: the FDA guidance, emergency use authorizations, the triaging of supplies there, the risk alternate profiles and all of that.

That’s a challenging one. Most people don’t want to spend a lot of time looking into the regulatory side of things, but a lot of the requirements are put there to help ensure safety – especially as we get into these other, bigger issues.

So for mask makers, an important thing is the labeling; making sure that what is in the masks is known by whoever is using them, especially in healthcare contexts. We’ve talked about latex allergies already. It’s just such a big one that people aren’t used to thinking about. So having the appropriate labeling with what materials are actually in the mask is really important. And then the cleaning and disinfection instructions are required by those FDA labeling requirements. They pretty much apply to people whether they are manufacturers like Old Navy or somebody in their home making masks for their local hospital.

We talked a little bit before about knowing what the mask is designed for and what it’s going to be used for. Clarifying that is going to be important for the general public and also for healthcare facilities. A lot of the masks they need are for patients coming in the door. The requirements for what that mask needs to be are very different than what the requirements need to be if you are going to be in an operating room. And right now, the guidance and things that hospitals are looking for in masks is based on surgical masks, which can withstand synthetic blood at high pressures, and respirators, which are for airborne contaminants. Figuring out how these new classes of masks fit into that is a challenge and has been one of the things that hospitals, administrators and mask makers are all trying to address.

AM: The hospitals are asking for multilayer cotton masks almost exclusively. I think there is an opportunity to educate them about the work that you’re doing and the up and coming science and see if they have preferences for these masks taking into account the differences. I would love to move forward and think about how we can do that in case we have another round.

JS: I think you’re right there. A lot of how the adoption has been going is hospital by hospital. I know in our area we have a number of hospitals that wanted to use the MakerMask designs with the NWPP. We’ve gotten a sense of how we want to wash and disinfect them and for what the requirements and rules are. In general in hospital settings, reusable masks have not been the standard because if you’re reusing a mask you need to be able to disinfect it or sterilize it. And in hospital settings, those words mean very specific things. You actually need both cleaning and disinfection and you need to demonstrate that you are getting the level of disinfection you need. In most of the hospital context, most of the masks being made – cotton or otherwise – is a scary thing because it’s not going through the normal processes. So making masks that can be disinfected and sterilized or autoclaved is important. But it’s not the way they’re used to processing things.

So with cotton, a lot of that is going into the laundering facilities that are off site in many cases. And those processes rely on bleach for disinfection. So that gets me back into whether we’ve actually performed a hazard analysis for the way they’re doing that kind of batch processing of things because most of the things you put through the laundry aren’t things that you’re going to be breathing in.

ETG: We got a recent request from our local library wanting to give out masks to people who come into the library. These kinds of requests come in all the time, and I don’t know – when you think about kids and adults and all kinds of people that are going to come in, I don’t know what the answer is.

JS: I think these are user cases where people with public health expertise really come in handy because one of the things that we really need is a massive public outreach and education campaign on how do you use a mask; how do you wear it correctly; how do you put it on; how do you take it off. Why is it that it’s not okay to pull it down below your nose? Every night on the news I see all these people with masks, and I’m going oh, no. It’s because it’s a new thing for people, so they don’t know that they need to adjust the nose bridge down and that every time they touch the front of their mask and move it around, anything that’s on their mask is now on their hands, and anything that’s on their hands is now on their face, and that’s not good. That goes back into your question about what should the library be using. What people in the library should be using is what people in the grocery store should be using, which is what the general public when they go into enclosed places should be using. That is the thing that the argument rages on. What the CDC recommends is not the same thing as what the WHO recommends is not the same as what I recommend. There’s still so much variation out there that it’s a struggle for everybody.

ETG: This is the American Chemical Society nano-study that was looking at the different layers of fabric. This is the one that’s getting all the attention that was published April 24.

JS: The WHO guidance references a new ACS nano-paper. That’s the one that’s all about the NWPP which was published June 2. It’s been accepted and is available but not in the finished format.

