Are handmade cloth masks doing enough to protect us?
Some European countries are mandating medical style masks like N95 or KN95 masks on public transportation and in stores.
Still, aerosol research from 2020 shows cloth masks are just fine as long as they properly filter particles and fit flush with your face.
As new, more contagious mutations of COVID-19 emerge, Europeans are ditching homemade cloth masks for the sturdier stuff.
In accordance with a new public mandate in Germany, people must wear an N95 or a surgical mask when visiting the grocery store or using public transportation. The same deal goes for France, where citizens are encouraged to swap hand-sewn face coverings for single-use surgical masks.
But should you really toss your stash of handmade face coverings and opt for medical-grade equipment instead?
We looked through the latest medical research to evaluate some of the most popular masks out there. From silk scarves to neck gaiters, and cloth masks to KN95s, these are the safest masks you can wear to protect yourself from COVID-19 and its new variants.
Long worn by doctors, nurses, and other medical professionals, the single-use surgical face mask has been a mainstay in public health for at least the last six decades.
According to the U.S. Food and Drug Administration (FDA), a surgical mask is defined as a "loose-fitting, disposable device that creates a barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment." These masks are often referred to generically as "face masks," but they're actually subject to specific regulations that homemade cloth masks aren't.
Surgical masks come in various thicknesses—some are three-ply, for example, while others are four-ply—which impacts their ability to protect you from splashes, sprays, large-particle droplets, or splatters that may contain viruses or bacteria.
An unsung hero of the surgical mask is the metal prong tucked into the seam at the bridge of the nose. You can manipulate the small wire to get the best seal possible along your nose and cheeks—a feature that's notably missing among most cloth face masks, although some DIYers have gotten crafty and added it in.
Still, these face masks aren't effective in blocking very small particles in the air that may be transmitted through coughs or sneezes due to the relatively loose fit of the mask to your face. That's why some researchers suggest double-masking for more safety.
In an extensive review of various face masks published last September in the journal Science Advances, researchers from Duke University found surgical face masks are the second-best option to protect yourself, coming in just behind N95 masks, which are considered the gold standard.
The N95 respirator is considered the gold standard of face coverings in the medical world, and even in the construction industry. These face coverings diverge from the surgical mask in that the edges are designed to fit snugly to the face.
The FDA defines N95 respirators as a "protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles." The Centers for Disease Control and Prevention (CDC), however, still doesn't recommend the general public wear them. That's in order to reserve supplies for health care workers and medical first responders.
The Duke researchers found N95 respirators were most effective in filtering out particles. Those masks had a droplet transmission rate of less than 0.1 percent. However, this is with the caveat that N95s don't necessarily protect others around you.
💡 Tip: Beware of counterfeits. According to the CDC, counterfeit respirators are on the rise amid the COVID-19 pandemic. The organization keeps a running list of bunk products here.
Here are a few signs to tell if your respirator is a counterfeit:
No markings at all on the filtering face piece respirator.
No approval (TC) number on filtering face piece respirator or headband.
No National Institute for Occupational Safety and Health (NIOSH) markings.
NIOSH spelled incorrectly.
Presence of decorative fabric or other decorative add-ons (like sequins).
Claims for the of approval for children (NIOSH does not approve any type of respiratory protection for children).
Filtering face piece respirator has ear loops instead of headbands.
There are also various types of N95 respirators, so make sure the one you're using is rated for the performance you want. Some are defined as surgical, while others aren't. Some aren't fluid-resistant. All N95 masks should protect you from airborne particles, though, according to 3M, the manufacturer of most N95s in the U.S.
"Furthermore, the performance of the valved N95 mask is likely affected by the exhalation valve, which opens for strong outwards airflow," the Duke scientists say. "While the valve does not compromise the protection of the wearer, it can decrease the protection of persons surrounding the wearer. In comparison, the performance of the fitted, non-valved N95 mask was far superior."
Cloth Face Masks
Last November, scientists from Virginia Tech published research on the inward and outward effectiveness of cloth face masks, surgical masks, and face shields. They posted that study to the preprint server medRxiv, which means the work hasn't yet been peer-reviewed.
The scientists found you don't, in fact, need to wear an N95 respirator and take personal protective equipment away from medical professionals in order to keep yourself safe. But according to the research, you do need to make a few considerations when choosing the right cloth mask.
Look for masks with three layers of filtering material. For the most effective filtration, you'll want to find a mask that has two woven layers of outside material with some sort of filtering material in the middle, whether that's a coffee filter, surgical mask, or vacuum bag.
Opt for a flexible material. Look for masks made of tightly woven material that will cling to your face. Otherwise, you'll have gaps. Bonus points if the mask has a metal prong at the nose, similar to a surgical mask.
Choose ties, not ear loops. You can better control the fit and contour of a mask if it's secured to your head with ties. Ear loops, by contrast, create a larger gap at the sides of your face. They can also hurt with long periods of use and cause headaches.
If you're not feeling secure in your homemade cloth mask, there's an easy solution: double up. While no two handmade face coverings are exactly the same, the least effective ones all have a few things in common: they're flimsy, feature gaps on the sides and at the top by the nose, and have a lack of extra filtering material inside.
With that in mind, the CDC updated its mask guidance in February to include recommendations on how to safely wear two masks at once, as well as how to wear a mask with a proper fit, to help quell the spread of COVID-19.
But does it work? February CDC research points to yes. The scientists found layering a cloth mask and a surgical mask can help reduce the transmission of SARS-CoV-2, the virus that causes COVID-19.
Once again, it all comes down to fit. In a research letter published on April 16 in JAMA Internal Medicine, scientists at the University of North Carolina at Chapel Hill compared the filtration efficiency of commonly available masks "worn singly, doubled, or in combinations."
They found the best coverage came from wearing a neck gaiter or a bandana over a surgical mask. However, the results were not the same in the opposite scenario: wearing a surgical mask over a neck gaiter. That led the researchers to conclude the magic of double masking all comes down to a more snug fit.
But you shouldn't wear three masks, as the triple layer of fabric starts to make it difficult to breathe, according to Dr. Dave Hnida, the medical editor at CBSN Denver. In a January interview, he said if you don't mind extra layers of material over your mouth and nose, you can opt for a cloth mask that uses filtration inserts for extra protection, instead.
There are a lot of rules to consider here, so if you only remember one thing, make it this: any mask is better than no mask.
Note: This story has been updated to include new guidance and research on the effectiveness of double masking from various sources. We will continue to update as we learn new information.
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