The Story Of The Universal Mask
The Universal Mask, originally known as 3MD Masks, was founded in March of 2020. The COVID-19 pandemic had just hit Seattle and Los Angeles. The CDC did not recommend mask wearing at that time. In fact, their policies directly discouraged it, saying that mask wearing could be harmful by causing people to touch their faces more frequently, and that the majority of the public would not wear their masks correctly. Hospitals were ramping up to prepare for the surge of patients, but medical masks were in scarce supply. Friends asked us to make masks for their family members who were physicians and ICU nurses, who had been told by their administrations that bandanas were sufficient protection against a still largely unknown pathogen in the absence of proper personal protective equipment.
Designing the Universal Mask
We were contacted shortly thereafter by a friend whose sister was a pediatric infectious disease specialist in Virginia, who was also tackling the problem of mask shortages. She had come to the same conclusion, that polyester felt could be used as a filter. Then she had taken it one step further in sourcing a 5-micron filtering polyester felt that was used in industrial air and solvent filtration. Could that be the solution? Immediately, I obtained a sample of the material from her, and sewed a prototype incorporating all of our ideas. As soon as a prototype was made, we sent the samples off to Nelson Labs to get tested for viral filtration efficiency so that we would have the assurance that our materials indeed were more protective than the standard 2-layered woven cotton masks people were starting to sew at home for healthcare workers. We were ecstatic when the results came back two weeks later indicating that our hypothesis was correct, and that we had a fully washable and reusable face mask with 93.6% viral filtration efficiency.
Fighting the Bias Against Mask Wearing
However, there was still widespread bias against mask wearing. My neighbors told me that I was going against CDC guidelines. My friends who were sewing masks for healthcare workers found it a chore to wear one themselves. I even recall going to the grocery store during the panicked rush for toilet paper, cleaning supplies and canned goods, and being the only one standing at the checkout counter wearing a fabric face mask. A little old woman who looked to be in her 80s walked straight up to me, inches away from my face, and said, “You know, that face mask doesn’t help.” She was only repeating what she had been told. I encouraged another friend who was also an infectious disease specialist to use her connections at the CDC to reverse their recommendation against public mask wearing. Clearly, if it was necessary for hospital workers, then the general public would benefit from mask wearing as well.
Logically, mask wearing or any type of face covering makes sense, whether it is the best fabric face mask, a medical mask, or even a simple bandana. However, it would be a hard sell, since most face masks are intended for source control, meaning that they block germs from coming out at the source (our own nose and mouth), but are not designed necessarily to block germs from coming in. This is due to the way gas and fluid mechanics work. I envisioned it as a spray bottle. We are all familiar with cleaning fluids that come in spray bottles, although in those days they were hard to find. If you place a piece of cloth or paper close to the nozzle of the bottle, you would capture nearly all of the fluid coming out. The further away you placed the cloth, the less you would capture, and the more fluid particles would become aerosolized into the air. This was the same scenario with people's breathing.
This is why doctors wear surgical masks in the operating room. No one wants me breathing or spitting in their eye during surgery, as this could cause a serious eye infection called endophthalmitis that could result in blindness. Research has shown that endophthalmitis is more frequent from intravitreal injections if the doctor or patient are unmasked and speaking, because fine respiratory droplets emitted by speech would contaminate the needle tip at close range. Retina specialists therefore always wear a mask and refrain from speaking during these intravitreal injections, as these practices were shown to statistically decrease the rate of endophthalmitis. Wearing a procedure or medical mask any time there is a risk of respiratory droplets contaminating the surgical field is common practice.
However, if medical masks were in short stock for medical workers, then they certainly were unavailable for the general public. There was also a risk that the public would hoard them the way they already were doing with toilet paper and hand sanitizer. I was surprised that no prominent voices in leadership seemed to have this insight that universal masking with simple fabric masks could flatten the curve and help slow the spread. I wrote to the governor to ask him to encourage universal mask wearing. I wrote to large clothing manufacturers like Gap to see if they could jump start the fabric mask making process. There was no way that stay-at-home moms and crafters could meet the demand. After sewing 50 masks myself in one weekend for the many friends who requested orders of my new face mask design, I found that even the best face mask I could sew was not up to my personal standard. I decided I needed to scale up to make these fabric face masks more widely available. We found a place to source large rolls of 5-micron filtering felt, as well as a lighter weight felt that had less air resistance.
Scaling Up and Producing Masks
I contacted my friend who was a children’s clothing designer to ask for recommendations for a manufacturer. I wanted all of our face masks made in Los Angeles. I met for the first time with the manufacturer in downtown Los Angeles just 2 hours before the building manager was telling him he needed to shut down production, because the building would be locked down for quarantine. My partner quickly wrote up a letter of intent to submit to the building manager, since we were attempting to provide an essential service. When our first batch of 2000 masks arrived, all of them were immediately snatched up by healthcare professionals in a matter of days. We felt it necessary to prioritize our fellow physicians, several of whom were still seeing patients with limited or dwindling supplies. Many were just wearing bandanas to work, as per CDC guidelines. We received high praise from these healthcare workers, who found these to be one of the best masks available given our tested filtration results. They appreciated the research behind creating the most protective fabric face masks. Many of these doctors began recommending our masks to others. This was extremely encouraging, and we reinvested the proceeds into making more and donating where it was needed.