ETG: This one is looking at filtration where you’re looking at breathability and protection. Filtration comes into yours because the polypropylene is what is keeping things out, but they weren’t looking at breathability necessarily; they were looking at…

JS: Pressure differential is their measure of breathability.

ETG: So when you look at this, what do you see?

JS: N95 do well at 99% filter efficiency, and the pressure drop is really small, which is good. As you go up, the pressure drop is a little bit higher though relatively close. If you use a cotton quilt, they’re saying it works okay for…

ETG: This is the weirdest part: They’re saying a cotton quilt is cotton batting and cotton. I’m not sure how that pressure differential is 2.5 when you’re literally breathing a quilt in. That’s bizarre to me.

JS: It is a bit bizarre. One of the combinations that I tested early on I didn’t use a cotton quilt; I used polyester batting with a layer of NWPP on either side. It worked okay in terms of filtration. I know when I was in the desert and the forest and the smoke from the fires was nearly choking me, one of the things I tried was taking my filtered jacket up over my mouth to try to block the air that way. It filters reasonably well, and I’m surprised that their pressure difference was as good as it is.

ETG: They said the way the cotton is put together it’s got a poly urethane scrim, and that’s why it was okay. But they weren’t using polyester batting; they were using cotton batting that had a scrim.

JS: In general, it works. The challenge there is that it is so hot. This is one of those things that gets into the CO2 accumulation and diffusion, which is another can of worms. If you have a loose-fitting mask, it doesn’t matter as much; if you have an N95 cell mask with a really good fit, that batting cracks the air into this weird buffer and you get carbon dioxide diffusing and accumulation, which you don’t get if you’re just using cotton. So quilting I would still say is bad for a lot of reasons.

ETG: The other one that seemed really promising was the cotton/chiffon, and that’s gotten a lot of attention. They gave us a list of what chiffon they used, which we can replicate.

JS: I haven’t done a deeper dive into chiffons. I would have to look at that more closely.

ETG: They did give us the number, so you can look it up at Jo-Ann’s store.

JS: That’s really convenient.

Don’t use anything with spandex. The stretchy materials are bad. I guess that would be my challenge with chiffon. As you pull it tight to get a good fit, it increases the pore size – the gaps and the holes – and your filtration isn’t as good. I’d have to look again at the details.

I’ve been so sucked into the paper that just came out with the WHO guidance talking about the three layers. It’s on the MakerMask website under the Research Blog. I did a quick summary of the findings.

ETG: You must have been thrilled about this study that it really confirms what you were saying about the polypropylene.

JS: I was excited to see somebody say polypropylene in their out-loud voice, yes.

ETG: “Multilayer polypropylene material is superior or at least comparable to materials used in some medical facemasks.” Amazing. Well, I’ve already ordered some bags off Amazon, so we’ll see how that goes.

JS: Being able to have the number for Jo-Ann’s Fabric for the material you can actually get which is the exact thing is just so helpful.

ETG: They did not do that with the cotton, though. They did the same thing with flannel. They got flannel from Wal-Mart, and I can’t find it. They didn’t say what the number was, just that it was from a Wal-Mart superstore. That to me just seemed a little unscientific.

JS: That is a really interesting thing watching all the studies come out about the materials is they’re not as scientific. There’s a gap between a lot of the testing that’s being done and the real-world scenarios.

ETG: I just wanted them to be a little bit more precise.

JS: That seems reasonable to me.

ETG: What their lack of specificity does is makes me doubt their conclusions. That’s the problem I have with it. Because the little bit that I know, they didn’t get right, it makes me not trust the science.

JS: I think that’s a real challenge. They provide information on the porosity, which is good, and the thread diameter. That doesn’t translate to things we can check or verify at home and when we’re trying to source materials. I also call it the apples and oranges problem because everybody measures it slightly different ways and providing different numbers. At least for this, they provided new information on N95’s which they gathered as well. So there’s some formalization. It doesn’t translate the information into something that’s usable by you to figure out how to replicate it. How do you replicate it? How does disinfection and cleaning work? Did they get the same numbers? Can they be cleaned? That’s another big can of worms because the science is so new for that. Before, you were talking about where things were in November. Where was all the data and research for homemade masks in November? The answer was there were very few studies. The materials were even less well specified than we’re seeing in these new studies. In November, most of the science for DIY masks was 100 years old.

