I recently sat down with Dr Dirk Koekemoer, Founder and CEO of eMoyo, a SouthAfrican company that is at the forefront of COVID-19 mask technology. Based in Linden, he chatted to me about his product and why masks play an important role in limiting the spread of COVID-19. I started by asking him what his masks were made of…
D.K: The mask is made of Quadrotex®. It is 2-way horizontal stretch microfibre polyester. It is knitted in South Africa and after knitting; the fabric is mechanically stretched under heat to create the soft fibres between the threads that give you that comfortable feeling on the skin, and at the same time the process increases the filtration efficiency.
D.K: So many masks are being sold with false claims. Wearing any cloth mask helps, but it is important to know that the DTI in S.A has established a minimum specification for masks. It is one thing for the filtration rate of a mask to be good, but can you still breathe through the filter? Will the person keep the mask on his face or drop it under his nose? Will the valve of a valve mask filter exhaled air?
The CE mark applied by an accredited medical device manufacturer like eMoyo means you can trust the filtration rate and the quality of the mask. The CE mark means the device was tested by laboratories to check that the filtration rate meets, or exceeds, the applicable standards, that the mask is of good quality and safe fabric.
DB: What should people consider when buying a mask?
D.K: Virtually any face-covering helps. One does however have to understand the following
Buy a cloth mask with good breathability or else you will not wear it
Do not buy a valve mask, they protect nobody
Do not think a plastic mask or visor works, you need a cloth to filter the exhaled air.
Ensure that the mask you purchase does not retain moisture - this can make it unbreathable and could cause panic and fainting.
When purchasing, make sure it is from someone that had done their homework and understands the reasoning for a mask.
Preferably buy a mask from an accredited medical device company. Look for the CE mark. Ask for the Declaration of Conformity of the mask.
D.B: Over the ears or around the head…which is the best method of keeping the mask on your face?
D.K: The soft lycra headbands of our mask are the best. It is soft to the skin, lasts for years, and does not lose its stretchability.
You can however also opt to tie the straps in such a way that it can hook around the ears instead of around the head, the decision is up to each individual.
The important thing is that the masks must be comfortable for as long as possible so you do not need a reason to take them off.
D.B: Why do people continue to wear their masks incorrectly? Surely you either wear it over your mouth and nose or not at all? Wearing it on your wrist or chin serves no purpose at all.
D.K: There are many reasons why this happens.
For instance, if the mask is made of multiple layers of cotton, the cotton will get wet and it will become difficult to breathe through. That means the person will have high resistance when breathing, which could cause anxiety. What is great about our masks is that they are moisture management controlled, allowing more air through when moisture builds up.
Another contributing factor is that some masks are designed without the use of stretch fabric and when opening the mouth the chin will pull the mask down under the nose.
Probably the most common reason is that the masks get old quickly and the elastic going around the ears are of low quality. It then loses its stretch and the masks start hanging like a toddler's nappy.
Lack of education on how to wear your mask correctly is also in short supply, people are scared to tell others if the mask is on incorrectly and virtually no education went out on how to wear a mask, just that you must wear a mask.
D.B: How often and how should masks be washed correctly?
D.K: You should wash your mask by hand every night using soap in running lukewarm water for 5 minutes. Hand-washed masks also last much longer and if you have a polyester mask with lycra straps like ours, then it will easily dry overnight.
If you are using a cotton mask that builds up moisture, you should have at least three masks with you in 8 hours to swap them out.
D.B: How many masks should a person purchase?
D.K: If it is a good quality mask that dries quickly like ours that will last 6 months you only need two masks. One you wear and wash every day and one backup for if the masks get dirty through the day or you lose your mask.
D.B: N95 masks, are these only for medical/ first responders?
D.K: In the early stages of the pandemic, there was a severe shortage of N95 masks and it was reserved for the frontline workers. It is however important to know that even with N95 masks you are only slightly protected from other people. The spread of the virus is significantly reduced if the source with COVID-19 wears the mask, even a cloth mask.
D.B: How long does a mask last? Is it a one-off purchase, or should they be replaced regularly?
D.K: The quality of cloth masks differs significantly. The eMoyo mask lasts months for instance. Most masks, however, only last a few weeks or days. That is why it does not make sense to buy a low-quality mask thinking that you will save money. I can remember when we started selling the eMoyo mask. At R84.50 some people thought that our masks were expensive, but those same people have now realized, after buying their 10th R15 mask, that they could have bought 2 eMoyo masks that would last a year.
D.B: Your masks contain detailed instructions as to how they should be worn, a year later is this still necessary?
D.K: By now most people know how to wear the mask. Whether they adhere to the guidelines is the main problem. As we are a CE-certified pandemic cloth mask we adhere to the strict ISO regulations of Europe and we need to include the ‘Instructions For Use’ on our masks.
D.B: How can you wear a mask correctly and stop fogging up your spectacles?
D.K: Most masks allow for air to escape through the holes between the skin of the face and the mask. This is a problem as it means unfiltered air can escape, just like when wearing a valve mask. Our masks were designed in such a way that they seal between the skin of the face and the mask. The issue with spectacles is air leaking upwards past the nose that could cause dry eyes and fog up of your spectacles. Our mask has an option to insert a pliable metal nose plate that can be bent to the form of the nose and prevent air from leaking out.
D.B: As a medical doctor, do you have any advice for those who still refuse to wear a mask in a public space?
D.K: The problem is that people do not understand why they are wearing masks. As long as people think it is their right not to wear a mask because they are not afraid of the virus the habits will not change. Usually, a person will change his habits once s/he understands these two points:
1] You wear a mask to protect those around you from getting COVID-19.
2] If we all wear a mask, we are then protecting each other.
D.B: From what age should a mask be worn? Can very young children wear them? What about the elderly who might have breathing issues?
D.K: People of all ages can wear masks as long as it is a good quality mask with excellent breathability. Even If you have breathing issues, find a mask that works for you as getting COVID-19 could prove fatal to those with co-morbidities.
Young people naturally comply with regulations. A child(from as young as 3) will wear a mask contentedly if the parents explain to him/her the benefits and set the example.
D.B: How long do you think that compulsory mask-wearing be with us?
D.K: Personally, I think it should continue until we have herd immunity. With vaccinations being rolled out it might even happen this year in South Africa. We just need to get to about 70% of people with immunity. Even if you had COVID-19 you should continue to wear a mask as staring death in the face makes wearing a mask is a no-brainer.
D.B: There is currently a video doing the rounds on social media that shows an extraordinary build-up of carbon dioxide behind a mask. Is this video a correct representation of what actually occurs? Is carbon dioxide behind a mask an issue if worn for an extended period?
D.K: If you understand science and understand lung functions then you will not even spread a video like this. The infodemic is probably the biggest problem during COVID-19. It is difficult to explain the flaw in these videos without getting technical. There are two major points I want to explain…
A] Dead space: Is the volume that you re-inhale, the volume of air you already tried to exhaled that is still in your trachea, throat, nose, and mouth that you will re-inhale. Mammals evolved to re-inhale exhaled air. If you put the CO2 sensor in your mouth or nose of the trachea you will get the same results. All that happens with a mask is that the dead space is slightly larger, probably less than 10% larger.
B] CO2 breathing response: The second important aspect of breathing to understand is that your brain does not control your breathing speed and volume by monitoring oxygen, it does so by monitoring CO2. Your brain evolved to know how to handle this.
Trust the science, and don’t believe the plethora of misinformed videos that now populate every social media platform.
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