I haven’t written about infectious diseases for a while, but a recent trip to my lung specialist to review a chest CAT scan (good news: it was finally clear of pneumonia) found her looking a little haggard. She admitted, doctor-to-doctor, that she’d been spending a lot of time caring for new COVID cases in recently filled local hospital wards.

With contagious infectious diseases always a concern for the family medic, it’s probably a good idea to review some of the new research that has come out on cloth masks. The belief that a cloth mask your granny made out of yarn will prevent infection as well as an N95 or even a surgical mask is, in my opinion, pretty dubious (though I’m sure she’s a very nice lady).

Sure, in early 2020, logistics issues meant that the public had to rely on cloth masks because of the lack of medical-grade supplies. The government specifically asked us to avoid using N95s so that healthcare workers can have some.

Sounds fair, but now, there’s a reasonable supply of the higher-quality gear that’s out there for purchase. Still, I see the majority of folks in our area wearing cloth masks in high-risk settings. Is this a wise move in general and in terms of your medical storage?

You say you’ve gotten attached to your cloth mask? It even has a moustache painted on it? Great, use it on Halloween. Arguments are now being made that the public, if they choose to wear masks, should start using masks that are more protective. Some countries have even tightened their rules on what masks you can use. For example: In France, homemade masks and store-bought cloth masks are now banned. Austria and Germany require real medical masks in many indoor public spaces. The mayor’s office in London is considering a similar requirement.

Now, I’m not saying there is no protection whatsoever from cloth masks. One study tested different face masks and reported that fabric face masks blocked at least 62.6% of fine particles, whereas surgical masks protected against an average of 78.2% of fine particles. N95 masks, however, blocked 99.6% of fine particles.

Despite the percentages above, how often is a mask fitted properly? How many times have you seen a cloth mask under the nose or basically dangling over the face? That provides zero protection. Other research has found that many cloth and even surgical masks only filter about 10 percent of exhaled aerosols. The rest go past, mostly around the cheeks and nosepiece. Higher-quality N95 and KN95 masks do a much better job at blocking aerosol droplets because of a tighter fit. See how to properly fit a medical mask below:

The CDC in the U.S. still recommends the use of cloth masks because, face it, they’re better than nothing and they want healthcare workers to have priority for the better items in the current pandemic. However, the average citizen may wind up taking care of a loved one during an epidemic and deserves similar protection. We shouldn’t fool the public into believing that cloth masks are just as good as the real thing.

Michael Osterholm, director for the Center for Infectious Disease Research and Policy at the U. of Minnesota, recently said that people should upgrade from cloth masks and bandannas to more-effective N95 respirators. He says to not assume that anything you put in front of your face works to prevent infection. He feels that many cloth masks are just not very effective.

Since N95 masks are now more widely available (see here), it’s worth having some for situations where infectious disease outbreaks are an issue in your community. Every medic should have a strategy for epidemics that they feel is appropriate according to their own research.

Personal responsibility should be the key, not politics nor government mandates. Decide the level of protection you need and learn how to use personal protection gear properly.

Joe Alton MD

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