ETG: Who’s going to make a mask out of a tea towel? As a quilter, we’re not going out to get tea towel fabric. So there was an interesting disconnect really early on.

JS: And that disconnect makes a lot more sense when you think about it in terms of a lot of those masks were being used for air pollution and smoke, which is not the same as infection control. Nylon may give you a great fit, but how do you take those nylons off in terms of infection control? It’s stretchy, so you’re getting anything that’s on that mask all over you, and then you’re pulling it up over your face, past your eyes, over your hair, so anything that was on the outside of that mask is now on the inside as you pull it up and off over your head; or you have to put your hands in it to pull it up and off. How do you do that without getting anything that’s on that mask all over your hands and your face. I’m just going to say that for COVID, I have problems with using the nylon on the outside. For airborne stuff that you need an N95 for, I think it’s great. If I have some reusable masks for air pollution and smoke, the nylon solution seems fine. But I do not recommend that for COVID.

ETG: I think the science will get more clear. But there’s kind of this weird moment of people almost like: Oh, we’re done with this. There’s a sense of: We’ve moved on.

Masks for Kids/School

What do you think? Do you think we should still be making masks and getting ready for the fall? What are your thoughts as people come back to school? There’s a lot going on at the moment, and I’m curious where masks fit in.

JS: I think that right now is a good time for us to be recollecting and having these conversations and thinking about next steps while we kind of stop and take a breath. Try to spread knowledge about how to wear masks correctly. Try to get that to be pervasive. As we hit summer, I think we’re actually going to see another bump in demand because the masks that we’ve been using in the colder months are not as usable now when it’s really hot. Think about how we’re going to adapt to have masks that provide the best protection we can that we can actually wear while we’re out doing the things we do in the hotter months.

Our target should be to make sure that whatever mask people have on, they’re willing and able to wear it for the amount of time that they are out and about in high-risk areas.

Think about how we make asks for kids and what safe combinations for kids are.

ETG: What do you think that is?

JS: That is a good question. Everything is a little bit riskier with kids because they’re smaller. It’s scarier to be in the unknown there. We’ve been making masks for the kids, and we do scaled down versions of the MakerMasks Surge – the pleated masks. We’ve been doing them with two layers of NWPP. In general, I’m erring on the side of decreasing by one layer.

ETG: Because why?

JS: Because their lung capacities aren’t as big. They’re not exchanging as much air as forcefully as adults. There’s some data that you can break down the age ranges for, but that’s the reason. Kids are not just miniature adults. I used to teach CPR for kids and adults, and the breath size that you use if you’re doing respirations is different. Lung volumes are different, and the force at which everything happens is different. So I want to make sure that kids are something that’s really breathable.

What are the reasons that people take masks off or pull them down so they’re just covering their mouth and not their mouth and their nose?

There are usually two reasons:

1. It’s not very breathable;
2. It’s getting too hot and it feels kind of claustrophobic.

Both of those things happen when the mask isn’t breathable enough.

So I definitely think you’re way better off doing two layers and wearing it for the entire hour you’re out – and this is true whether you’re an adult or a kid – than having the best filter in the world that you’re only willing to wear for 15 minutes.

ETG: So putting cotton or something that’s comfortable on the inside is completely fine, but having the outside be polypropylene.

JS: That’s what I would do. Just as a reminder, the CDC says no masks for kids under two. Some other countries say no masks for kids under three. I would keep that in mind for young children or anybody who can’t take the mask off unassisted; they shouldn’t be wearing a mask.

For kids that have sensory issues, I do recommend that inner-most layer have a pair of pajamas or anything they love that’s comfortable that they’re willing to have touch their skin. Depending on  age, I would make sure they have two masks. We make matching masks for their dolls.

ETG: Can we throw them in the wash? Are they not getting clean enough that way? You did say that you were washing them in a lingerie bag.

