The use of face masks in public settings has been widely recommended by public health officials during the current COVID-19 pandemic. The masks help mitigate the risk of cross-infection via respiratory droplets; however, there are no specific guidelines on mask materials and designs that are most effective in minimizing droplet dispersal. While there have been prior studies on the performance of medical-grade masks, there are insufficient data on cloth-based coverings, which are being used by a vast majority of the general public. We use qualitative visualizations of emulated coughs and sneezes to examine how material- and design-choices impact the extent to which droplet-laden respiratory jets are blocked. Loosely folded face masks and bandana-style coverings provide minimal stopping-capability for the smallest aerosolized respiratory droplets. Well-fitted homemade masks with multiple layers of quilting fabric, and off-the-shelf cone style masks, proved to be the most effective in reducing droplet dispersal. These masks were able to curtail the speed and range of the respiratory jets significantly, albeit with some leakage through the mask material and from small gaps along the edges. Importantly, uncovered emulated coughs were able to travel notably farther than the currently recommended 6-ft distancing guideline. We outline the procedure for setting up simple visualization experiments using easily available materials, which may help healthcare professionals, medical researchers, and manufacturers in assessing the effectiveness of face masks and other personal protective equipment qualitatively.
The use of face masks in public settings has been widely recommended by public health officials during the current COVID-19 pandemic. The masks help mitigate the risk of cross-infection via respiratory droplets; however, there are no specific guidelines on mask materials and designs that are most effective in minimizing droplet dispersal. While there have been prior studies on the performance of medical-grade masks, there are insufficient data on cloth-based coverings, which are being used by a vast majority of the general public. We use qualitative visualizations of emulated coughs and sneezes to examine how material- and design-choices impact the extent to which droplet-laden respiratory jets are blocked. Loosely folded face masks and bandana-style coverings provide minimal stopping-capability for the smallest aerosolized respiratory droplets. Well-fitted homemade masks with multiple layers of quilting fabric, and off-the-shelf cone style masks, proved to be the most effective in reducing droplet dispersal. These masks were able to curtail the speed and range of the respiratory jets significantly, albeit with some leakage through the mask material and from small gaps along the edges. Importantly, uncovered emulated coughs were able to travel notably farther than the currently recommended 6-ft distancing guideline. We outline the procedure for setting up simple visualization experiments using easily available materials, which may help healthcare professionals, medical researchers, and manufacturers in assessing the effectiveness of face masks and other personal protective equipment qualitatively.
Infectious respiratory illnesses can exact a heavy socio-economic toll on the most vulnerable
members of our society, as has become evident from the current COVID-19 pandemic. The disease has overwhelmed healthcare
infrastructure worldwide, and its high
contagion rate and relatively long incubation period have made it difficult to trace and isolate infected individuals.
Current estimates indicate that about 35% of infected individuals do not display overt
symptoms and may contribute to the
significant spread of the disease without their knowledge. In an effort to contain the
unabated community spread of the disease, public health officials have recommended the
implementation of various preventative measures, including social-distancing and the use of
face masks in public settings.The rationale behind the recommendation for using masks or other face coverings is to reduce
the risk of cross-infection via the transmission of respiratory droplets from infected to
healthy individuals. The pathogen
responsible for COVID-19 is found primarily in respiratory droplets that are expelled by
infected individuals during coughing, sneezing, or even talking and breathing. Apart from COVID-19,
respiratory droplets are also the primary means of transmission for various other viral and
bacterial illnesses, such as the common cold, influenza, tuberculosis, SARS (Severe Acute
Respiratory Syndrome), and MERS (Middle East Respiratory Syndrome), to name a few. These pathogens are enveloped
within respiratory droplets, which may land on healthy individuals and result in direct
transmission, or on inanimate objects, which can lead to infection when a healthy individual
comes in contact with them. In another mode of transmission, the droplets or their
evaporated contents may remain suspended in the air for long periods of time if they are
sufficiently small. This can lead to airborne transmission when they are breathed in by another person, long after the
infected individual may have left the area.Several studies have investigated respiratory droplets produced by both healthy and infected
individuals when performing various activities. The transport characteristics of these
droplets can vary significantly depending on their diameter. The reported droplet diameters vary
widely among studies available in the literature and usually lie within the range 1
µm–500 µm, with a mean diameter of ∼10 µm. The larger droplets (diameter >100 µm)
are observed to follow ballistic trajectories under the effects of gravity and aerodynamic
drag. Intermediate-sized
droplets may get carried
over considerable distances within a multiphase turbulent cloud. The smallest droplets and particles (diameter <
5 µm–10 µm) may remain suspended in the air indefinitely,
until they are carried away by a light breeze or ventilation airflow.After being expelled into the ambient environment, the respiratory droplets experience
varying degrees of evaporation depending on their size, ambient humidity, and temperature. The
smallest droplets may undergo complete evaporation, leaving behind a dried-out spherical mass
consisting of the particulate contents (e.g., pathogens), which are referred to as “droplet
nuclei.” These desiccated nuclei, in
combination with the smallest droplets, are potent transmission sources on account of two
factors: (1) they can remain suspended in the air for hours after the infected individual has
left the area, potentially infecting unsuspecting individuals who come into contact with them
and (2) they can penetrate deep into the airways of individuals who breathe them in, which
increases the likelihood of infection even for low pathogen loads. At present, the role of
droplet nuclei in the transmission of COVID-19 is not known with certainty and the matter is
the subject of ongoing studies.
