Read a Dutch version of this article here: ? Haak je eigen COVID-19 mondmasker en daarmee is de (net)kous af: analyse België vs. Taiwan — Wie roept de overheid tot verantwoording op??
If you want to protect yourself from COVID-19, wear a certified N95 or FFP2 or FFP3 mask (without a valve) … or a mask of equivalent certification (depending on your region). Keep your distance and wash your hands. Open windows (natural ventilation) to ensure clean air. Ensure a good fit.
When do we call upon the Belgian government to provide its residents with masks that are as safe as possible? It has been almost 1 year since the start of the outbreak, and all we have received so far is 1 piece of an inferior mouth mask per person: 1 mask for the rest of your life.
In Taiwan, 7 people have died so far from COVID-19.[ℹ️] Their capital Taipei is much more densely populated than ours. In Taiwan, the government has been providing 9 adult masks or 10 child masks available per person, every 2 weeks, through their National Health Insurance (NHI), for months (since April 2020),[ℹ️] health insurance that covers 99% of the population.[ℹ️] Belgium and Taiwan have a similar area, but Taiwan even has double so many inhabitants. As a Belgian, you cannot enter Taiwan without 2 weeks of quarantine [ℹ️] [a] (since the end of June, Taiwan has made exceptions for business travelers from low- and medium-risk countries, who only have to quarantine for 5 or 7 days).[ℹ️][b]
Nearly 10,000 COVID-19 deaths have occurred in Belgium.[ℹ️][ℹ️] In Belgium, that one-piece once-in-a-lifetime mouth mask per person which was made available by the government through pharmacies from mid-June was made from polyester and cotton,[ℹ️] which is very much inferior to a professional medical mouth mask.
According to a series of Japanese universities that performed simulations in August 2020 with Fugaku – the fastest supercomputer in the world – woven polyester and cotton masks only block 60% of droplets of 20 micrometers and smaller, while non-woven professional masks block 90% of those droplets.[ℹ️][ℹ️][ℹ️] An April 2020 technical report from The European Center for Disease Prevention and Control clearly also clearly states that scientific literature indicates that non-medical masks are less effective than professional medical masks against spreading germs.[ℹ️] In January 2020, the WHO still explicitly wrote that woven (ie cotton or gauze) masks are not recommended for COVID-19, not under any circumstances.[ℹ️]
Not to mention the fiasco that the insert of more than 80% of these Belgian masks states that you can hand wash them at a maximum of 30°C (and that a maximum of 30 times),[ℹ️][c][ℹ️] which is completely in violation with the standard that the mask is said to meet, which implies a minimum temperature of 60°C for washes.[ℹ️][d] By the way, these 80% masks were supplied by a letterbox company Avrox from Luxembourg that (on paper) made a loss of € 9,000 in 2017 and had barely € 62,000 in assets; and with car rental as principal activity in the Articles of Association, no history of Personal Protective Equipment.[ℹ️] Here you can watch a French-language RTBF documentary from September 23, 2020 about the company and the mouth mask deal: ? https://www.rtbf.be/info/article/detail_investigation-avrox-mysterieuse-societe-aux-15-millions-de-masques?id=10587548. The documentary also reveals that between Version 1.0 (published on 2020-04-24) and Version 1.1 (published on 2020-04-28) of the reference document[d] to which the masks had to comply in order to win the public tender, the wordings “Recommendations and Requirements for Maintenance” were suddenly changed to “Recommendations for Maintenance”, thereby not letting the masks of Avrox with their 30°C washes (which is lower than your body temperature) get into formal problems, in contrast to the 60°C previously stipulated as a requirement in the standard. The website of Avrox is also empty. The only article on their ‘news blog’ is about the masks deal with the Belgian government.[ℹ️] The only ‘product’ that their website mentions: those same masks for the Belgian government.[ℹ️] Their website didn’t even exist before 2020.[ℹ️] Please note, the remaining 20% masks were ordered from a company that was not active in the Personal Protective Equipment sector either: a Ghent company Tweeds & Cotton, known in Belgium for the River Woods brand,[ℹ️] active in general fashion and clothing.
Belgium has become a true wild west for mouth mask deals and lobbying.
I saw how a group of enthusiasts (with good intentions, but no scientific basis) lobbied our government in March 2020 for the recognition of a project whereby residents themselves would have to make their mouth masks with old pieces of cloth. Hooray for those lobbyers that they succeeded in getting government recognition, and nice for many pop-up COVID-washed mouth mask manufacturers, but what about scientific accountability and the safety of the residents? The project has been recognized because the Federal Agency for Medicines and Health Products (FAGG) did not want to publicly acknowledge that they could not get hold of a stock of medical masks. With a false sense of security as a result. For the Belgian rules it doesn’t even matter what you pull over your nose and mouth, fishnet stockings are OK as well.