JS: I put them in the lingerie bag so the nosepiece doesn’t get deformed. Be careful with the detergents you use, and use the hottest temperature that’s reasonable. The NWPP I hang dry.

ETG: Do you think that would be okay even if you had a cotton side of it?

JS: Yes. It takes longer to dry with the cotton.

ETG: But you’re okay with washing it in hot water and letting it hang dry.

JS: Yes. And if you don’t want to hang dry, tumble dry low.

ETG: I feel like I have some direction. I ordered the bags, and we also have some polypropylene that we got that’s very thin. I’m not sure what that is, but maybe I can putt that between. I’m going to make three layers, two layers, and two layers with cotton so that we’ll have those to test and see how people feel about them.

JS: When I go out hiking, I use a two-layer NWPP.

ETG: Because it’s too thick when you’re really exerting, and you’re not in the middle of people.

JS: Right. For me it’s a low-risk environment. I stay at least six feet away from everyone as much as possible, and it’s an outdoor space so the risk parameters are different. In the grocery store, I want a three-layer one. I’m also used to using masks, and that makes a difference because it isn’t the same. No matter how good a mask is, it’s still different. I have to remind myself when I first put it on to breath easy for a few breaths to get used to it again and not to run up the stairs right away.

ETG: I did housework in a mask just to get used to it and determine at what point does it seem impossible. Just get used to how it is.

JS: That’s the thing I haven’t heard other people talk about, either, is practice. Whenever you’re using a new tool, it takes practice. Facemasks are medical equipment.

ETG: I know everyone is going to be beyond excited to hear this because really, you are who we’ve been looking for. I feel like I have direction, which I really didn’t before.

AM: I’m a health economist and not a science person. I read all the studies and was trying to do the best approximation of what was in the study, but it was a very poor substitute. I didn’t feel like I could replicate it with any confidence. So I think this was really great to have a scientist that actually understands the materials we can get, because that’s a big deal.

JS: And this is a hard problem. If there was one set of best practices everyone could follow, we’d be doing it and it wouldn’t be as hard. It’s hard for everybody to be sorting through all this. We expect the higher-up people to be saying yes, this is what everybody should be doing. We thought we were going to get that in March, then in April, then in June. The world is still converging on best practices, and I think we’re all getting better as we go. That part is exciting.

ETG: It’s been a really interesting intersection of science and sewing that was unexpected.

JS: And DIY efforts.

ETG: You’ve spent some nice, quality time with your mom, I’d imagine.

JS: And she’s way better at sewing than I am, and we have one machine. She’s always telling me I run the sewing machine with a lead foot. Slow it down, and it’ll come out straighter.

Whitney Chatmon, Host:

When all these studies about masks are coming out, and scientific articles in general, how do you go about analyzing the research and what do you assess when you’re looking through all of it?

JS: That is a really good question and probably a whole course.

WC: I found myself recently reading some research, and I was – I haven’t taken science since I was a freshman in college.

JS: I first check to see if they’re original research and if they’ve been peer reviewed because that makes a big difference. A lot of the stuff that’s coming out is meta-analysis, which is stretching back for three decades. I read all those older papers at the beginning, and I’m curious to see what the new ones are. I would look to see if they have error bars; if they have more than one sample. A lot of them are using the same word: particle filtration. Particle filtration means about a thousand different things depending on who’s saying it. I look to see if the method they’re using is the same as anything else and anywhere else because if I can’t compare it to other things, it’s not super helpful.

WC: I was wondering given your personal history with respiratory illness, how did you view the current pandemic when it was starting and the progression of it?

JS: I think it meant that I was cautious earlier. I actually went to Las Vegas for a conference in January, and I knew I was going to be backpacking for a week in the desert afterwards without having any contact with what was going on. So I went to that prepared. I had my masks with me. I wear a mask when I fly all the time, anyway, because otherwise, seven days after getting off the plane, I would get a new respiratory illness.

