A High Efficiency, Low Resistance Antibacterial Filter Formed by Dopamine-Mediated In Situ Deposition of Silver onto Glass Fibers.

The coating of filter media with silver is typically achieved by chemical deposition and aerosol processes. Whilst useful, such approaches struggle to provide uniform coating and are prone to blockage. To address these issues, an in situ method for coating glass fibers is presented via the dopamine-mediated electroless metallization method, yielding filters with low air resistance and excellent antibacterial performance. It is found that the filtration efficiency of the filters is between 94 and 97% and much higher than that of silver-coated filters produced using conventional dipping methods (85%). Additionally, measured pressure drops ranged between 100 and 150 Pa, which are lower than those associated with dipped filters (171.1 Pa). Survival rates of Escherichia coli and Bacillus subtilis bacteria exposed to the filters decreased to 0 and 15.7%±1.49, respectively after 2 h, with no bacteria surviving after 6 h. In contrast, survival rates of E. coli and B. subtilis bacteria on the uncoated filters are 92.5% and 89.5% after 6 h. Taken together, these results confirm that the in situ deposition of silver onto fiber surfaces effectively reduces pore clogging, yielding low air resistance filters that can be applied for microbial filtration and inhibition in a range of environments.

Effectiveness of cloth face masks to prevent viral spread: a meta-analysis.

BACKGROUND: The effectiveness of cloth face masks to prevent viral spread has not yet been conclusively established. In this meta-analysis, we evaluate their effectiveness in comparison to standard medical/surgical and N95-typed masks against viral spread. METHODS: We identified literature through a systematic search in three databases and meta-analytically synthesized relevant studies by means of random-effects as well as multilevel modelling. RESULTS: Twelve studies comprising k = 28 effect sizes (N = 338) were included. Medical/surgical and N95-typed masks outperformed cloth masks, yielding a large effect (g = 1.40). This effect remained robust when data were grouped according to comparisons with medical/surgical masks (g = 1.25) and N95-typed masks (g = 1.29). However, effects were differentiated according to mask fit, indicating reversals of signs when cloth mask effects were compared with ill-fitting medical/surgical and N95-typed masks (gs = -12.50 and - 10.90, respectively). CONCLUSIONS: Cloth face masks were found to have significantly poorer filtering performance than medical/surgical masks and N95 masks, but only if non-cloth masks were properly fitted. Our results illustrate the necessity of using well-fitting medical/surgical or N95-typed masks to prevent viral spread, although some allowance should be made in circumstances where higher compliance with cloth mask mandates are expected.

Determining the filtration effectiveness of non-standard respiratory protective devices by an ad-hoc laboratory methodology.

The recent pandemic caused by COVID-19 profoundly changed people's habits. Wearing a face mask has become usual in everyday life to reduce the risk of infection from airborne diseases. At the beginning of the pandemic, the massive request of surgical or filtering face piece (FFP) masks resulted in a global shortage of these devices for the most exposed people, such as healthcare workers. Due to this high demand for respiratory protective devices, many industrial plants have partly converted to the production of face masks using adapted materials and not complying with any specific regulation (non-standard respiratory protective devices or community masks). In this work, an ad-hoc laboratory methodology has been developed to evaluate the filtration efficiency of the materials that compose the community masks using specific instrumentation. The instrumentation consists of three main tools: an aerosol generator, a specifically designed measuring chamber, and an optical particle sizer (OPS) for the measurement of aerosol concentration. The generated aerosol was sent into the measuring chamber, divided into two separate sections by the respiratory mask. The OPS measured the aerosol mass concentration upstream and downstream of the respiratory mask, and from the concentration difference the filtration efficiency was evaluated. The proposed methodology has been validated by evaluating the particle filtration efficiency (PFE) of certified respiratory masks and was then applied for the evaluation of the filtration efficiency of different types of non-standard or community masks to analyze their effectiveness in protecting from the risk of infection of airborne diseases.

How do three-layer surgical masks prevent SARS-CoV-2 aerosol transmission?

