COVID-19 Face Mask Guide – Types, When to Wear & Best Practices

About 35 states and the District of Columbia mandated the use of masks or face coverings in indoor public spaces (and in some cases, certain outdoor spaces) as of March 2021. Hundreds of counties and cities, including many major population centers in places without statewide mask mandates, also require masks or face coverings in some or all indoor public spaces.

With so much to keep straight amid the still-raging COVID-19 pandemic, it’s vital that all of us learn the key differences between common types of medical and nonmedical face coverings and masks, when to wear (and not wear) them, and best practices for mask usage.

Why You Should Wear a Face Mask

The reason for public mask-wearing mandates is abundantly clear. Months after hard-hit countries in Asia got their pandemics more or less under control, the virus responsible for COVID-19 disease remains rampant in many parts of the United States. Indeed, the country is in the throes of a nasty second wave of the pandemic whose human and economic toll could dwarf that of the first.

Medical masks protect wearers and those around them. But even nonmedical masks and face coverings can reduce the spread of respiratory droplets and aerosols capable of carrying pathogens like SARS-CoV-2, the virus that causes COVID-19.

While there is significant evidence that nonmedical masks and face coverings dampen the spread of infectious respiratory disease, the evidence they reduce infection risk for the wearer is not as strong. Nevertheless, wearing a nonmedical mask in public is more about protecting others than protecting yourself. It’s a sign you care about your fellow community members’ well-being, particularly those in populations at high risk of developing severe complications from COVID-19.

This is all the more true amid growing evidence that newer strains of SARS-CoV-2 are more transmissible than the original. Indeed, public health authorities like Dr. Anthony Fauci, President Biden’s chief medical adviser, now recommend double-masking — ideally, with a NIOSH N95 respirator or CDC-approved non-NIOSH KN-95 respirator covered by a multilayer nonmedical mask.

These same authorities no longer recommend face coverings once believed to be adequate, including neck gaiters and single-layer cloth masks. The CDC now advises doubling up single-layer coverings. And research suggests face shields are not protective by themselves, but they may provide some protection when paired with adequate masks.

Common Mask Types for Reducing the Spread of Respiratory Droplets

The most common types of masks and face coverings include nonmedical cloth masks, melt-blown surgical masks, and disposable respirators (which some people call “dust masks”). Multiple subtypes and configurations exist within each broad category, each with its own wearing instructions and protective power.

All types of masks and face coverings on this list are designed to reduce the spread of larger respiratory droplets — larger particles emitted when the wearer coughs, sneezes, speaks, or raises their voice.

According to the Food and Drug Administration (FDA), some, such as medical-grade N95 masks, provide two-way protection — for the wearer and those around them — against larger droplets and smaller respiratory aerosols. That’s crucial because smaller respiratory aerosols can remain airborne for minutes. Surgical masks provide two-way protection against droplets but not smaller aerosols.

Nonmedical cloth masks and face coverings are not necessarily designed to meaningfully protect the wearer, per the Centers for Disease Control and Prevention (CDC). They might, however. A June 2020 study in The Lancet found that high-quality face coverings can significantly reduce the wearer’s risk of infection when combined with other infection-control measures, such as social distancing.

The CDC notes that even face coverings that don’t confer medical-grade protection on the wearer do protect those around them by reducing their droplets’ volume and velocity, which in turn can reduce the number and rate of infections in the broader community.

However, with more-transmissible strains of SARS-CoV-2 now prevalent in the United States and medical-grade masks more widely available, health authorities recommend wearing two face coverings — an N95 or KN-95 covered by a double-layered or melt-blown nonmedical mask — for adequate two-way protection.

Cloth Masks & Face Coverings

Reusable cloth masks and other double-layered or melt-blown face coverings reduce the spread of larger respiratory droplets, which can contain high loads of harmful pathogens like the virus responsible for COVID-19, from the wearer’s mouth and nose.

These masks aren’t as effective at reducing the spread of smaller aerosol particles, which remain airborne for longer under normal conditions and can contain smaller (but still infectious) pathogen loads. They’re not indicated to protect the wearer from inhaled droplets or aerosols.

