The Ultimate Guide to COVID-19 Masks
What masks to buy and how to wear them to protect against coronavirus
By Michael Y. Park
Even after a year of living in the grips of the COVID-19 pandemic, it can be hard to filter out the truth from fiction when it comes to wearing masks to protect against coronavirus. Health officials agree that universal and diligent mask-wearing is one of the most critical steps to defeating COVID-19 and getting back to a world where we can safely return to the office, our kids can return to school and businesses can get back to normal.
We got the most up-to-date guidance on masking from Marisa Glucoft, MPH, CIC, Director of Accreditation and Licensing, Infection Prevention and Emergency Management at Children’s Hospital Los Angeles, to help everyone stay safe from coronavirus.
Why we mask
Masking is as much about self-protection as it is about preventing the virus from spreading to others. What makes COVID-19 particularly contagious is that it's infectious even if the carrier has no symptoms. You might feel fine and relax your masking habits, but you could still pass the virus on to someone else—or vice versa.
Every time you sneeze, cough, eat or even merely breathe out, you're expelling a cloud of potentially infected respiratory droplets that could spread the virus to anyone nearby. A mask physically blocks that cloud, keeping those droplets from getting out into the air.
What to wear and how it fits
"The most important feature of the mask is that it fits your face very well, with not a lot of gaps on the side or bottom," says Glucoft. "For me, for example, some cloth masks tend not to fit my face, so I have had to shop around to find a mask that fits."
After a good fit, the next most important thing to look for in a mask is breathability. An additional layer could add more protection, but at a certain point, you're not going to be able to breathe comfortably and are less likely to wear a mask at all. The CDC recommends a minimum of two layers, however, if you're relying on homemade cloth masks.
The most effective mask for COVID-19 that is generally recommended for health care workers is the N95 medical-grade respirator. An N95 label signifies that the National Institute for Occupational Safety and Health, or NIOSH, has tested and certified a product and found that it can filter out 95% of particles sized between 0.1 and 0.3 microns. (The COVID-19 virus is about 0.12 microns big, and always comes attached to a larger particle, so it does get filtered out—ignore the social-media posts that claim otherwise.) The CDC website publishes a list of NIOSH-approved N95s. Because of the rise of counterfeiting, it's always a good idea to check up on the source of your masks.
Additional NIOSH ratings for respirators include P95 and R95, which are just as effective at filtering as N95 products but provide additional protection against oil-based particles, which isn't an issue when it comes to coronavirus. Those designations are geared toward industrial, not medical use. Just don't buy anything with exhalation valves, which do nothing to filter the air you breathe out. (Remember, masks help prevent the spread to the people around you.)
You'll also notice that some products are called "respirators" and some are called "masks." The difference is that respirators are a regulated standard for a face covering that's expected to form a tight seal around the face, while masks are looser-fitting. For most people, it's perfectly fine to wear masks.
"The Catch-22 about N95s is that they need to fit your face, and when they fit your face very well, they're pretty uncomfortable to wear all day," Glucoft says. "And because they filter so well, it can get harder to breathe over time."
Making N95s even more troublesome to use are the chronic supply shortfalls, which have made them scarce even for medical professionals around the country. To fill that gap, masks that have met standards in other countries have flooded the U.S. market, like FFP2s, which are roughly the European counterpart to the N95. By far, the most commonly available are KN95 masks, certified by the Chinese equivalent of NIOSH, which are supposed to be as effective as NIOSH N95 masks—on paper. Unfortunately, a lot of KN95s on the market have proven to be fraudulent or simply less effective than promised.
"Use them with caution," Glucoft says. "They're perfectly fine for protecting others, but I wouldn't put all your eggs in one basket wearing a KN95."
Though they aren't as effective as N95s for filtration, surgical masks—those rectangular disposable masks you used to most commonly see on hospital staff—are perfectly good, and much easier to find. They're a nice balance between fit and comfort.
"I think the best kind of mask in general is a medical-grade surgical mask, which they do make in children's sizes," Glucoft says.