In addition to generating microscopic droplets, the action of sneezing can expel sheet-like
layers of respiratory fluids, which may
break apart into smaller droplets through a series of instabilities. The majority of the fluid
contained within the sheet falls to the ground quickly within a short distance.Regardless of their size, all droplets and nuclei expelled by infected individuals are
potential carriers of pathogens. Various studies have investigated the effectiveness of
medical-grade face masks and other personal protective equipment (PPE) in reducing the
possibility of cross-infection via these droplets. Notably, such
respiratory barriers do not prove to be completely effective against extremely fine
aerosolized particles, droplets, and nuclei. The main issue tends to be air leakage, which can
result in aerosolized pathogens being dispersed and suspended in the ambient environment for
long periods of time after a coughing/sneezing event has occurred. A few studies have
considered the filtration efficiency of homemade masks made with different types of
fabric; however, there is
no broad consensus regarding their effectiveness in minimizing disease transmission. Nonetheless, the evidence suggests
that masks and other face coverings are effective in stopping larger droplets, which, although
fewer in number compared to the smaller droplets and nuclei, constitute a large fraction of
the total volume of the ejected respiratory fluid.While detailed quantitative measurements are necessary for the comprehensive characterization
of PPE, qualitative visualizations can be invaluable for rapid iteration in early design
stages, as well as for demonstrating the proper use of such equipment. Thus, one of the aims
of this Letter is to describe a simple setup for visualization experiments, which can be
assembled using easily available materials. Such setups may be helpful to healthcare
professionals, medical researchers, and industrial manufacturers, for assessing the
effectiveness of face masks and other protective equipment qualitatively. Testing designs
quickly and early on can prove to be crucial, especially in the current pandemic scenario
where one of the central objectives is to reduce the severity of the anticipated resurgence of
infections in the upcoming months.The visualization setup used in the current study is shown in Fig. 1 and consists of a hollow manikin head which was padded on the inside to
approximate the internal shape and volume of the nasal- and buccal-cavities in an adult. In
case a more realistic representation is required, such a setup could include 3D-printed or
silicone models of the internal airways. The manikin was mounted at a height of ∼5 ft and 8
in. to emulate respiratory jets expelled by an average human male. The circular opening
representing the mouth is 0.75 in. in diameter. The pressure impulse that emulates a cough or
a sneeze may be delivered via a manual pump, as shown in Fig.
1, or via other sources such as an air compressor or a pressurized air canister. The
air capacity of the pump is 500 ml, which is comparable to the lower end of the total volume
expelled during a cough. We note that the
setup here emulates a simplified representation of an actual cough, which is an extremely
complex and dynamic problem. We use a
recreational fog/smoke machine to generate tracer particles for visualizing the expelled
respiratory jets, using a liquid mixture of distilled water (4 parts) and glycerin (1 part).
Both the pressure- and smoke-sources were connected to the manikin using clear vinyl tubing
and NPT fittings wherever necessary.
FIG. 1.
Left—experimental setup for qualitative visualization of emulated coughs and sneezes.
Right—a laser sheet illuminates a puff emerging from the mouth.
Left—experimental setup for qualitative visualization of emulated coughs and sneezes.
Right—a laser sheet illuminates a puff emerging from the mouth.The resulting “fog” or “smoke” is visible in the right panel of Fig. 1 and is composed of microscopic droplets of the vaporized liquid mixture.
