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Can reusable mask be a better solution for the next pandemic after COVID-19?


A recently published study by the Chinese University of Hong Kong1 shows that Totobobo mask largely retain the fitting property after repeated cleaning process. More specifically, after 15 times of ethanol cleaning cycles, 17 out of 22 (77%) participants retain satisfactory fit-test performance.

However, the results after 30 cleaning cycles drops to 53%. The study shows there are challenges and promises of the Totobobo mask as a reusable, eco-friendly solution within a hospital setting during a pandemic situation.

Supply issue in a pandemic:
At the early phase of the COVID-19 pandemic, limited stockpile of disposable respirators was a major issue. The broken supply chain made it extremely difficult to get regular supply. What can we learn in order to prepare for the future? It is difficult to predict when a pandemic may strike. Constantly stocking up for peak demand requires a lot of space. Large quantities of unused masks may be wasted if there is no pandemic before the expiry date of the masks.

Logistic issues of facemask during a pandemic: Sourcing, Storage and distribution
Facemask supply issues during a pandemic: 1, Sourcing 2, Storage, 3, Distribution

Promises of Totobobo mask:

Scientists estimated there are 129 billion face masks added to the plastic pollution each month. Thus, the reusability of Totobobo mask is desirable as a solution to reduce wastes. The effort of sourcing and the cost of distribution and storage of multiple models/sizes of N95 masks may be greatly reduced if most of the HCW reuse their personalized Totobobo mask.

Furthermore, the transparent Totobobo mask can be important in healthcare because it is easier for communication between the HCW and patients. A recent randomized controlled trial found that patients rated surgeons who wore clear instead of covered masks were better in providing understandable explanations, demonstrating empathy and eliciting trust2.

Comfort is another important factor that affects compliance and protection. A comfortable mask allows the user to wear it continuously for a long time. In the study, 90% of the participants reported the Totobobo mask is either more comfortable or the same as their regular N95 mask.

Comfort rating: Totobobo VS N95 masks

Challenges for Totobobo:

In order to reuse, the mask has to be disinfected. This is a new problem compared to a disposable mask. The research team from the Chinese University of Hong Kong came up with a simple and practical solution. They submerge the used mask and filters into a box of ethanol for 5 minutes and then remove the filters and let the mask dry before reuse. It is known that COVID-19 viruses can be inactivated within 1 minute of exposure to 70% ethanol3

To validate this method, fit tests were performed for each participant before and after 15 ethanol cleaning cycles. A third fit test was performed after a second set of 15 cycles ethanol cleaning processes. Based on the same requirement as N95 masks, a fit factor of ≥100 was considered an adequate fit. 

Followings are the results from the all the fit-tests:

The overall fit factors (median) of the first fit test was 139.5 and for the second fit test was 134 and for the third fit test was 122. All the median fit factors ≥100 yet, the value declined as the number of cleaning cycles increased.

Final thoughts:

Next pandemic, it is a question of “when” rather than “if” it will come. To better prepare for the future, there is good potential for reusable solutions such as the Totobobo mask to play a bigger role in protecting the public and may be also healthcare workers in the next pandemic.

Compared to stocking up multiple models and sizes of disposable masks, It is a lot easier and cheaper to stock up sufficient filters, providing customized protection while minimizing the burden on the environment. However, for Totobobo mask, there is room for improvements in the area of longer lasting fit-performance and ease of customization.

1. The effect of ethanol immersion on fit performance and comfort of a fit tested reusable mask
2. Effect of Clear vs Standard Covered Masks on Communication With Patients During Surgical Clinic Encounters (A Randomized Clinical Trial)
3. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents

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