RI mask mandate: What experts say about which masks to wear

Rhode Islanders are preparing to pull up their masks once again amid new rules from Gov. Dan McKee in an effort to stop the surge of COVID-19 cases.

Starting Monday, large venues must require masks while small businesses can choose between masks or proof of vaccination.

With a multitude of face coverings on the market, what offers the best protection? Here's expert advice from two infectious disease specialists; the Department of Health's Dr. Philip Chan and The Miriam Hospital's Dr. John Lonks:

Earlier this year, skepticism emerged over the effectiveness of cloth masks versus surgical masks when some news outlets cited a study from Bangladesh involving researchers from Yale and Stanford. The study suggested that a surgical mask provides a stronger barrier against the virus than cloth — a point Chan echoed.

The hierarchy of mask protection, in Chan's description, goes like this: N95s at the top followed by KN95s, KF94s — both of which are seen as similar to N95s — then surgical masks, followed by cloth masks, which Chan said "aren't quite as good" as the superior options.

However, Chan acknowledged supply chain issues with N95 masks, urging the public to look toward KN95s and KF94s.

If you opt for a cloth mask, which Chan referred to as "OK protection," placing it over a surgical mask is ideal, particularly indoors.

Lonks feels that cloth masks remain a suitable choice, though he emphasized the importance of two layers of material.

"The answer is it offers protection both ways. It has some protection when you breathe in to not get yourself infected," Lonks said, adding that it also prevents infected people from shedding as much of the virus as they would without masking up.

The CDC, in its research, has determined that while respirators and medical masks generally provide better filtration than cloth, "cloth masks may provide some protection if well designed and used correctly."

"Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection," the agency's guidance says.

Masks with valves are a no-no.

"The recommendation is not to use any mask that has a valve in it," Lonks said. "Some of the masks that have valves are made for industrial use, where you're protecting yourself from breathing in some kind of environmental dust or particle, but when you breathe out, the valve allows everything out of your respiratory tract to go out unblocked."

Chan said valved and vented masks "actually spew out respiratory droplets," thus putting others at increased risk.

Other options to avoid, according to Chan, are bandannas, gaiters, scarves, ski masks and face shields used without a mask underneath.

First, you might not have to look. The state has decided it will begin giving out 100,000 KN95 masks per week because of the omicron variant's transmissibility. Health Department spokesman Joseph Wendelken said the state is partnering with "dozens of community organizations, libraries, Catholic social services, Refugee Center, Liberian Community Center, Boys and Girls Club, Thundermist, etc." to distribute the masks.

However, opinions on the necessity of such heavy-duty protection are varied. For the average person not in a health-care setting, Lonks said KN95s and N95s are not needed for everyday use.

Chan believes that both the KF95, the Chinese version of the N95, or the KF94, the Korean version, are fine for public use.

For those looking to buy online, beware of fakes. Phony KN95s, which have been treated as an alternative to N95s, have run rampant, even being sold on Amazon. According to the CDC, about 60% of KN95s in the U.S. are bogus.

To check if yours is the real deal, consult the CDC's list of signs of counterfeit respirators. Note the lack of any markings, the absence of National Institute for Occupational Safety and Health markings, or the misspelling of the institute's name. All are red flags. Also check the CDC's online list of tested products and their filtration efficiency.

Those who find themselves in possession of counterfeit masks can contact Customs and Border Patrol online through the e-Allegations Online Trade Violation Reporting System or call 1-800-BE-ALERT.

When in doubt, Chan recommends trusting your gut.

"You want to just make sure that the website looks legitimate and passes that look test," he said. "You want to make sure that there's no broken links, misspelled domains, other things."

Keep an eye out also for ultra-low prices and words like "genuine" or "real," Chan said. Overselling a product as authentic is a warning sign.

Whatever you choose, make sure you keep it clean. Cloth masks should be washed once a day and disposable masks should be thrown out after a day of use, Lonks and Chan said.

For those traveling during the holidays, Lonks said a typical mask will do, though Chan would opt for a mask with high protection, such as KN95s and KF94s.

"Those really are the best masks, and the material in those masks is designed to filter out the virus as you breathe in," Chan said.

Aside from covering your face, try to maintain as much distance as you can.

"Most airports [have] very high ceilings, lots of air and other stuff," Lonks said. "It's not like it's a small, enclosed space. So it's mostly you’re distancing [from] other people."

If you're flying, Lonks has another reassuring message.

"Once the airplane is flying at full speed, you have very good air exchange and air flow inside the airplane," he said.

Cases in R.I.: 207,556 (1,199 reported Thursday)

Negative tests in R.I.: 6,114,750 (18,468 reported Thursday; 6.1% positive rate)

R.I. COVID-related deaths: 2,985 (5 reported Thursday)

Rhode Islanders hospitalized with COVID: 261 (41 in intensive care)

Fully vaccinated in R.I.: 789,670 (875,255 at least partially vaccinated)

Cases in Mass.: 991,709

Mass. COVID-related deaths: 19,753

Cases in U.S.: 50,446,051

U.S. COVID-related deaths: 803,093