The three-layer surgical mask was recognized by the World Health Organization as an effective-protection tool for reducing SARS-CoV-2 transmission during the COVID-19 pandemic; however, the contribution of each layer of this mask to the particle size-dependent filtration performance resistance remains unclear. Here, both experimental work and numerical simulation were conducted to study the role of each mask layer in particle size-dependent filtration and respiratory resistance. By using scanning electron microscopy images of a commercial three-layer mask, composed of two spun-bond and one melt-blown nonwoven polypropylene fabric layers, four representative models were constructed, in which the computational fluid dynamics of multiphase flow were performed. The pressure drop of all models under different flow conditions was measured next. Numerical simulation was then verified by comparing the experimental results in the present study and other theoretical works. The filtration efficiency of the spun-bond polypropylene nonwoven fabric layer was much lower than that of the melt-blown nonwoven polypropylene fabric layer for the particle diameter in the range of 0.1-2.0 µm. Both the spun-bond and melt-blown nonwoven polypropylene fabric layers demonstrated extremely low filtration efficiency for particles was<0.3 µm in diameter, with the maximum filtration efficiency being only 30%. The present results may facilitate rational design of mask products in terms of layer number and structural design.

Effectiveness of a low-cost UVGI chamber for decontaminating filtering facepiece respirators to extend reuse.

In emergencies like the COVID-19 pandemic, the reuse or reprocessing of filtering facepiece respirators (FFRs) may be required to mitigate exposure risk. Research gap: Only a few studies evaluated decontamination effectiveness against SARS-CoV-2 that are practical for low-resource settings. This study aimed to determine the effectiveness of a relatively inexpensive ultraviolet germicidal irradiation chamber to decontaminate FFRs contaminated with SARS-CoV-2. A custom-designed UVGI chamber was constructed to determine the ability to decontaminate seven FFR models including N95s, KN95, and FFP2s inoculated with SARS-CoV-2. Vflex was excluded due to design folds/pleats and UVGI shadowing inside the chamber. Structural and functional integrity tolerated by each FFR model on repeated decontamination cycles was assessed. Twenty-seven participants were fit-tested over 30 cycles for each model and passed if the fit factor was ≥100. Of the FFR models included for testing, only the KN95 model failed filtration. The 3M™ 3M 1860 and Halyard™ duckbill 46727 (formerly Kimberly Clark) models performed better on fit testing than other models for both pre-and-post decontaminations. Fewer participants (0.3 and 0.7%, respectively) passed fit testing for Makrite 9500 N95 and Greenline 5200 FFP2 and only two for the KN95 model post decontamination. Fit testing appeared to be more affected by donning & doffing, as some passed with adjustment and repeat fit testing. A ≥ 3 log reduction of SARS-CoV-2 was achieved for worn-in FFRs namely Greenline 5200 FFP2. Conclusion: The study showed that not all FFRs tested could withstand 30 cycles of UVGI decontamination without diminishing filtration efficiency or facial fit. In addition, SARS-CoV-2 log reduction varied across the FFRs, implying that the decontamination efficacy largely depends on the decontamination protocol and selection of FFRs. We demonstrated the effectiveness of a low-cost and scalable decontamination method for SARS-CoV-2 and the effect on fit testing using people instead of manikins. It is recognized that extensive experimental evidence for the reuse of decontaminated FFRs is lacking, and thus this study would be relevant and of interest in crisis-capacity settings, particularly in low-resource facilities.

A critical review on the role of leakages in the facemask protection against SARS-CoV-2 infection with consideration of vaccination and virus variants.

The protection provided by facemasks has been extensively investigated since the beginning of the SARS-CoV-2 outbreak, focusing mostly on the filtration efficiency of filter media for filtering face pieces (FFP), surgical masks, and cloth masks. However, faceseal leakage is a major contributor to the number of potentially infectious airborne droplets entering the respiratory system of a susceptible individual. The identification of leaking spots and the quantification of leaking flows are crucial to estimate the protection provided by facemasks. This study presents a critical review on the measurement and calculation of facemask leakages and a quantitative analysis of their role in the risk of SARS-CoV-2 infection. It shows that the pairing between the mask dimensions and the wearer's face is essential to improve protection efficiency, especially for FFP2 masks, and summarizes the most common leaking spots at the interface between the mask and the wearer's face. Leakage is a crucial factor in the calculation of the protection provided by facemasks and outweighs the filtration performances. The fit factors measured among mask users were summarized for different types of face protection. The reviewed data were integrated into a computational model to compare the mitigation impact of facemasks with vaccination with consideration of new variants of SARS-CoV-2. Combining a high adoption rate of facemasks and a high vaccination rate is crucial to efficiently control the spread of highly infectious variants.