The Centexbel microbiology laboratory (the only accredited laboratory in the Benelux equipped to test medical mouth masks) also explicitly warns against a false sense of security, so that medical workers would not fall for self-made (= ‘artisan’ masks) and sub-standard serially created mouth masks (= ‘community’ masks):
“The need for face masks is enormous during this COVID-19 pandemic. People are encouraged to sew, 3D print, even crochet and knit mouth masks, based on the – understandable – idea that you are better protected than not at all. Nevertheless, we want to make sure that our medical workers are adequately protected and do not develop a false sense of security , which can create serious dangers for them and general public health. That is why – as a certified laboratory authorized to test medical mouth masks – we are happy to indicate which performance requirements a safe [medical] mouth mask must meet, according to the European Directive on medical devices.”[ℹ️][e]
For your information: the one mask per person to be found in the Belgian pharmacies is also a ‘community’ mask.
The Belgian reference document developed by Centexbel (the competence center for textiles and plastics), Sciensano (Belgian research institute for public health, among others) and FPS Economy (Federal Public Service for Economy) also states that community and artisan masks do not meet the requirements standards against which medical mouth masks are tested:
“Neither a community nor an artisan mask meets the requirements of the masks covered by Regulation (EU) 2017/745 / Directive 93/42 / EEC on medical devices (applicable standard NBN EN 14683: 2019), nor with the Regulation (EU) 2016/425 on personal protective equipment (applicable standard NBN EN 149: 2001 + A1: 2009).”[ℹ️][f]
And yet, via ‘www.info-coronavirus.be’, the general information channel to residents, the government continues to specifically encourage residents to make masks themselves, and to purchase fabric / community masks.[ℹ️] As long as the government does not provide, we live in a two-class society of those who enjoy the luxury to inform themselves and to pay for adequate protection, and those who have to find cheaper masks.
In comparison, in Taiwan, the rationed masks are superior medical masks for the general population. They all comply with the national CNS 14774 standard (台灣標準CNS 14774 T5017:2018醫用面(口)罩)[ℹ️][g] or equivalent international standards.[ℹ️] The Food and Drug Administration of Taiwan maintains an on-line database where anyone can verify whether any batch of a particular medical mask model meets the correct standard.[ℹ️]. Here is an overview of the measures taken by the Taiwanese government to provide sufficient professional medical masks for all its residents, even resulting in a large surplus for export:[ℹ️]
The Taiwanese government immediately invested in 60 additional production lines, and thus Taiwan was able to increase its production from 1.88 million masks per day in January 2020 to 16.5 million per day in April,[ℹ️] to 20 million per day in May 2020.[ℹ️] Taiwan exports their masks abroad for about NT$10 (≈ €0.30) per piece.[ℹ️][h] The actual manufacturing cost for a mask is approximately NT$ 1 (≈ €0.03) and sold through their pharmacists for NT $5 (≈ €0.15).[ℹ️] For comparison: Avrox’s masks were sold to the Belgian government for €2.50 each.[ℹ️]
Here is a small overview of some more blunders by the Belgian government during that period. It reminds me of that line: ‘crisis is the wrong time to exchange business cards’:
⚫ In March, the Belgian Ministry of Social Affairs and Health placed two orders: an order for mouth masks for an amount of more than EUR€10 million, and an order for FFP2 masks for an amount of more than EUR € 27 million. On the same evening that the Ministry issued the final contracts, it suddenly canceled the orders.
⚫ During the peak of the crisis in Belgium, many intensive care beds remained unused, while at the same time hospitalization was refused based on age or stay in a residential care center. This was one of the causes leading to the deaths of more than 5,700 elderly people in care centers.[ℹ️][ℹ️] This is how Belgium experienced in April 2020 the highest level of excess mortality since WWII.[ℹ️] These centers also did not have enough professional masks.
⚫ In June 2020, the Belgian government had already bought 30 million mouth masks which, it turned out after the purchase, were rejected because they did not meet the correct requirements.[ℹ️]
But also with regards medical masks in Belgium, there is a lot of lying and not enough checking. ‘Test Aankoop’ wrote in June 2020 that even in Belgian pharmacies, 80% of ‘surgical masks’ do not meet the standards of surgical mouth masks at all in terms of filter efficiency. The filter efficiency must always be at least 95%.[ℹ️]
So if you, as a government, give up on purchasing and control the safest masks for residents, you don’t take responsibility for boosting or starting up reliable production, and you continue to do so consistently for nearly a year after the start of the outbreak, then you also send a signal to your residents that the problem does not have to be dealt with too professionally or seriously. If you encourage your residents to sew an uncontrolled mask from some old fabric themselves, and consistently pretend this is equivalent to professional high-quality masks, then there are holes in that plan, literally and figuratively.
Masks are not opium for the people. Without strict standards which are checked one doesn’t achieve safety.