Disposable masks of any sort with adjustable nose wires will provide a better fit than those without. Mask braces worn over a mask can also help eliminate gaps that virus can leak through.
Manufacturers do not recommend you reuse any sort of disposable mask. Their effectiveness has been tested on the assumption that they're being thrown away after each use, and they will lose their tight fit and breathability as time goes on.
Instead of disposable surgical masks, many people wear reusable cloth masks, which provide less filtration than the certified medical-grade masks but are still an acceptable and affordable alternative. The benefit of cloth masks is that you can simply throw them in your wash with regular detergent and reuse them for as long as they fit your face well.
Regardless of whether your cloth masks are store-bought or homemade, ensure that they have a tight fit that doesn't leave much in the way of gaps, especially at the sides, and that they have at least two layers of cloth. You might also want to buy or sew masks with a filter pocket, so that you can insert a filter for another layer of protection. The CDC website provides instructions for sewing your own masks.
Many people use neck gaiters, which generally fit tightly but only have one layer of cloth. Glucoft suggests using them only as a secondary layer over another mask.
How to wear and care for your masks
At a minimum, your mask should fully cover your mouth and nostrils. Whether it's secured with ear or neck loops, make sure it's tight enough against your face to avoid gaps around the edges—common problem spots are on either side of the nose and at the bottom. If you wear glasses and find them fogging up, it means you need to tighten up the gaps at the top of your mask.
If you have facial hair, don't fret—as long as you're not expected to spend a lot of time in a high-risk health care setting. Though facial hair pushes the mask away from your face and makes a tight seal harder to achieve (as does heavy makeup), the level of protection you can achieve in most cases will still be OK for the purposes of general protection, Glucoft says.
Masks that get dirty or wet are less effective and harder to breathe through than clean, dry masks, so try to keep them that way as long as you can. Keep from touching, fidgeting with or readjusting your mask once it's on. Handle it only by the loops, not by the surface of the mask.
Use common sense and be prepared for days when you may need a spare ready. For example, if you know there's going to be a downpour, it makes sense to pack an extra mask in a Ziploc bag to pull out when your first one becomes waterlogged.
The data's still not in on whether double-masking helps cut down on COVID transmission rates, but medical leaders, including Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and the chief White House medical adviser, have given the practice the thumbs up. It's worth considering, as long as it doesn't make you less likely to mask up at all.
"If it makes it harder to breathe, it's not worth it, but if it makes your face mask fit better, I don't think there's any downside," Glucoft says.
Note that the CDC does not recommend doubling up with two disposable masks or combining N95 masks with other masks at all.
Masking and vaccines
Though COVID-19 vaccines have been approved and are being rolled out, it's important to continue to wear a mask even if you've been fully vaccinated, for several reasons.
"The best vaccines are 94 to 95% effective two weeks after the second dose," Glucoft says. "while this is high, we’re still dealing with a highly contagious disease and until enough people have been vaccinated and while infection rates remain high, there’s still a risk of contracting the disease.”
Even if you're one of the vast majority of people for whom the vaccine will work as intended, it's not clear how far its protection extends.
"We know the vaccine protects against symptomatic disease, but we don't know if you can still pass it on,” adds Glucoft. “We're not at the point yet where it's not a concern."
Finally, there are the quickly spreading COVID-19 variants that have been shown to be more contagious and may impact the efficacy of vaccines. Masks are the best protection against the spread of the new COVID-19 types, even for those who've been vaccinated.
"Until we have herd immunity we still need to wear masks, because we still don't know how fast or far these variants will spread," Glucoft says.
Continue to practice social distancing, wash your hands and avoid crowded indoor spaces. Don't be lulled into thinking you're invulnerable to COVID-19 or can't pass it on to other people just because you're masked up.
The government and scientific experts may change their recommendations as they learn more about the coronavirus or as it spreads, recedes or mutates. Glucoft advises you to keep up with the guidelines put out by your local health department, which will tailor recommendations to the realities of your area.