Filtering efficiency model that includes the statistical randomness of non-woven fiber layers in facemasks.

Facemasks have become important tools to fight virus spread during the recent COVID-19 pandemic, but their effectiveness is still under debate. We present a computational model to predict the filtering efficiency of an N95-facemask, consisting of three non-woven fiber layers with different particle capturing mechanisms. Parameters such as fiber layer thickness, diameter distribution, and packing density are used to construct two-dimensional cross-sectional geometries. An essential and novel element is that the polydisperse fibers are positioned randomly within a simulation domain, and that the simulation is repeated with different random configurations. This strategy is thought to give a more realistic view of practical facemasks compared to existing analytical models that mostly assume homogeneous fiber beds of monodisperse fibers. The incompressible Navier-Stokes and continuity equations are used to solve the velocity field for various droplet-laden air inflow velocities. Droplet diameters are ranging from 10 nm to 1.0 µm, which covers the size range from the SARS-CoV-2 virus to the large virus-laden airborne droplets. Air inflow velocities varying between 0.1 m·s-1 to 10 m·s-1 are considered, which are typically encountered during expiratory events like breathing, talking, and coughing. The presented model elucidates the different capturing efficiencies (i.e., mechanical and electrostatic filtering) of droplets as a function of their diameter and air inflow velocity. Simulation results are compared to analytical models and particularly compare well with experimental results from literature. Our numerical approach will be helpful in finding new directions for anti-viral facemask optimization.

Can disposable masks be worn more than once?

Disposable facemasks are a primary tool to prevent the transmission of SARS-COV-2 during the COVID-19 pandemic. However, plastic waste generated from their disposal represents a significant environmental problem that can be reduced by maximizing the service life of disposable masks. We evaluated the effect of repeated wearing on the fitted filtration efficiency (FFE) of N95, KF94, KN95, and procedure/surgical masks. The FFEs of masks were compared following extended wearing with and without washing. Results reveal that most disposable facemasks can retain a high level of their baseline FFE after extended wearing, even after 40 h of wearing. Laundering disposable masks degraded FFE in some instances. We conclude that the durability of disposable facemask performance is considerably longer than their intended single use indication, suggesting that reusing disposable masks is a safe means of reducing plastic waste in the environment.

Development and application of a modified procedure for quantitative fit testing of disposable masks and respirators.

In this study, a modified procedure for quantitative fit testing of disposable masks and respirators using condensation nuclei counting was developed and applied. The procedure permits disposable masks and respirators to be initially tested and retested multiple times after use. Different types of masks and respirators were tested over time and quantitative results were obtained. It was found that after multiple testing that the N95 respirator passed the testing requirements with a fit factor above 100, the KN95 respirator did not perform satisfactorily in the tests, and the disposable masks did not reach fit factors above 4 or 7. The results in this study provided relevant information toward use, reuse, and testing of disposable masks and respirators, particularly relevant during the COVID pandemic when access to N95 respirators was limited.

Community Masks - from an Emergency Solution to an Innovation Booster for the Textile Industry.

The COVID-19 pandemic resulted in shortages of personal protective equipment and medical devices in the initial phase. Agile small and medium-sized enterprises from regional textile industries reacted quickly. They delivered alternative products such as textile-based community masks in collaboration with industrial partners and research institutes from various sectors. The current mask materials and designs were further improved by integrating textiles with antiviral and antimicrobial properties and enhanced protection and comfort by novel textile/membrane combinations, key factors to increase the acceptance and compliance of mask wearing. The innocuity and sustainability of masks, as well as taking into account particular needs of vulnerable persons in our society, are new fields for textile-based innovations. These innovations developed for the next generation of facemasks have a high adaptability to other product segments, which make textiles an attractive material for hygienic applications and beyond.

Comparison of measurement systems for assessing number- and mass-based particle filtration efficiency.