The 5 micron felt filter mask was initially intended for these healthcare workers who had no other resources. It was designed with head straps that would pull the mask snuggly around the face to provide the type of seal we are accustomed to having with an N95. While an N95 is still gold standard, we wanted to try our best to design something that could approximate its utility in a time of shortage. We designed a separate mask for community members, who were less accustomed to mask wearing, and would balk at the tightness of the head straps or the air resistance of the 5 micron filter, attributes that a regular N95 user would find comforting. The community mask had ear loops, which I had always found uncomfortable to wear for long periods of time, but these were more user friendly. Once we redesigned the ear loops out of soft knit elastic with a soft adjustable silicone toggle, they became far more comfortable. One of my partners loves the ear loops, whereas I still prefer the elastic head straps, and my other partner prefers the bias ties. The masks with bias fabric ties were produced later upon request as these are more familiar to those who wear surgical masks.
Once the CDC finally changed their stance on mask wearing in April 2020, orders came in nonstop for weeks. When one manufacturer was not sufficient to keep up with the pace of production, we acquired a second. When two were not enough, we acquired a third. While we were excited that people seeing the benefits of mask wearing, but it was difficult to match the pace of production with the demand. Fortunately we saw other mask companies starting to crop up. Many of those other companies used a different design that required individual sizing in order to fit well without gaps, some had a nose-piece and some did not, and most tended to use only woven fabrics. When we had tested two layers of woven fabric at Nelson labs, the viral filtration efficiency was only 61%. Other researchers have found the same, that woven fabrics do not filter as well as a combination of woven and nonwoven fabrics. Nevertheless, if these companies could make it appealing for people to wear masks, and articles in GQ magazine and Vogue could make mask wearing stylish, then at least 61% was an improvement from zero.
Since school had come to a complete halt and most children were quarantined at home with their families, we did not have a children’s mask available at the beginning. However, when it became apparent that kids' masks would also be necessary as the pandemic dragged on, we worked on several iterations and designs to create something that would be comfortable, breathable, and easy for kids to wear. My own children contributed significantly to the ultimate design of the kids' masks, from the size and fit to the choice of 6 vibrant colors. We are one of the few companies that have managed to incorporate a nose piece and a filter into our children’s mask. Visit our other blogs for more about how to choose a kids mask as well as fun ways to customize your kids mask.
Several of my kids' friends helped model our kids' masks. In fact, several of our models are friends and fellow medical professionals, running the gamut from general surgeon, ophthalmologist, pediatrician, intensivist, genetic counselor, physical therapist, pharmacist, social worker, and an aspiring medical student.
Growing A Mask Business
While California was abiding by the stay-at-home order, my ophthalmology clinic had closed, allowing me time and freedom to create and continually improve my mask design. Our clinic has now reopened and is fully running, and while juggling a burgeoning mask making business and work as a full-time physician and full-time parent is difficult, it certainly is rewarding. We have since added face shields and medical masks for those who need additional protection. There have been many ups and downs along the way, as with any start-up business. Creating a brand new start-up during a pandemic certainly offered its own unique set of challenges. My partners and I are continually pushed to learn new things in areas that we had never explored before.
One new challenge I particularly enjoyed was the making of our first video ad and first music video. While I had limited experience in photography from before, I had almost zero film experience. I hardly even watched TV on a regular basis. But my children were involved in musical theater, and were eager participants. My middle daughter had been cast in a commercial herself prior to the pandemic, but all of her auditions had been cancelled subsequent to quarantine. “Save the PPE” seemed like an appropriate first ad. We wanted people to understand that while personal protective equipment (PPE) would provide greater protection, they were also largely unnecessary for routine use in the public setting, so long as social distancing and careful hand hygiene were also observed. It was the message that the CDC should have put out initially. Fortunately, medical professionals have generally felt extremely supported by the public, and it was heartwarming to experience the generosity of many individuals who donated supplies.
Our second music video, “Wear a Mask” was composed by my 9 year old, with lyrics by my 12 year old. It addresses some of the struggles we have had trying to convince the general public that mask wearing would be beneficial. While healthcare workers found transitioning to universal mask wearing easy and sensible, many others did not. I have been called every name in the book, although “sheep” stands out as the most common. There have been debates about simple fabric masks being too porous to keep viral particles out, yet strong enough to selectively deplete one’s O2 supply while simultaneously retaining CO2. Both O2 and CO2 are tiny molecules that are a small fraction of the size of a viral particle. There is also the struggle that even when people do wear a mask, it often sits below their nose, or even worse below their chin. I understand that mask wearing can often feel uncomfortable, but so are high-heeled shoes or underwear, and a mask seems just as essential if not more. Using music was especially a struggle for me since I am a bit rhythm-impaired, but what I lacked my children compensated for twofold. They also recruited their friends to help with choreography. More details behind making of these videos is available on our behind the scenes blog.
Overall, we are grateful for the opportunity to have something meaningful and productive to do at a time when much of the world is experiencing chaos and loss. It has been a long road since March, and some of us feel like we’ve lived through eons in these few short months. We hope that we can continue to innovate and find new ways to help slow the spread of COVID-19, as well as to be a positive influence in encouraging people to protect one another.