C/O John Case

By: Esther Liu, Contributor

The Silhouette: Could you give an overview of the website clothmasks.ca?

Dr. Catherine Clase: We were very concerned about dialysis patients early in the pandemic and we were concerned about the spread of COVID-19 in the dialysis unit, particularly for patients who have to come in for in-centre hemodialysis. There wasn’t enough protective equipment to allow for universal masking at that point back in March so I started reading about cloth masks and their filtration properties.

Then, we recognized quite quickly that there was a lot of evidence about this and that many examples of cloth that we found in [the] literature were actually showing fairly reasonable filtration properties. At the same time, modelling studies that were coming out were showing us that even an imperfect mask was likely to have a big effect on the pandemic. So, a group of us who are epidemiologists who normally write about kidney disease, we got together and wrote a piece around immediate community implementation of masking, recognizing the uncertainty of the evidence.

As we were writing that, the CDC was updating its guidance and then Health Canada, a few days after that. So by the time we advocated for that, the many people working in public health and many epidemiologists around the world had already come to that conclusion. We’d amassed quite a lot of information on the filtration properties of cloth and we thought it was worth publishing that. So, we published that as a review article.

Then, we knew that everybody was trying to make cloth masks or scouring the internet, trying to find the original papers trying to interpret them. We had recognized, by doing that ourselves, how difficult it was. So, we thought that it would be really great to have a plain language version for everybody else, for everybody who doesn’t want to read the version that has all the technical details in it. And so, we created the website clothmasks.ca and then some volunteers translated that into other languages for us. We have had 50,000 visitors over the time that [this] has been in place.

Could you also elaborate on your role in the initiative?

My role was really to be sort of a facilitator and team lead because there was a tremendous amount of work always being done by other people . . . we had a team of people taking information out of the primary papers and creating very large tables with all this information. We did it all in duplicate and it was all checked. The people who did that were junior researchers and a PhD student, Edouard Fu. He led the data extraction team, so he did tremendously work on this initiative.

How are you finding running the initiative?

It’s challenging, though we’re very fortunate because McMaster recognized very early in the pandemic that there was a problem with PPE. Here in the city, here in Canada and around the world, McMaster engineering very creatively decided to use internal investments to create this new Center of Excellence in Protective Equipment Materials . . . Now, I find myself part of something so much bigger. My part is the epidemiology and my piece around cloth masks and around trying to advocate for better cloth masks to be designed. The engineers have really engaged with us. One of the engineering graduate students, Scott Laengert, he has changed his PhD to work in this area. Charles de Lannoy, his supervisor is very actively engaged [in] cloth masks. Other than that, there are many other engineers that are also working on other aspects of PPE. All the knowledge and expertise, it’s all going to help build a critical mass, which is going to make PPE at every level better.

Speaking more about interdisciplinary approach, you earlier talked about how it’s difficult for you to go about this since your focus is primarily on kidneys. Could you elaborate a little bit more on that?

My background is in clinical research and my clinical area is usually kidney disease. Within kidney disease, we have expertise in a whole variety of different research methods and ways of looking at things — one of the areas of expertise that I’ve used over the years is the expertise that allows us to summarize things in informal ways. So really, it’s that part of my background that I’m drawing on.

My motivation comes from wanting to protect people with chronic diseases and the whole society more generally. Every day, I interact with my patients who are living with chronic diseases who, if they were to get COVID-19, would likely be severely affected and would likely be in the group that experiences higher mortality. On the one hand, I have these tools that come from my experience as a systematic reviewer and then on the other hand I have this motivation that tells me what to do. So, I find that, though this is challenging and it’s a really new area for me, I feel really well supported by the engineers who are my new colleagues. I feel that interdisciplinary teamwork is always important and especially important in the pandemic.

What future steps are you envisioning for the initiative?

At the moment, our goal is a better cloth mask. One of the recent changes in Health Canada was to suggest that we should use this substance, polypropylene. So we wrote an article about that in the conversation about what spunbond reusable industry-grade polypropylene is.

What we’re really hoping in the very long term, perhaps not for this pandemic but eventually, is that we can move away from materials such as polypropylene which is plastic – not very biodegradable – to materials that are truly sustainable. If I had a dream, that would be my doing: eventually, these pandemic community masks that we wear will be made from something that’s sustainably sourced and is compostable so [disposal] doesn’t have a huge environmental impact.

If I was going to dream even bigger, I would say: “What if we could have this personal protective equipment in hospitals that meet those same criteria? What if we could have reusable masks that go to the sterilizing department, get washed, get autoclaved, we can wear them again, and they are as good as the masks we’re wearing now?” That is a very long way away from where we are now, perhaps an impossible dream, but if we’re thinking really big, then that would be my goal.

Any additional comments?

I just want to really give a big shout out to my colleagues at the Center of Excellence in Protective Equipment and Materials. Before I met them, at the beginning of the pandemic, they realized that there was a problem [with] personal protective equipment: that we didn’t have enough. We had no Canadian manufacturer, we had no Canadian testing, we had no ability to ramp up our internal supply. And, as you know, borders were closing and planes were getting stopped, and you remember how difficult that was. My colleagues in engineering recognized that and they stepped up and they started doing things . . . Altruistically, that thinking of “I’m going to stop doing what I normally do and I’m going to do that” and so many of them choosing that – that to me was really extraordinary. The way that they have worked as an interdisciplinary team, including those of us from medicine and epidemiology, that too has been an amazing experience. I really just want to recognize all those people who had that idea and then made it happen.

The one last thing that I want to say is that I think we all feel like there is no light on the horizon, that things may not be [getting] better. I think what we all have to do is just keep doing the things that we’ve been doing, keep reinforcing the importance of doing the simple things that we’ve been doing to protect ourselves and protect others for the last few months. Head into the darkest months of this winter with patience and strength and hope for the future. I think things will get better, but we have to get through the next few months first.

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