Masking is something that isn’t going away. Pick a mask, or masks, that works best for you. What is the right one for you?
Last week I had a post about whether masking will become a normal part of life. Although we are unlikely to be permanently masking, we are likely to have recurrent situations in which they are needed. Mass vaccination will go a long way towards ending the current COVID pandemic but new concerns are now arising about variants which are more contagious or possibly more difficult to suppress via vaccines. In addition, the duration of immunity provided by vaccines is not known. COVID has made us more aware that viruses are a recurrent and persistent cause of serious illness and pandemics. Face masks are a vital part of avoiding respiratory viruses.
To pick the right mask for you, think of 3 F’s followed by cost:
I.Filtration, II.Fit, III.Feel, and IV.Price
Masks work by filtering particles so that they can neither be breathed in from or out to the environment. Maximum filtration is essential in some situations but not in others. Figure out how much filtration you need. As a rule of thumb, the stronger the filter, the more work is required to breathe through the filter.
- The N-95 Mask has a strong filter and traps 95% of very small particles including viruses in droplets and aerosols. The N-95 is in limited supply and is indicated for people, usually healthcare workers, who are most likely to be exposed to COVID.
- Other masks such as KN-95 are more easily available and also provide high filtration capacity. Look for “NIOSH” certification to assure a quality product since many products claiming to be N-95 or KN-95 are counterfeits/fake. KN-95s are especially appropriate for people with risk factors such as chronic illness, obesity, advanced age and/or frequent exposure to other people. For instance, if you ride on a bus, a KN-95 is a good choice. It is also appropriate for caregivers.
- Another alternative is double-masking, wearing two, one over the other. The CDC has very recently made a strong recommendation to double-mask because of increased filtration and better fit. The mask with the better filtering capacity should go on first. Double-masking is another way of providing protection when there is significant concern about exposure to the Corona virus.
- Disposable surgical masks provide some protection but do not provide a high level of filtration. They are useful for filtering drops of fluid such as when talking, coughing, and sneezing. They are not optimal when there is a high risk of exposure to the Corona virus. (Tip: if your surgical mask is loose, try tying knots in the ear loops to keep it taut.)
- Cloth masks provide some protection but do not provide a high level of filtration. They are good for lower risk situations. When I go out for an everyday outdoor activity I wear a cloth mask. In addition, I follow the 6 foot physical distancing rule of thumb and my conversations are no more than several minutes. I stay away from crowds.
Cloth masks are quite variable in quality. Double layering and denser fabrics improve filtration. Many cloth masks have pockets to insert HEPA (high efficiency particulate air) or PM2.5 filters. Shine a light through a cloth mask. Filtration is not strong if the light shines through.
No matter how well a mask filters, it isn’t effective if it doesn’t fit right. As a doctor, I am “fit tested” every year to make sure that I use the correct size N-95. A mask must fit you correctly to avoid droplets coming in or escaping without being filtered. This is true for any mask you use, including cloth ones. You don’t want gaps in the mask along the sides of your face where contaminated air can sneak in. The fit should be snug and provide a good seal around your nose and mouth. Some masks are especially designed for people with beards.
To make sure your mask fits you, do a “user seal check”. Put your hands over the mask to block the air moving through it, and exhale gently. You should not feel air coming out the side or up toward your eyes.
You are less likely to wear a mask if it doesn’t feel comfortable or makes breathing difficult. Some fabrics can cause irritation or discomfort. People with glasses need a mask that fits with their glasses. The straps need to be just right for you, not too tight nor too loose. A mask fitter, also known as a brace, can be placed outside the mask. For now, mask fitters are a bit harder to find but are being promoted. A fitter is designed to follow the natural contours of your face. it improves comfort and fit while decreasing the need to pull hard on the straps. (A bracket, which is placed inside a mask, is not the same as a fitter.) A nose wire adds comfort and also helps keep a mask firmly on the nose.
Lastly, pick a mask that you like.
High filtration masks such as the N-95 or KN 95 are expensive and not meant to use multiple times. Lower priced ones may be counterfeit. Surgical and disposable masks are meant to be used only once. Cloth masks are washable and reusable and can be more cost effective for daily use.
- Face shields provide added protection but are not adequate when used instead of a mask. Shields alone do not seal.
- Scarves, bandanas, “gaiters”, any loose single layer of cloth over the nose mouth and neck are generally discouraged now and are not approved for air travel.
- Masks with “vents” or “valves” are not recommended because they can cause droplet formation.
- A “frame or bracket”, worn under a mask, makes it easier to breath but the impact of frames on effectiveness is not clear.
This is my favorite casual mask, what’s yours?
PS: I’m here to support you. Be connected, stay strong.