However, the aforementioned study suggests that they may provide some level of protection in conjunction with other preventative measures, such as social distancing and eye protection (such as face shields or protective goggles that keep potentially infectious droplets and aerosols away from wearers’ eyes).

Generally speaking, thicker fabrics make better face coverings. You can get a general sense of a particular fabric’s protective ability by holding a sample up to a bright light. The less light or translucence you can see coming through, the more protective the fabric is likely to be. Common materials for cloth face coverings include:

Denim
Flannel
High-thread-count cotton
Batik fabric
Canvas

Because breathability is a concern for many wearers, natural fibers (such as cotton and cotton derivatives like denim) often work better than synthetic fibers. Again, look for masks with at least two layers of fabric. Single-ply masks do not provide adequate protection in either direction.

Cloth masks and face coverings come in a variety of configurations. Most fit flat against the face, have flexible folds that allow them to stretch and create some internal airspace, or have rigid protrusions around the wearer’s nose for increased comfort. Folding and protruding masks tend to be more comfortable and may fit more snugly.

Some cloth masks have thin metal strips (nose wires) along the bridge of the nose to improve fit and keep wearers’ glasses from fogging. You can purchase adhesive nose wires separately. A 100-pack retails for less than $10 on Amazon, though pricing is volatile.

Most cloth masks and face coverings secure to the wearer’s face in one of two ways: dual earloops tucked behind the wearer’s ears or dual ties secured behind the wearer’s head and neck. If you prefer the former, look for masks with adjustable earloops, which can be more comfortable and tend to fit more snugly.

Many premade cloth masks have internal pockets where the wearer can place a removable particulate filter. It’s relatively easy to make your own mask with space for a removable filter as well.

In either case, look for PM2.5 filters capable of filtering aerosol particles as small as 2.5 microns (most respiratory aerosols encountered in health care settings are larger than 2 microns, according to a 2013 article in the medical journal Virulence) or static-charged polypropylene inserts that can double filtration capacity. A 20-pack of PM2.5 filters retails for around $5 on Amazon. Always remember to remove particulate filters before washing your mask — a single wash cycle is more than enough to destroy a filter.

Some premade cloth masks come with front-facing vents that make it easier for the wearer to breathe freely (or feel as if they can breathe freely). Avoid these masks, as the vents actively counter the covering’s primary purpose: protecting others from potentially infectious respiratory droplets.

DIY Cloth Masks & Face Coverings

Cost: Minimal when made from materials already on hand

You can make the most affordable and easy-to-obtain cloth mask or face covering at home. DIY masks and face coverings come in more than a dozen varieties — limited only by your imagination and fabrication ability. But remember: Your DIY masks and face coverings must have at least two layers, and the best DIY masks have pockets for PM2.5 filters (purchased separately) for added droplet protection.

The simplest “no-sew” masks and coverings require only scissors, measuring tape, pen or pencil (for marking measurements), and common fabrics you almost certainly have lying around the house, such as:

Old jeans
Old flannel shirts
Thick cotton sheets and pillowcases
Heavy cotton shirts
Quilting cotton
Canvas bags

Professionally Manufactured Cloth Masks & Face Coverings

Cost: $1 and up for a lighter-duty one-piece covering

If you lack the time or think you lack the creativity to make your own face covering, buy a double-layered nonmedical cloth covering instead. They’re more affordable than you might imagine too.

Attractive masks with patterned coverings start around $5 for one double-layered mask (Etsy’s selection is representative, and Maloja offers good value when buying in bulk). Personalized coverings cost more — expect to pay $20 or more for a specially made number.

You’ll also pay a premium for masks with pocket filters — figure $10 for a double-layered filter mask, double what you might pay for an unfiltered equivalent — and for specialized masks appropriate for contact sports and other intense activities, like the Shock Doctor Play Safe Mask.

Surgical Masks

Cost: Variable, but generally well under $1 per mask when purchased in bulk

Surgical masks (also known as procedural masks) are disposable masks made from lightweight fabric that’s melted and blown rather than woven, to reduce porosity. They affix to the wearer’s face via earloops or elastic straps that encircle the head.

Unlike cloth masks, which are increasingly fashion-forward, surgical masks are no one’s idea of fashionable. Most are solid blue, white, or green. Their shape completely covers the wearer’s mouth, nose, and chin from ear to ear, and they have folds to accommodate wider faces and beards. Properly worn surgical masks fit snugly but not tightly against the wearer’s face.

Surgical masks provide two-way protection against the spread of potentially virus-laden droplets produced by sneezing, coughing, and talking. They don’t provide meaningful protection from smaller aerosols.

Though they were in short supply during the early stages of the pandemic, surgical masks are now widely available and not particularly expensive. They’re ideal for lower-risk members of the general population without the time or patience to wash reusable cloth masks. They’re also readily available in bulk. A 50-pack of flat masks from Necano retails at about $20 at Walmart.

Disposable Respirators

Cost: Variable but generally less than $5 per mask (and significantly less when purchased in bulk)

The type of disposable, usually white mask many Americans know as a “dust mask” is a type of disposable respirator designed to protect the wearer from inhaling tiny particles, including respiratory aerosols. Quality disposable respirators are approved by the National Institute for Occupational Safety and Health (NIOSH) and rated to filter at least 95% of particles as small as 2.5 microns, — so they provide significant two-way protection.

Because they look similar, it’s important to distinguish between nonrespirator dust masks and proper disposable respirators that filter at least 95% of PM2.5 particles. Nonrespirator dust masks protect the wearer from larger particles but don’t confer meaningful protection against inhaled aerosols. When scouting disposable respirators, look for the NIOSH logo and a filtration rating of at least 95%.

Disposable respirators come in two main shapes: rounded (bulbous) and conical. Bulbous masks curve smoothly around the wearer’s mouth and nose, while conical masks reach an apex at the median of the wearer’s face (in line with the tip of the nose). Both fit snugly to the sides of the face, but conical masks can achieve some separation from the wearer’s mouth and nose, which some wearers find more comfortable. Both bulbous and conical masks have comparable protective abilities, assuming their filtration ratings are equal.

Disposable respirators’ filtration ratings use an alphanumeric scale. “N” masks protect against dry particles and water-based droplets and aerosols only. “P” masks also protect against oil-based particles. Two- or three-digit numbers denote masks’ filtration capabilities.

N95 masks, the cheapest and most common type of high-grade disposable respirator, filter 95% of non-oil-based PM2.5 particles. CDC-approved KN-95 masks, the Chinese-made equivalent of the N95, provide comparable protection. N99 and N100 masks filter 99% and 99.7% of non-oil-based PM2.5 particles, respectively.

During periods of high demand, N95 (and higher) masks are appropriate for higher-risk segments of the population and anyone in high-risk situations, such as health care workers and customer-facing employees in indoor places where high numbers of people congregate for relatively long periods, such as bars and movie theaters

However, N95 and KN-95 masks have become more plentiful since the start of the pandemic, as manufacturers ramp up production. Due to the ongoing potential for supply shortages, N and P99 and 100 respirators remain inappropriate for use outside healthcare settings. It’s best to leave these highly specialized devices for health care workers whose degree and duration of likely SARS-CoV-2 exposure elevates the risk of serious illness or complications.

N95 and higher masks also provide the wearer with meaningful protection against various other inhaled hazards, such as particulate pollution, wildfire smoke, dust from construction, demolition, and agricultural or horticultural activity. They’re useful in a variety of situations not related to infectious respiratory disease.

N95 masks cost significantly more than surgical masks, so they’re best purchased in bulk and used in higher-risk situations only. Chinese-made N95s, known as non-NIOSH KN95s, are more abundant and affordable. A 10-pack of COVAFLU conical KN-95 masks retails for about $20 on Amazon, for example. But KN95s aren’t always guaranteed by U.S. quality control authorities to provide 95% wearer protection or better, so you may wish to spend more for peace of mind.

For more information about approved KN95 masks, refer to FDA Appendix A: Authorized Respirators, Non-NIOSH Respirators Manufactured in China.

When to Wear a Mask

Guidelines published by the CDC recommend that most adults and children over the age of 2 wear cloth face coverings in public settings and other circumstances in which maintaining distance from people you don’t live with is impossible.

Asymptomatic Adults & Children in Indoor Public Spaces

Given the efficiency with which SARS-CoV-2 spreads in climate-controlled indoor environments, this is where wearing a mask or face covering does the greatest good.

Even if it’s not required by law, adults and children over age 2 should always wear face coverings in public indoor spaces like grocery stores, warehouse stores, malls, restaurants, bars, offices and coworking spaces, medical clinics and hospitals, public transportation, and any other spaces occupied by members of the general public. Masks are required on public transportation in the United States, including intercity trains and airplanes.

Asymptomatic Adults & Children in Outdoor Spaces Where Social Distancing Is Not Possible

Evidence suggests the virus responsible for COVID-19 does not spread efficiently in typical outdoor settings. That said, outdoor transmission is undoubtedly possible, especially in urban areas with high levels of fine particulate pollution and low wind, according to a June 2020 study published in PNAS.

Outdoor transmission is also more likely in crowded environments such as city parks, pools, beaches, boardwalks, outdoor malls, alfresco eating and drinking establishments, backyard gatherings and block parties, and demonstrations. When maintaining 6 feet of distance from people you don’t live with is not possible, wear a mask.

Asymptomatic Adults & Children in Indoor Private Spaces With People Other Than Household Members

Awkward as it might feel at that first “masks-on” game night, it’s the right thing to do for guests and hosts alike. Mask up whenever you’re in close contact with people you don’t live with indoors, even in private residences.

Adults With Symptoms, Confirmed Positive Cases, or Probable Exposure

If you’re experiencing COVID-19 symptoms, have a confirmed positive case regardless of symptoms, or have been in close contact with a known positive case, avoid venturing out in public at all.

At home, wear a mask whenever you can’t maintain your distance from other household members. That includes your pets. There’s some evidence humans can infect certain animals, including cats and dogs, according to the CDC.

Caregivers of Those With COVID-19

Wear a protective mask, such as an N95 respirator, when caring for someone with a confirmed or probable COVID-19 infection.

When Not to Wear a Mask

Mask usage isn’t necessary in private homes where only members of the same household are present and when the risk of respiratory droplet transmission is otherwise low.

And the CDC actively advises against mask usage (or recommends modified mask usage) for certain population groups, including very young children, those with certain respiratory issues, and those with certain other health conditions or disabilities. That includes:

Children Under Age 2. Masks can restrict breathing or present choking hazards for very young children as well, per Children’s Hospital of the King’s Daughters (CHKD), a North Carolina health care system.
People With Hearing Impairment. People who need to read lips to communicate effectively should consider clear face coverings (such as plastic face shields) and may wish to encourage family members and close friends to do the same in settings where mask usage would typically be appropriate. Bear in mind the jury is still out on the protective benefits of face shields — one reason, in addition to their expense and relative scarcity, the CDC does not recommend their use in the general population.
People With Intellectual or Developmental Disabilities. The CDC recommends that people with any intellectual, developmental, or sensory disabilities (or their caregivers) consult their health care providers for guidance on mask-wearing.
Younger Children. Some types of mask can present suffocation risks for younger children, according to CHKD. Talk to your pediatrician about the best masks for kids.
Swimmers and Bathers. Masks and face coverings are less effective and can actively impair breathing when wet.
High-Intensity Exercisers. Though many states mandate masks in public gyms and many gyms require masks even when they have leeway not to, certain types of masks can impede breathing or otherwise cause discomfort during high-intensity exercise. If you can’t comfortably wear a mask during your workout, take it outside or to nonpublic indoor spaces (such as your home exercise bike or treadmill) whenever possible.
Certain Workers. Mask-wearing can trigger breathing problems in workers in very hot work environments, per the CDC. In certain other work environments, such as factory floors where dangerous machinery is present, masks can pose unacceptable safety risks.

Best Practices for Wearing Masks

Widespread mask-wearing reduces the spread of respiratory droplets and aerosols that can contain harmful pathogens like the virus responsible for COVID-19 — if those wearing masks follow certain best practices recommended by the CDC and other public health authorities.

