Here’s how to make any mask work against the spread of COVID-19


ORLANDO, Florida – Omicron variant of COVID-19 is making people rethink how they protect themselves.

Some media reports tell people to ditch their sheet masks and go straight for N95 respirators.

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While the N95 is a gold standard that will offer the wearer more protection against COVID-19 than other face covers, some researchers say the mask that fits well and is comfortable for each individual to wear is best. – and that might not be the N95 for you.

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“There are several issues around the masks,” said Prof. Steven Luby of Stanford University, one of the main authors of a study on the effectiveness of masks. “One is their filtering quality and the other is their fit. So if they don’t fit very well, the quality of the filtering doesn’t matter.

Types of masks

U.S. health officials have also long told us that when a person wears a mask, they are protecting others rather than themselves, as the mask minimizes the particles expelled when that person coughs or sneezes.

The N95 respirator is highly regarded by the National Institute for Occupational Safety and Health for its performance in workplaces where workers are exposed to small particles or viruses. The N95 actually offers some protection to the wearer.

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At the start of the pandemic, concerns over PPE shortages led health officials to tell the public not to go out and buy face masks, and then use cloth masks or disposable surgical masks at the start of the pandemic. as they became more available, in order to keep stocks for healthcare workers.

Now they are no longer available, but they are not for everyone.

The Centers for Disease Control and Prevention says masks should not be worn:

  • If you have certain types of facial hair

  • If it is difficult to breathe

  • If it is wet or dirty

  • With other masks

Luby said there was not a lot of data at the moment on reusing an N95 mask, but points out that some healthcare professionals at the start of the pandemic were often only able to use one mask per day. due to supply issues, although guidelines required them to change masks with each new patient examined.

“You have a mask for the day and you wear it all day,” Luby said. “And you know, when you look at the amount of transmission that has taken place using this approach, very little. I mean, health workers who had good masks and practiced good hygiene had very low transmission, which tells me that we probably don’t need to change all the time. “

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NIOSH says it does not recommend that medical workers reuse N95s unless their facility implements crisis strategies. For the general public, NIOSH says people should follow the manufacturer’s instructions.

“N95 respirators cannot be washed. They should be discarded when they are dirty, damaged or difficult to breathe, ”a spokesperson for the agency said.

There is another type of mask called KN95 mask. Although it is similar to the N95, it is not the same.

“So the KN95 is made in China and aspires to have the same filtration efficiency, but they haven’t been certified by the US NIOSH,” Luby said. “And CDC has a site where they have tested several different brands, and some of them have met this standard, and some have not and so, so it is less clear when you buy them whether you have one that meets this high standard or not. And I think that’s something very difficult for consumers.

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NIOSH said KN95 masks are rated by an international standard and manufacturers can ask NIOSH to review them, but then they would be classified as N95 masks, not KN95.

The CDC also warns on its website that approximately 60% of KN95 masks sold in the United States are counterfeit and unapproved.

Disposable masks for medical (or surgical) procedures and fabric masks are more widely known and accessible to the general public. While not as effective as N95 or similar masks, they do provide protection when used in a community setting.

Luby, professor of infectious diseases, and his team conducted a Large-scale clinical trial of over 300,000 people in Bangladesh. Some of the subjects used fabric masks while the rest used surgical masks. His team found that people who wore surgical masks performed significantly better than people who wore cloth masks, even when cloth masks had multiple layers – 30% to 40% for cloth masks.

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“Unlike the 90% and more we would get from medical grade masks,” Luby said.

Even more surprisingly, Luby said surgical masks always performed better than cloth masks after being washed.

“What we found in Bangladesh was that we could wash them with detergent, wash them and dry them and people could wear them. Wear them for up to a month during the trial, ”Luby said. “And when you do that, when you get them wet, you lose some of the filtration efficiency, because some of it is based on the load of the spun polyester. But they still outperform even when washed, they still outperform cloth masks. “

Luby said the masks were hand washed with a detergent similar to laundry detergent.

However, Luby said the cloth masks still interrupt the symptoms of COVID-19.

“I’m not saying cloth masks are worthless, but rather we’ve received a strong signal on surgical masks,” Luby said.

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He also points out that fabric masks tend to fit some people better and, again, that fit can make a difference.

How to get a good fit on your mask

NIOSH researchers published a study in the American Journal of Infection Control in December on the effectiveness of masks and the prevention of the spread of infection.

A surgical mask with an added splint around the mask to improve the fit. (NIOSH)

The study focused on two areas that Luby said are important: filtration and fit.

The study concluded that a three-ply fabric mask over a medical mask (known as double masking) or the attachment of a medical mask provided the best protection against particles from respiratory systems, aside from N95. .

This again comes down to the importance of a properly fitted mask to prevent these particles from passing through.

The study offered several options to improve the fit of the surgical mask, including adding a splint to the mask, using flip flops for earrings, or tying the earrings. The study said crossing the earrings or putting a support under the mask did not increase performance.

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A side view of a mask with the earrings tied to improve the fit on a mannequin. (NIOSH)

“There is always a kind of open question of how much is wearing a mask – that people who have COVID now wear a mask and therefore we receive less transmission of COVID, compared to how much by wearing a mask I am protecting myself,” Luby said. “And for example, the N95 is really designed to protect caregivers. Yes, but if we put surgical masks on patients, we also know that for tuberculosis and other airborne illnesses it protects both healthcare workers and the community. So in a sense, when we put that in, are we trying to optimally reduce shedding, or are we trying to protect ourselves? And I suspect it’s a bit of both. And for the best fit, the more you force both inhale and exhale through the mask. And so that there are many more opportunities to stop particles. “

What about the filters?

“So the more you can put between the air and between the outside and the inside, the better. And so, multi-layer masks tend to outperform single-layer masks, including those with inserts, ”Luby said.

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If you want to stick with a cloth mask and don’t want to double the mask, the more layers the better. Some mask designs and designer retailers like Very Bradley have sold two-layer fabric masks that come with a PM.2 filter that you can insert between layers.

There isn’t enough actual data on the filters in the masks to determine if they are really that effective.

A study published last summer in the American Chemical Company Nano found using polypropylene filters could potentially provide protection, but more research is needed.

Polypropylene is the same material used to make N95 masks, and polypropylene filters are available for purchase.

The number of studies of masks as effective in warding off the disease continues to grow. the The EPA also has an efficacy study, and there is other studies published in the last six months. the CDC has the latest mask guidelines and choosing the right one on its website.

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While not all face coverings are created equal, Luby says what matters is that people wear a mask, more than the guy.

“I’d much rather they put on a cloth mask than put on a surgical mask or an N95 and say ‘it’s so uncomfortable’. Forget it,” and rip it off and go without a mask, “Luby said. “So I think people would protect themselves and their communities if they wore a mask. The better the mask, the more protected they are, the more their community is protected.”

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