Which Facial Covering is Better? Experts on the Best Options

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With the distribution of the COVID-19 vaccines slowly underway, the number of SARS-CoV-2 infection cases is finally on the decline, which comes as welcome news after the record high spikes at the beginning of January. But even with the vaccine rollout, experts are still urging the importance of masks — and in some cases, as Dr. Anthony S. Fauci said this week, double masks.

But between the KN95, the N95, surgical masks, and cloth masks, it can be overwhelming to decipher the best option and for whom. We reached out to several medical experts who shed light on the benefits and differences between various masks.

Though there are many different options to choose from, according to an article in the medical journal Science Advances, the latest reports are that fitted, non-valved N95 masks are the best for the highest level of protection.

But what is the difference between an N95 and a KN95 mask?

The biggest benefit to the N95 or the KN95 masks is that they filter 95 percent of aerosol particulates. Both masks are made from several synthetic material layers and are intended to be worn over the mouth and nose. By wearing the mask properly, they both filter out 95 percent of aerosol particles that could potentially be carrying the novel coronavirus.

However, the difference is that only the N95 has been approved by the National Institute for Occupational Safety and Health (NIOSH), the U.S. organization responsible for regulating masks.

"The KN95 has not been approved by NIOSH," said Dr. Ting Ting Wong, internist and infectious disease specialist at NewYork-Presbyterian Medical Group Brooklyn. "It has been approved in other countries, namely China. [The United States] has a very rigorous approval process. The mask has not gone through it yet."

In September 2020, ECRI reviewed KN95 masks and found that nearly 70 percent of those produced in China did not meet the NIOSH filtering requirements.

"As a result, it's vital to ask where the mask is manufactured to be more certain about personal risk, as well as the experience of other hospitals and providers with the mask," said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York. "That said, even KN95s that do not meet U.S. standards for filtering efficiency might still provide better protection against COVID-19 than a surgical or cloth mask."

However, it is vitally important to note that neither mask is effective unless worn properly.

"What's important to realize is that it's the tight-fitting seal on your face that gives the N95 superior protection, other than the actual high quality filtering properties of the mask itself," said Glatter. "This is vital for healthcare workers and others who may have close contact with confirmed COVID-19 patients or those at risk."

If you don't have access to an N95 or KN95, a surgical mask is the next best option. However, the latest from Fauci is that it may be best to double mask surgical masks to increase their effectiveness.

According to the Centers for Disease Control and Prevention (CDC), there are several key differences between surgical masks and N95 masks:

"I think surgical masks are highly effective," said Wong. "I agree with Dr. Fauci's recent comments about double masking. I am reserved to use cloth masks because there are many different kinds of cloth out there. For the general public, a surgical mask is fine."

The last option would be cloth masks. Cloth masks are not tested or regulated, and each type of cloth has a different level of filtration.

That said, a cloth mask is preferred over no mask at all. But to have the maximum amount of protection and filtration, a doubled-up surgical mask or a properly worn N95/KN95 is preferred.

"Cloth masks are the most permeable and offer the least protection, but are better than no mask at all," added Dr. Eric Cioe-Pena, director of global health at Northwell Health in New Hyde Park, New York. "I have often said that the best mask is the one people are going to wear at all times when out of the home. A KN95 is not better than a surgical mask when you keep taking it off."