Who knows how to put pressure on the government? The story of the government suppressing us and imposing too many rules, so to speak (despite errors and selectivity), plays to the advantage of the government, which in fact has never done enough itself, neither in terms of testing.
I demand the provision of scientifically controlled face masks of superior quality by the Belgian government. Get rid of the laissez-faire-crochet-your-own-mask-and-there-you-have-it.
This article is written under a Creative Commons CC BY-NC-ND 4.0 license.
[a] “Regulations of Citizens/Non-Citizens Entering Taiwan (since 00:00 July 16 Taipei Standard Time)” [ℹ️] consultable in PDF via https://www.immigration.gov.tw/5475/5478/6928/6940/212474/232997/.
[b] “Regulations of Entering Taiwan–Taiwan Nationals, Foreign Nationals since 00:00 September 17 Taipei Standard Time” [ℹ️] consultable in PDF via https://www.immigration.gov.tw/5475/5478/6928/6940/212474/239473/.
[c] Technical file (insert) “Communitymasker” [ℹ️] consultable in PDF via https://www.info-coronavirus.be/nl/news/mondmaskers-federale-overheid/.
[d] “Richtlijn NBN/DTD S 65-001:2020” [ℹ️] consultable in PDF via https://www.info-coronavirus.be/nl/news/mondmaskers-federale-overheid/.
[d] “LEES MEER OVER DE VERSCHILLENDE TYPES MONDMASKERS!” [ℹ️] consultable in PDF via https://www.centexbel.be/nl/medische-mondmaskers-tijden-van-corona.
[f] Belgian technical document “NBN/DTD S 65-001:2020. Community-en Artisanale maskers -Gids van de minimale vereisten, confectie, onderhoud en gebruik”[ℹ️] requestable via https://www.nbn.be/nl/nieuwsberichten/zelf-mondmasker-maken-officiele-regels-experten in drie talen:
- Dutch: https://www.nbn.be/files/NBN_DTD_S_65-001_2020_nl_versie_1_2.pdf
- French: https://www.nbn.be/files/NBN_DTD_S_65-001_2020_fr_version_1_2.pdf
- English: https://www.nbn.be/files/NBN_DTD_S_65-001_2020_en_version_1_2.pdf
[g] More information about the CNS 14774 T5017:2018 standard in “醫用面(口)罩製造工廠品質管理指引”[ℹ️] consultable in PDF via https://www.fda.gov.tw/TC/siteListContent.aspx?sid=310&id=30392.
For comparison: medical masks according to the European standard EN 14683 comply with the following conditions:
- BFE (Bacterial Filtration Efficiency) of at least 95%
- Pressure difference (H2O/cm²) of less than 3.0 (for type I) or less than 5.0 (for type IIR)
Medical masks according to the Taiwanese standard CNS 14774 comply with the following conditions:
- BFE (Bacterial Filtration Efficiency) of at least 95% (with the exception of the chirurgical type ‘D2’ mask, which has to comply with a Synthetic Blood Penetration Liquid Barrier Resistance of 80 mm Hg, as well as with a Submicron Particle Protection Rate of at least 95%)
- Pressure difference (H2O/cm²) of less than 5.0
[h] Regarding the masks made available via Taiwanese pharmacies, as part of the NIH: this price (NT$5) was the result of the rationing system by the Taiwanese government. However, this rationing and price ceiling system has stopped in June 2020 because of the surplus of mask. It still costs less than NT10 dollar each now that mask returned to a free market demand-supply mechanism. All of these masks are CNS 14774 certified. Info via 江卓翰 on the 8th of October 2020.
Update — companies are now producing medical masks in Belgium:
⚫ ECA – Van Heurck is aiming to produce around 190 million medical masks per year in Assenede, Belgium.[ℹ️][ℹ️]
⚫ BruMed (https://en.brumed.com/) is aiming to produce 100 million medical masks (EN 14683: type II) per year in Kontich, Belgium.[ℹ️][ℹ️] Prices are around EUR€0.14 per mask (starting from 100,000 pieces) including delivery in Belgium (information as of 27th of september 2020).
⚫ Ontex (https://ontex.com/company/around-the-world/eeklo/) is aiming to produce 80 million medical masks per year (EN 14683: type IIR) in Eeklo, Belgium.[ℹ️][ℹ️]
⚫ Deltrian — Newco (https://health.deltrian.com/) is aiming to produce 30 million medical masks (EN 14683) per year in Fleurus, Belgium.[ℹ️].
⚫ Belgium Mask is hoping to produce around 25 million medical masks (EN 14683) per year in Nivelles, Belgium.[ℹ️]
⚫ Contact me if you know further Belgian producers of certified medical masks and I will list them here.
This combined capacity results in around 425 million masks per year. Meaning a bit over one million masks per day.
“Fig. 1.” from “Maintaining mask stockpiles in the COVID-19 pandemic: Taiwan as a learning model”[ℹ️]: