After a year of wearing masks, the Centers for Disease Control and Prevention has decided that wearing two masks on your face is really what you should do if you want to avoid COVID-19.
Recent studies using mechanical devices that simulate breathing and generate “cough droplets” gave the alarming result that you receive only 42% protection wearing a standard surgical mask and 44% wearing a cloth mask. The researchers used 3-ply masks for the experiment. Therefore, they recommend double masking: a disposable medical mask under a cloth mask.
I have been saying all along that I felt cloth masks were not enough to provide the protection needed to avoid getting the virus. I have also said that standard surgical masks are not enough either, at least compared to the well-known N95. Still, I was surprised to see a protection rate in the low forties for both cloth and surgical masks, since the Wake Forest Institute of Regenerative Medicine published data in April 2020 suggesting that these masks gave protection rates in the 62-79 percent range.
N95 masks are supposed to give at least 95% protection against particles 3 microns in size or more. The SARS-CoV2 virus is actually smaller than that, though, so how can I say that wearing an N95 is the way to go? Is it better than the other options? Wouldn’t those tiny particles just go right through even N95s?
Studies were performed using medical workers dealing with the related (and similarly-sized) MERS virus in 2012. Results showed that those who used the N95 had less incidence of infection than those wearing lesser protection. The researchers stated that “policymakers might prefer to err on the side of caution and support recommendations for full protective equipment, including the use of N95 masks for MERS-CoV, an emerging novel respiratory virus.”
Well, in the 2020s, there’s a new novel respiratory virus (not so novel now), but the CDC has given mixed and confusing signals about mask wear since the pandemic began. They said not to buy N95 masks so that medical workers could have them. This was in the face of a scarce supply of these masks in the Strategic National Stockpile.
Mask production has ramped up since then, but the FDA.gov website still publishes this statement: “The Centers for Disease Control and Prevention (CDC) does not recommend that the general public wear N95 respirators to protect themselves from respiratory diseases, including coronavirus (COVID-19).”
They cite the importance of availability to health workers (certainly true), but then, the CDC endorsed home care for mild-moderate cases of COVID-19, cases that won’t kill you but certainly make you contagious. That made the average family caregiver a “health care worker” at risk too. The unavailability of quality masks, however, led to most people using cloth coverings or standard surgical masks.
The problem with these masks is that it’s hard to get a tight fit. The grand majority of procedure masks are fluid-resistant “melt blown” fabric secured with ear loops. They’re produced according to American Society of Testing and Materials (ASTM International) standards and designed to protect from splashes and prevent aerosol particles from getting into the air. They don’t offer a perfect seal and tend to have openings where microbes can go in or out. Not a good thing, if you’re dealing with a virus that’s airborne.
N95 masks, however, are manufactured according to standards set by another body, NIOSH (The National Institute for Occupational Safety and Health). NIOSH testing considers a “worst-case” scenario as the testing conditions are the most severe likely to be experienced by the wearer.
On top of discouraging N95 usage, the FDA issued an Emergency Use Authorization on April 18th, 2020, allowing for the production of medical face masks without fluid resistance. These may be manufactured from materials other than melt blown fabric, such as cloth. This began the cottage industry in cloth coverings encouraged by the government.
The problem with these masks is that it’s hard to get a tight fit with ear loops. All N95 “respirator” masks are equipped with elastic straps which hold the mask tightly to the users face. The recently-reported low percentage of protection from cloth coverings and standard procedure masks could possibly be improved with training in proper mask fitting.
A good mask fit forms a seal between the mask and the person’s face, decreasing the chance of infection. One recent recommendation is to tie a knot in each ear loop as close to their attachment to the mask itself as possible, in the hopes of getting a better seal. This involves modifying each mask, and making sure to tie it properly. It’s very important to tuck in material that may represent a hole in your defenses. This method, the government says, is almost as good as wearing two masks.
Also important is training on how to properly remove masks so as not to contaminate one’s hands. The front of the mask should be considered at risk for contamination and shouldn’t be touched if possible. To learn how to get a proper fit and seal for different masks, and how to properly remove them to avoid contamination, see my video from January of 2020, at the very beginning of the pandemic, where I originally discussed the importance of correct mask techniques. Click below:
Truth is, there is nothing like having the right medical equipment in normal times as well as pandemic times. If you can find N95 masks, you should invest in a supply. If you don’t have the best mask, you end up wearing two or modifying a less protective one. Next month’s CDC recommendations? Use the contact form to let me know what you think.
Joe Alton MD
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