The particle filtration efficiency (PFE) of a respirator or face mask is one of its key properties. While the physics of particle filtration results in the PFE being size-dependent, measurement standards are specified using a single, integrated PFE, for simplicity. This integrated PFE is commonly defined concerning either the number (NPFE) or mass (MPFE) distribution of particles as a function of size. This relationship is non-trivial; it is influenced by both the shape of the particle distribution and the fact that multiple practical definitions of particle size are used. This manuscript discusses the relationship between NPFE and MPFE in detail, providing a guide to practitioners. Our discussion begins with a description of the theory underlying different variants of PFE. We then present experimental results for a database of size-resolved PFE (SPFE) measurements for several thousand candidate respirators and filter media, including filter media with systematically varied properties and commercial samples that span 20%-99.8% MPFE. The observed relationships between NPFE and MPFE are discussed in terms of the most-penetrating particle size (MPPS) and charge state of the media. For the sodium chloride particles used here, we observed that the MPFE was greater than NPFE for charged materials and vice versa for uncharged materials. This relationship is observed because a shift from NPFE to MPFE weights the distribution toward larger sizes, while charged materials shift the MPPS to smaller sizes. Results are validated by comparing the output of a pair of automated filter testers, which are used in gauging standards compliance, to that of MPFE computed from a system capable of measuring SPFE over the 20 nm-500 nm range.

Recent developments in filtration media and respirator technology in response to COVID-19.

Abstract: The COVID-19 pandemic triggered a surge in demand for N95 or equivalent respirators that the global supply chain was unable to satisfy. This shortage in critical equipment has inspired research that addresses the immediate problems and has accelerated the development of the next-generation filtration media and respirators. This article provides a brief review of the most recent work with regard to face respirators and filtration media. We discuss filtration efficiency of the widely utilized cloth masks. Next, the sterilization of and reuse of existing N95 respirators to extend the existing stockpile is discussed. To expand near-term supplies, optimization of current manufacturing methods, such as melt-blown processes and electrospinning, has been explored. Future manufacturing methods have been investigated to address long-term supply shortages. Novel materials with antiviral and sterilizable properties with the ability for multiple reuses have been developed and will contribute to the development of the next generation of longer lasting multi-use N95 respirators. Finally, additively manufactured respirators are reviewed, which enable a rapidly deployable source of reusable respirators that can use any filtration fabric.

Why does the spread of COVID-19 vary greatly in different countries? Revealing the efficacy of face masks in epidemic prevention.

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is highly contagious, and the coronavirus disease 2019 (COVID-19) pandemic caused by it has forced many countries to adopt 'lockdown' measures to prevent the spread of the epidemic through social isolation of citizens. Some countries proposed universal mask wearing as a protection measure of public health to strengthen national prevention efforts and to limit the wider spread of the epidemic. In order to reveal the epidemic prevention efficacy of masks, this paper systematically evaluates the experimental studies of various masks and filter materials, summarises the general characteristics of the filtration efficiency of isolation masks with particle size, and reveals the actual efficacy of masks by combining the volume distribution characteristics of human exhaled droplets with different particle sizes and the SARS-CoV-2 virus load of nasopharynx and throat swabs from patients. The existing measured data show that the filtration efficiency of all kinds of masks for large particles and extra-large droplets is close to 100%. From the perspective of filtering the total number of pathogens discharged in the environment and protecting vulnerable individuals from breathing live viruses, the mask has a higher protective effect. If considering the weighted average filtration efficiency with different particle sizes, the filtration efficiencies of the N95 mask and the ordinary mask are 99.4% and 98.5%, respectively. The mask can avoid releasing active viruses to the environment from the source of infection, thus maximising the protection of vulnerable individuals by reducing the probability of inhaling a virus. Therefore, if the whole society strictly implements the policy of publicly wearing masks, the risk of large-scale spread of the epidemic can be greatly reduced. Compared with the overall cost of social isolation, limited personal freedoms and forced suspension of economic activities, the inconvenience for citizens caused by wearing masks is perfectly acceptable.

Size- and Time-Dependent Particle Removal Efficiency of Face Masks and Improvised Respiratory Protection Equipment Used during the COVID-19 Pandemic.

Size- and time-dependent particle removal efficiency (PRE) of different protective respiratory masks were determined using a standard aerosol powder with the size of particles in the range of an uncoated SARS-CoV-2 virus and small respiratory droplets. Number concentration of particles was measured by a scanning mobility particle sizer. Respiratory protective half-masks, surgical masks, and cotton washable masks were tested. The results show high filtration efficiency of FFP2, FFP3, and certified surgical masks for all sizes of tested particles, while protection efficiency of washable masks depends on their constituent fabrics. Measurements showed decreasing PRE of all masks over time due to transmission of nanoparticles through the mask-face interface. On the other hand, the PRE of the fabric is governed by deposition of the aerosols, consequently increasing the PRE.