Then because of my previous respiratory history, I have almost every able commercial reusable mask that was in existence before, as well as disposable masks. So I had a full set of them to be able to compare and a lot of experience with what I liked and disliked and absolutely abhorred in masks. So that gave me some context to be thinking about it about a month earlier than a lot of other people were.

ETG: COVID-19  causes blood clots in your respiratory system and a lot of other things. How did you feel about that, personally?

JS: I think like everybody else, nervous. It’s scary. I’m a first responder, too, so my first impulse was to want to get out on the front lines and help. It was really hard to not be in a position to help in the way that I wanted to help. For me, deciding to pour my heart and soul and science into these mask efforts was my way of helping because I couldn’t physically be on the front line. So I wanted to do what I could for my friends who were: the first responders, EMTs, firefighters, the people who show up on the scene and weren’t being prioritized in the triage of who needs PPE. So as a former EMT, as a first responder, I want a mask that’s going to provide me as much of a barrier to bodily fluids as I can get.

WC: Through all the interviews and things that we’ve been doing, I think the main thing I’ve found is that the people who have been getting involved with the effort of mask making, it’s become a way of coping with everything going on with the pandemic.

JS: Yeah, it’s a way to channel the energy into something positive.

WC: I had so much anxiety about everything going on. Just cutting fabric – even though it was mindless labor almost – was so calming in a way because I felt that I was helping and I was taking control.

Making Masks is Trail Magic

JS: Finding the things that you can do. As the pandemic initially was spreading, and it felt like something we couldn’t do anything about, I think for me at a secondary level – the first level was I have all this information and all this stuff about masks and my family, and all the backpacking I’ve done walking across the country three times for the Appalachian Trail, Pacific Crest Trail and Continental Divide Trail, I have pockets of family that are scattered up and down the country all over the place in rural America. They’re people who have opened their hearts and their homes and invited me in and have made me part of their family that were complete strangers. We call that trail magic.

WC: I believe it. I’m from Appalachia.

JS: So I feel like all the people who are coming together to make masks are providing a version of that trail magic on a much bigger scale. We have these resources and supplies and skills that we can put out there to try to make things just a little better even if we’re one person or one day; it’s something we can do. That part is really what renews your faith in humanity when a lot of other things in the world may not.

ETG: That’s part of why we’re doing the Summit to bring everybody together, have these conversations, but also record and celebrate. As part of it, we’re doing a giveaway: If people sign up, they get entered into a giveaway that all these companies have donated as a thank-you to the sewists who have been working so hard.

JS: A lot of people are in positions already where the need for masks isn’t as great, but that isn’t everywhere. The stuff I see on the news makes it seem like everyone that needs masks has masks, and that does not match the reality that I’m living in. The shortages are expected to continue. That gets into some of the more complicated issues of whose voices are heard and which stories are being told.

ETG: The story of the masks is really multifaceted, and I think it brings up social inequities, economic inequities, and now we’ve got politics injected into it in a really stupid way, and then all of the supply chain; so there’s just a lot to all of it.

JS: One of the questions I was not expecting was: What do you do when you get tear gas or pepper spray in your mask?

That is a really legitimate question and concern right now.

ETG: So now you need at least two masks when you go out because you’ve got to have a backup. But what do you say to that?

JS: What I say to that is there’s a lot we don’t know. I haven’t seen any studies with pepper spray and masks. But what it really means is that you should change the mask as soon as possible, especially because if you have absorbent materials, it’s going to be the gift that keeps on giving.

ETG: Polypropylene might help because it will act as a barrier more than cotton would.

JS: If it’s in a water-based or droplet-based form, it may help. Once again, this gets back into the privilege of how many masks you have. And if you don’t have a sewing machine and you haven’t been sewing your own, you may not have a dozen masks even though that’s a target that everybody should be working towards because as soon as it gets wet or dirty, you should change it.

ETG: The concern that I have is that we’re looking at these commercial masks and they’re just all over the place. A lot of them are super cheaply made and you don’t know what they made them out of. They seem kind of dangerous to me on some level. You just don’t know. There’s no rating system; there’s no requirements; there’s no standardization.