Don’t Hoard Protective Equipment Meant for Health Care Workers & Other High-Risk Individuals

Unless you’re a health care worker or member of a high-risk group following guidance from your health care provider, don’t hoard high-grade protective equipment meant for clinical or other high-risk settings — that is, respirators with filtering capabilities of 99% or higher. Health care providers need high-grade equipment to work safely and remain healthy. Widespread availability of such equipment ensures hospitals and clinics can provide care to every patient who needs it.

If you already own high-grade disposable respirators, perhaps left over from a DIY home improvement project, consider donating them (if they’re still in the original packaging) or using them yourself until you exhaust your supply.

Put on & Remove the Mask Properly

Follow CDC guidance for safely putting on and taking off face coverings. Always wash your hands before handling your mask, using hand sanitizer only if soap and water aren’t available. Handle the mask only by the strings or loops, fold the mask when not in use, and avoid touching your mouth, nose, eyes, or face after handling (until you’ve rewashed your hands).

Always Cover Your Nose

Masks and face coverings are far less effective when worn over the mouth only. Resist the urge to pull down your mask below your nose or all the way down below your chin when speaking.

Fit the Mask Snugly to the Sides & Top of Your Face

Try to reduce the gap between your mask and the sides of your face, if any, without deforming or ripping the fabric. It’s easier to do with tie and adjustable earloop masks, so if you’re consistently failing to get the fit you’d like, consider switching.

Keep at Least 1 Spare Mask in Your Car or Bag

Always keep a spare mask or covering in your car (or bag if you live without a car or commute by bike). That way, you have no excuse not to wear one indoors, won’t be turned away from businesses that require masks, and won’t find yourself on the wrong side of a local mask mandate.

Keep Your Mask on Until You’re Home

Tempting as it is to take off your mask once you’re in the solitude of your car, resist the urge and keep it on until you’ve returned home and washed your hands. That’s the surest way to reduce the risk of cross-contamination (and potential infection) as you remove the mask.

Don’t forget to wash your hands after removing and handling the mask to reduce infection risk further.

Clean Reusable Masks After Every Use

Clean your reusable cloth mask or face covering every day if you use it — ideally after every use, though that might not be possible on active days.

Follow the CDC’s detailed cleaning guidelines. When machine washing, use the highest appropriate temperature setting on your washing machine and dry on high heat until completely dry or leave out to air-dry (in direct sunlight, if possible). If washing by hand, use four teaspoons of bleach to 1 quart of water, let it soak for five minutes, and rinse thoroughly with cool or room-temperature water.

Know When to Dispose of Used Masks

No mask or face covering lasts forever. For reusable cloth masks, periodically perform the “light test” — holding the mask up to a bright light — and discard it once it’s visibly worn or threadbare. Discard disposable respirators, such as N95 dust masks, after eight to 10 hours of public use.

Follow CDC guidelines for mask use and disposal in situations when you’re likely to come into contact with infectious droplets, aerosols, or bodily fluids.

Always Follow Social Distancing & Self-Isolation Guidelines

When worn correctly, masks and face coverings reduce the spread of droplets and aerosols, and some provide real protection for the wearer. But they’re not perfect, so don’t use them to justify risky behavior. Whether you’re masked or not, follow social distancing best practices The CDC recommends staying at least 6 feet away from others and limiting face-to-face contact in general.

And if you’re experiencing any COVID-19 symptoms, have tested positive for the disease, or know you’ve been exposed to a positive case, remain isolated at home until a medical professional clears you to reengage with the community.

Final Word

Multiple rounds of coronavirus-related economic stimulus notwithstanding, few of us can afford to stay at home and away from anyone other than members of our immediate families indefinitely.

Wearing a mask or cloth face covering is a much easier — and surprisingly low-cost — way to slow the spread of the virus responsible for COVID-19 while allowing for some semblance of normal life to return. Likelier than not, mask-wearing is already mandatory in your area or required by businesses you patronize regularly. Even if not, why not do your part to set a trend that literally saves lives?

Published at Wed, 10 Mar 2021 14:00:53 +0000