Household Materials Selection for Homemade Cloth Face Coverings and Their Filtration Efficiency Enhancement with Triboelectric Charging.

The COVID-19 pandemic is currently causing a severe disruption and shortage in the global supply chain of necessary personal protective equipment (e.g., N95 respirators). The U.S. CDC has recommended use of household cloth by the general public to make cloth face coverings as a method of source control. We evaluated the filtration properties of natural and synthetic materials using a modified procedure for N95 respirator approval. Common fabrics of cotton, polyester, nylon, and silk had filtration efficiency of 5-25%, polypropylene spunbond had filtration efficiency 6-10%, and paper-based products had filtration efficiency of 10-20%. An advantage of polypropylene spunbond is that it can be simply triboelectrically charged to enhance the filtration efficiency (from 6 to >10%) without any increase in pressure (stable overnight and in humid environments). Using the filtration quality factor, fabric microstructure, and charging ability, we are able to provide an assessment of suggested fabric materials for homemade facial coverings.

Meltblown fabric vs nanofiber membrane, which is better for fabricating personal protective equipments.

The coronavirus disease 2019 (COVID-19) pandemic has led to a great demand on the personal protection products such as reusable masks. As a key raw material for masks, meltblown fabrics play an important role in rejection of aerosols. However, the electrostatic dominated aerosol rejection mechanism of meltblown fabrics prevents the mask from maintaining the desired protective effect after the static charge degradation. Herein, novel reusable masks with high aerosols rejection efficiency were fabricated by the introduction of spider-web bionic nanofiber membrane (nano cobweb-biomimetic membrane). The reuse stability of meltblown and nanofiber membrane mask was separately evaluated by infiltrating water, 75% alcohol solution, and exposing under ultraviolet (UV) light. After the water immersion test, the filtration efficiency of meltblown mask was decreased to about 79%, while the nanofiber membrane was maintained at 99%. The same phenomenon could be observed after the 75% alcohol treatment, a high filtration efficiency of 99% was maintained in nanofiber membrane, but obvious negative effect was observed in meltblown mask, which decreased to about 50%. In addition, after long-term expose under UV light, no filtration efficiency decrease was observed in nanofiber membrane, which provide a suitable way to disinfect the potential carried virus. This work successfully achieved the daily disinfection and reuse of masks, which effectively alleviate the shortage of masks during this special period.

The face mask: How a real protection becomes a psychological symbol during Covid-19?

'The Mask' has become a byword and a precious possession universally. Except for its use by the medical fraternity, answers to the common questions-whether it provides enough protection, which type is optimal for the general public and who really needs to don it, remain poorly understood. For a frontline healthcare worker, wearing mask is a necessity as an important person protection equipment, it is perhaps the most-powerful psychological symbol for the general public. Surprisingly, it even undermines all other recommended practices of infection control and breaking the transmission chain of Covid-19, like hand washing, personal hygiene and social distancing. 'The mask' has evolved with time and yet there is a need to further improve the design for safety, tolerability and comfort. In this review we present the journey of face mask, originating from the first masks aimed at stopping the bad smell to its industrial use to its all-important place in the medical field. Various types of face masks, their filtration efficiency, reusability and current recommendations for their use are presented.

Universal masking during COVID-19 pandemic: Can textile engineering help public health? Narrative review of the evidence.

The Coronavirus Disease-2019 (COVID-19) pandemic caused by the virus SARS-CoV-2 is spreading very quickly around the world. In less than 7 months since it became known to the international community, the virus has infected 18 million in more than 180 countries and killing more than 700,000 people. Person-to-person transmission through infected respiratory droplets from patients with symptoms and asymptomatic carriers is the main mode of spread in the community. There is currently no standard agreed upon drug to treat the disease and the prospect of having a safe and efficacious vaccine might be years away. Thus, public health interventions such as social distancing and hand washing have been introduced and has, to some extent, slowed the progression of the pandemic. Universal masking as a public health intervention is currently mandatory in a vast majority of countries around the world. To avoid personal protective equipment (PPE) shortage crisis for medical staff and other frontline workers, health authorities are recommending the use cloth masks. Although in theory, cloth masks can be helpful to limit the spread of the COVID-19, serious consideration should be given to the choice of textile, the number of layers of cloth used, pre-treatment of the material with water repellent material and other compounds that can enhance the filtration efficiency of the masks without compromising their breathability. This review uses concepts of textile engineering and the theoretical principles of filtration to make suggestions and recommendations to improve the quality and safety of cloth masks for the general public.