These are comparable in size to the smallest droplets expelled in a cough jet (∼1
µm–10 µm). We estimate that the fog droplets are less than
10 µm in diameter, based on Stokes’ law and our observation that they could
remain suspended for up to 3 min in completely still air with no perceptible settling. The
laser source used to generate the visualization sheet is an off-the-shelf 5 mW green laser
pointer with 532 nm wavelength. A plane vertical sheet is created by passing the laser beam
through a thin cylindrical rod (diameter 5 mm) made of borosilicate glass.We first present visualization results from an emulation of an uncovered heavy cough. The
spatial and temporal evolution of the resulting jet is shown in Fig. 2. The aerosolized microscopic droplets visible in the laser sheet act as
tracer particles, revealing a two-dimensional cross section of the conical turbulent jet.
These tracers depict the fate of the smallest ejected droplets and any resulting nuclei that
may form. We observed high variability in droplet dispersal patterns from one experimental run
to another, which was caused by otherwise imperceptible changes in the ambient airflow. This
highlights the importance of designing ventilation systems that specifically aim to minimize
the possibility of cross-infection in a confined setting.
FIG. 2.
An emulated heavy cough jet travels up to 12 ft in ∼50 s, which is twice the CDC’s
recommended distancing guideline of 6 ft. Images taken at (a) 2.3 s, (b) 11 s, and (c) 53 s after the
initiation of the emulated cough.
An emulated heavy cough jet travels up to 12 ft in ∼50 s, which is twice the CDC’s
recommended distancing guideline of 6 ft. Images taken at (a) 2.3 s, (b) 11 s, and (c) 53 s after the
initiation of the emulated cough.Despite high variability, we consistently observed jets that traveled farther than the 6-ft
minimum distance proposed by the U.S. Centers for Disease Control and Prevention (CDC’s). In the images shown in Fig. 2, the ejected tracers were observed to travel up to 12 ft within ∼50
s. Moreover, the tracer droplets remained suspended midair for up to 3 min in the quiescent
environment. These observations, in combination with other recent studies, suggest that current social-distancing
guidelines may need to be updated to account for the aerosol-based transmission of pathogens.
We note that although the unobstructed turbulent jets were observed to travel up to 12 ft, a
large majority of the ejected droplets will fall to the ground by this point. Importantly,
both the number and concentration of the droplets will decrease with increasing distance, which is the fundamental rationale behind
social- distancing.We now discuss dispersal patterns observed when the mouth opening was blocked using three
different types of face masks. For these results, we focus on masks that are readily
accessible to the general public, which do not draw away from the supply of medical-grade
masks and respirators for healthcare workers. Figure 3
shows the impact of using a folded cotton handkerchief mask on the expelled respiratory jet.
The folded mask was constructed by following the instructions recommended by the U.S. Surgeon
General. It is evident that while the
forward motion of the jet is impeded significantly, there is notable leakage of tracer
droplets through the mask material. We also observe a small amount of tracers escaping from
the top edge of the mask, where gaps exist between the nose and the cloth material. These
droplets remained suspended in the air until they were dispersed by ambient disturbances. In
addition to the folded handkerchief mask discussed here, we tested a single-layer
bandana-style covering (not shown) which proved to be substantially less effective in stopping
the jet and the tracer droplets.
FIG. 3.
(a) A face mask constructed using a folded handkerchief. Images taken at (b) 0.5 s, (c)
2.27 s, and (d) 5.55 s after the initiation of the emulated cough.
(a) A face mask constructed using a folded handkerchief. Images taken at (b) 0.5 s, (c)
2.27 s, and (d) 5.55 s after the initiation of the emulated cough.We now examine a homemade mask that was stitched using two-layers of cotton quilting fabric
consisting of 70 threads/in. The mask’s impact on droplet dispersal is shown in Fig. 4. We observe that the mask is able to arrest the
forward motion of the tracer droplets almost completely. There is minimal forward leakage
through the material, and most of the tracer-escape happens from the gap between the nose and
the mask along the top edge. The forward distance covered by the leaked jet is less than 3 in.
in this case. The final mask design that we tested was a non-sterile cone-style mask that is
available in most pharmacies. The corresponding droplet-dispersal visualizations are shown in
Fig. 5, which indicate that the flow is impeded
significantly compared to Figs. 2 and 3. However, there is noticeable leakage from gaps along the
top edge. The forward distance covered by the leaked jet is ∼6 in. from the mouth opening,
which is farther than the distance for the stitched mask in Fig.
4.
FIG. 4.
(a) A homemade face mask stitched using two-layers of cotton quilting fabric. Images
taken at (b) 0.2 s, (c) 0.47 s, and (d) 1.68 s after the initiation of the emulated
cough.