JS: All you have to do is have a label. If it doesn’t have a label telling you what the materials are and how to wash it, it is not okay. You have to be able to know what’s in it and know how to wash or disinfect it.

ETG: We’ve ordered some commercial masks, so they should be showing up at some point. We haven’t talking about shields. Tell me what your thoughts are about mask+shield. Do you think that’s a good thing?

JS: Yes. Face shields are just another piece of the puzzle. I think face shields are a good thing. The data out there says they’re not the same as masks, so a face shield and a mask is good. I am not a face shield specialist. There are other people who have done all the research and analysis there. Certainly, if you can do a mask and a face shield – eye protection is good.

ETG: Are glasses enough or do you want goggles? I’m going to be so suited up when I finally leave my house!

JS: And it’s going to be 95 degrees.

ETG: And I’m going to fall over.

JS: Here we go into another topic about heat stroke and heat exhaustion and making sure that you are hydrating appropriately. If you’re wearing a mask and/or you’re out for a long period of time, you need to drink. How do you drink without touching your mask?

ETG: We’ve seen joke ones with the straws. It’s not good. That must make you completely insane.

JS: If we’re talking about things that make me cringe, we can talk about the masks with the exhalation valves because they’re blowing all of your respiration all over everybody. We talked before about if you have just a single layer it might act as a diffuser and spread everything out, but a ventilation valve might act as a focuser.

We were talking about the straws. Anything that goes in and out through that control area of the mouth is bad.

ETG: And you know they’re going to be popular in New Orleans.

JS: Like all these things, there are better ways to do it and worse ways. How do you get the straw in without holding the bottom of the mask? Now you’re touching the mask in two places. At least minimize the points of contact. I do have some with straws.

ETG: They’re going to be on Bourbon Street, and they’re wearing a mask with a straw hole. Maybe that’s better. I don’t know.

JS: That’s that thing with why is it people are saying maybe we shouldn’t open bars. Alcohol does inhibit boundaries. People aren’t as good at paying attention, not as good at motor control. Wearing your mask while drunk.

WC: During the beginning of things really exploding, I knew people who were going to the bars, and I was like: Are you crazy? And they were like: The alcohol will kill the virus if it’s in my mouth. I’m like: Okay. That’s a strange and very risky line of thinking.

JS: It’s a common one. I shouldn’t legitimize any of it, but the proof you need your alcohol to be at for it to act as any kind of disinfectant is 160 proof.

ETG: That’s just a challenge to some.

JS: If the alcohol you’re drinking is 160 proof, then you have a lot of issues ahead of you. The chances that the behavior being engaged in while drinking alcohol of that proof is risky is high. That is true with or without COVID as an additional risk factor.

So, we’ll just say no on the alcohol acting as a disinfectant. We can dive into the data of how risk is likely to be amplified in those circumstances, but certainly it is in a lot of different ways.

So drink responsibly; wear your mask responsibly; do all the things as responsibly as you can, realizing that nothing is perfect but you’ve got to try. If we all do a little bit better as we move forward, that’s going to amplify and hopefully we get better and better and better until we get nearly there.

I’m hoping that as we go through the summer and the pace is maybe not quite as frenetic as it was at the beginning, it gives us a little bit more time to think about the whys behind the things we’re doing instead of just doing it in panic mode so that we can move forward more responsibly.

ETG: I think that’s very true. It takes time to do the science, so it’s interesting to watch what’s happening with that. To watch science work its thing, that doesn’t happen very often. My kid’s best friend’s mom asked me if I saw the ACS study on masks. This is regular conversation now, which is so fascinating and awesome in some way, right?

JS: Right. And there’s this new study that the WHO references that hasn’t made it quite into the full cycles yet.

ETG: I can’t wait to see it.

JS: The link is on that MakerMask webpage.

ETG: Well, you’re amazing, and you’ve given us so much time. We kind of super geeked out on you, and I know everybody is going to be so excited to listen to this.

JS: This is a dialog that we’re all going to keep participating in. That’s the important bit.