Extended use of face masks during the COVID-19 pandemic - Thermal conditioning and spray-on surface disinfection.

The current COVID-19 pandemic has resulted in globally constrained supplies for face masks and personal protective equipment (PPE). Production capacity is limited in many countries and the future course of the pandemic will likely continue with shortages for high quality masks and PPE in the foreseeable future. Hence, expectations are that mask reuse, extended wear and similar approaches will enhance the availability of personal protective measures. Repeated thermal disinfection could be an important option and likely easier implemented in some situations, at least on the small scale, than UV illumination, irradiation or hydrogen peroxide vapor exposure. An overview on thermal responses and ongoing filtration performance of multiple face mask types is provided. Most masks have adequate material properties to survive a few cycles (i.e. 30 min disinfection steps) of thermal exposure in the 75°C regime. Some are more easily affected, as seen by the fusing of plastic liner or warping, given that preferred conditioning temperatures are near the softening point for some of the plastics and fibers used in these masks. Hence adequate temperature control is equally important. As guidance, disinfectants sprayed via dilute solutions maintain a surface presence over extended time at 25 and 37°C. Some spray-on alcohol-based solutions containing disinfectants were gently applied to the top surface of masks. Neither moderate thermal aging (less than 24 h at 80 and 95°C) nor gentle application of surface disinfectant sprays resulted in measurable loss of mask filter performance. Subject to bio-medical concurrence (additional checks for virus kill efficiency) and the use of low risk non-toxic disinfectants, such strategies, either individually or combined, by offering additional anti-viral properties or short term refreshing, may complement reuse options of professional masks or the now ubiquitous custom-made face masks with their often unknown filtration effectiveness.

Home-made masks with filtration efficiency for nano-aerosols for community mitigation of COVID-19 pandemic.

OBJECTIVES: The novel coronavirus disease 2019 (COVID-19) epidemic that emerged in December 2019 has rapidly evolved in recent months to become a worldwide and ongoing pandemic. Shortage of medical masks remains an unresolved problem. This study aims to investigate the filtration efficiency (FE) of home-made masks that could be used as alternatives for community mitigation of COVID-19. STUDY DESIGN: Experimental observational analytic study. METHODS: The FE of home-made masks and medical masks (as the control) were tested under laminar flow within a scaled air duct system using nebulised NaCl aerosols sized 6-220 nm. The size-resolved NaCl aerosol count was measured using a scanning mobility particle-sizer spectrometer. Home-made masks with an external plastic face shield also underwent a splash test. In addition, the fibre structures of medical masks were studied under an electron microscope after treatment with either 75% alcohol or soap and water at 60 °C. RESULTS: The FE of the home-made masks at 6-200 nm were non-inferior to that of medical masks (84.54% vs 86.94%, P = 0.102). Both types of masks achieved an FE of 90% at 6-89 nm. A significantly higher FE was achieved when one piece of tissue paper was added adjacent to the inner surface of the medical mask than medical mask alone (6-200 nm: 91.64% vs 86.94%, P < 0.0001; 6-89 nm: 94.27% vs 90.54%, P < 0.0001; 90-200 nm: 82.69% vs 73.81%, P < 0.0001). The plastic face shield prevented the home-made mask from fluid splash. The fibre structures of the external surface of medical masks were damaged after treatment with either 75% alcohol or soap and water at 60 °C. CONCLUSIONS: The home-made masks in this study, which were made of one piece of tissue paper and two pieces of kitchen towels, layered from face to external, had an FE at 6-200 nm non-inferior to that of medical mask materials, which had a certified FE of ≥95% at 3 µm. In the current COVID-19 pandemic with the shortage of medical masks, these home-made masks combined with an external plastic shield could be used as an alternative to medical masks for community mitigation. In addition, one piece of tissue paper could be placed adjacent to the inner surface of a medical mask to prolong effective lifespan of the medical mask. These demand reduction strategies could be used to reserve medical masks for use in healthcare and certain high-risk community settings, such as symptomatic persons, caregivers and attendees to healthcare institutions.