What’s the best face mask etiquette?

When the reality of the pandemic was starting to settle in March, I got a call from my mother, a skilled artist and quilter, who lives in Montreal. She was making face masks for health-care workers, she told me. The reality of the pandemic hadn’t hit me yet and I struggled to imagine a situation in which doctors would be wearing colourful masks made of quilters’ cotton.

Of course, just months later, now that the medical community believes the primary mode of transmission for COVID-19 is through respiratory droplets, and public health organizations are recommending we wear masks in public, the practice has become a vital issue for Canadians to wrap our heads around. “Each time we talk or cough, we’re sharing our droplets, and if we want to stop transmission, we need everyone to keep their droplets to themselves,” says Dr. Susan J. Bartlett, who is a professor of medicine at McGill University. “Social distancing is our most effective public health strategy, but in situations where you can’t maintain that, like a grocery store, wearing a mask lets you keep your droplets to yourself.”

Bartlett is also the forward-thinker who set up a network of quilters — including my mother — to begin making high-quality cotton masks for front-line health-care workers to use as backup. “In nine weeks, we made more than 8,000 masks — it’s given us all a sense of purpose and meaning.”

Once it was clear that there was a soaring need for masks — Bartlett’s sister-inlaw, who is a doctor in Ontario, asked for eight masks for her clinic staff in early March; two days later, she called back and asked for 250 — Bartlett set about informing herself on fabrication. “Being a scientist, I knew where to look for the literature on masks, and while there wasn’t much available, there was a study done in the first week of April at Wake Forest University in North Carolina in which they tested different fabrics and concluded that the best material that you can use for cloth masks is quilters cotton, because it’s high quality and so has a tight weave.” Though stores were closed in Quebec, the volunteer quilters ripped through their personal collections of fabric, and Bartlett managed to talk an elastic distributor in Montreal’s garment district into selling her elastic at cost — despite a worldwide elastic shortage.

Now that non-medical masks are being suggested in any situation in which you can’t guarantee you’ll be able to keep a two-metre distance from others, like going into a store, walking on a sidewalk downtown, using public transit, the problem is less one of access because there are many available for purchase and it’s possible to get DIY tutorials and free patterns — and more one of attitude. Many Canadians either don’t want to wear a mask — or simply don’t know how to wear one correctly. “It’s really curious, isn’t it? It’s almost as if we have an aversion to wearing a mask in North America,” says Barlett, who acknowledges that the practice is certainly a departure from our traditional customs. “In the States, whether you’re wearing a mask has now become almost a political identification, which is very unfortunate because it is actually an important public health strategy. More than 70 countries now legally require having a mask on every time you leave your house, and their rates of transmission are far, far lower.”

I know wearing a mask feels weird at first — I certainly felt odd the first time I wore one to the store — but it’s critical to focus on the deeply Canadian impetus behind the new-to-us custom. “When I wear a mask, I’m showing you respect; I’m showing my interest in protecting others. When you wear a mask, you’re showing me respect. In that way, I think it’s a deeply Canadian request since we tend to look out for each other and think about the common good.” And wearing a cloth mask, of course, shows that you’re making sure medical-grade masks are available for those who need them most.

Knowing how to wear a mask correctly is equally important. “Your nose and mouth must be covered completely, but a super tight seal is not important if you’re not in, say, a health care setting,” Bartlett explains. Rather, you want a comfortable-fitting mask that loops around your ears or ties securely without needed adjustment. “Put the mask on before you leave your house — and then don’t touch it and don’t readjust it; it stays on your face until you get home, put it directly into a laundry hamper to wash it in soapy water or the washing machine, without bleach which might degrade the fabric. And then wash your hands.” You don’t want to be fiddling with your mask, pulling it up and down between stores, removing it to talk to someone who can’t quite hear you, or any other reason you can dream up. If you’re doing that, you’re just increasing the risk of contaminating others and yourself. (Those who are back to work and wearing a mask all day, should stock up so that they can have three masks a day, suggests Bartlett since masks get damp and uncomfortable after a while.)

Though there’s a lot of buzz about using homemade filters in your mask — Bartlett has heard of people using everything from HEPA vacuum filters to landscaping cloth — two layers of cotton is sufficient. “Two layers of cotton is effective and allows the mask to be comfortable because if you feel claustrophobic you won’t wear it. Also vacuum filters were never designed to be placed close to our nose and mouth and have not been tested for that — whereas we know cotton is safe, effective and comfortable.”

So the situation is complicated and painful, but the recommendation is simple: Get a mask made of high-quality cotton (a $3 mask is likely an indication of a cheaper source material) that fits snugly so you don’t have to fuss with it (a wire nose piece can help keep it in place and helps prevent your glasses from fogging) and then just wear it.

“It’s a new normal, but until we’re able to develop a vaccine, this is what we need to do,” says Bartlett. “And if everyone wore a mask in public, we could bring this problem under control pretty quickly in Canada and all get back to our lives. Wouldn’t that be lovely?”