FIG. 5.
(a) An off-the-shelf cone style mask. (b) 0.2 s after initiation of the emulated cough.
(c) 0.97 s after initiation of the emulated cough. The leading plume, which has dissipated
considerably, is faintly visible. (d) 3.7 s after initiation of the emulated cough.
(a) A homemade face mask stitched using two-layers of cotton quilting fabric. Images
taken at (b) 0.2 s, (c) 0.47 s, and (d) 1.68 s after the initiation of the emulated
cough.(a) An off-the-shelf cone style mask. (b) 0.2 s after initiation of the emulated cough.
(c) 0.97 s after initiation of the emulated cough. The leading plume, which has dissipated
considerably, is faintly visible. (d) 3.7 s after initiation of the emulated cough.A summary of the various scenarios examined in this study is provided in Table I, along with details about the mask material and the
average distances traveled by the respiratory jets. We observe that a single-layer
bandana-style covering can reduce the range of the expelled jet to some extent, compared to an
uncovered cough. Importantly, both the material and construction techniques have a notable
impact on the masks’ stopping-capability. The stitched mask made of quilting cotton was
observed to be the most effective, followed by the commercial mask, the folded handkerchief,
and, finally, the bandana. Importantly, our observations suggest that a higher thread count by
itself is not sufficient to guarantee better stopping-capability; the bandana covering, which
has the highest thread count among all the cloth masks tested, turned out to be the least
effective.
TABLE I.
A summary of the different types of masks tested, the materials they are made of, and
their effectiveness in impeding droplet-dispersal. The last column indicates the distance
traveled by the jet beyond which its forward progression stops. The average distances have
been computed over multiple runs, and the symbol “∼” is used to indicate the presence of
high variability in the first two scenarios listed.
Mask type
Material
Threads/in.
Average jet distance
Uncovered
…
…
∼8 ft
Bandana
Elastic T-shirt material
85
∼3 ft 7 in.
Folded handkerchief
Cotton
55
1 ft 3 in.
Stitched mask
Quilting cotton
70
2.5 in.
Commercial maska
Unknown
Randomly assorted fibres
8 in.
CVS Cone Face Mask.
A summary of the different types of masks tested, the materials they are made of, and
their effectiveness in impeding droplet-dispersal. The last column indicates the distance
traveled by the jet beyond which its forward progression stops. The average distances have
been computed over multiple runs, and the symbol “∼” is used to indicate the presence of
high variability in the first two scenarios listed.CVS Cone Face Mask.We note that it is likely that healthcare professionals trained properly in the use of
high-quality fitted masks will not experience leakage to the extent that we have observed in
this study. However, leakage remains a likely issue for members of the general public who
often rely on loose-fitting homemade masks. Additionally, the masks may get saturated after
prolonged use, which might also influence their filtration capability. We reiterate that
although the non-medical masks tested in this study experienced varying degrees of flow
leakage, they are likely to be effective in stopping larger respiratory droplets.In addition to providing an initial indication of the effectiveness of protective equipment,
the visuals used in this study can help convey to the general public the rationale behind
social-distancing guidelines and recommendations for using face masks. Promoting widespread
awareness of effective preventative measures is crucial, given the high likelihood of a
resurgence of COVID-19infections in the fall and winter.
DATA AVAILABILITY
The data that support the findings of this study are available within this article.
Authors: Ignazio Maria Viola; Brian Peterson; Gabriele Pisetta; Geethanjali Pavar; Hibbah Akhtar; Filippo Menoloascina; Enzo Mangano; Katherine E Dunn; Roman Gabl; Alex Nila; Emanuela Molinari; Cathal Cummins; Gerard Thompson; Tsz-Yan Milly Lo; Fiona C Denison; Paul Digard; Omair Malik; Mark J G Dunn; Catherine M McDougall; Felicity V Mehendale Journal: IEEE Open J Eng Med Biol Date: 2021-01-20
Authors: Jeremy Howard; Austin Huang; Zhiyuan Li; Zeynep Tufekci; Vladimir Zdimal; Helene-Mari van der Westhuizen; Arne von Delft; Amy Price; Lex Fridman; Lei-Han Tang; Viola Tang; Gregory L Watson; Christina E Bax; Reshama Shaikh; Frederik Questier; Danny Hernandez; Larry F Chu; Christina M Ramirez; Anne W Rimoin Journal: Proc Natl Acad Sci U S A Date: 2021-01-26 Impact factor: 12.779
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