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Sep 02, 2023

Which Masks Are Safest?

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There's a lot of information out there. Here's how to find the right face covering for you.

Your handmade face masks in every color and pattern under the sun may make for quirky accessories, but they should no longer be your go-to protective face coverings during the COVID-19 (coronavirus) pandemic, according to new guidance from the U.S. Centers for Disease Control and Prevention (CDC).

In a January 14 update to its mask guidance page, the CDC recommends the use of N95 or KN95 respirators over surgical masks or homemade cloth masks. The change comes amid a continuing surge of COVID-19 cases in the U.S. due to the highly contagious Omicron variant.

This aligns with a trend among some European countries last year, in which governments urged the use of medical-grade face coverings over DIY masks. About a year ago, Germany announced a public mandate that required the use of an N95 or a surgical mask while visiting the grocery store or using public transportation. In France, the government urged citizens to swap their hand-sewn face coverings for single-use surgical masks.

But should you really toss your stash of handmade face coverings and opt for only medical-grade equipment?

We looked through the latest medical research to evaluate some of the most popular masks out there. From silk scarves to neck gaiters, and cloth masks to KN95s, these are the safest masks you can wear to protect yourself from the Omicron variant of COVID-19.

Long worn by doctors, nurses, and other medical professionals, the single-use surgical face mask has been a mainstay in public health for at least the last six decades.

According to the U.S. Food and Drug Administration (FDA), a surgical mask is defined as a "loose-fitting, disposable device that creates a barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment." These masks are often referred to generically as "face masks," but they're actually subject to specific regulations that homemade cloth masks aren't.

Surgical masks come in various thicknesses—some are three-ply, for example, while others are four-ply—which impacts their ability to protect you from splashes, sprays, large-particle droplets, or splatters that may contain viruses or bacteria.

An unsung hero of the surgical mask is the metal prong tucked into the seam at the bridge of the nose. You can manipulate the small wire to get the best seal possible along your nose and cheeks—a feature that's notably missing among most cloth face masks, although some DIYers have gotten crafty and added one in.

Still, these face masks aren't effective in blocking very small particles in the air that may be transmitted through coughs or sneezes due to the relatively loose fit of the mask to your face. That's why some researchers suggest double-masking for more safety (you could also use a mask brace to achieve the optimum fit).

In an extensive review of various face masks published in September 2020 in the journal Science Advances, researchers from Duke University found surgical face masks are the second-best option to protect yourself, coming in just behind N95 masks, which are considered the gold standard.

The N95 respirator is considered the gold standard of face coverings in the medical world, and even in the construction industry. These face coverings diverge from the surgical mask in that the edges are designed to fit snugly to the face.

The FDA defines N95 respirators as a "protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles." Formerly, the U.S. Centers for Disease Control and Prevention did not recommend the public use N95s due to a shortage of medical equipment for frontline workers. This month, the CDC reversed that guidance, recommending the use of N95 or KN95 masks in lieu of homemade masks or surgical face coverings.

The Duke researchers found N95 respirators were most effective in filtering out particles. Those masks had a droplet transmission rate of less than 0.1 percent. However, this is with the caveat that N95s don't necessarily protect others around you if they use a valve.

💡 Tip: Beware of counterfeits. According to the CDC, counterfeit respirators are on the rise amid the COVID-19 pandemic. The organization keeps a running list of bunk products here.

Here are a few signs to tell if your respirator is a counterfeit:

"Furthermore, the performance of the valved N95 mask is likely affected by the exhalation valve, which opens for strong outwards airflow," the Duke scientists say. "While the valve does not compromise the protection of the wearer, it can decrease the protection of persons surrounding the wearer. In comparison, the performance of the fitted, non-valved N95 mask was far superior."

There are also various types of N95 respirators, so make sure the one you're using is rated for the performance you want. Some are defined as surgical, while others aren't (the CDC recommends that you skip the surgical-grade N95s so that health care professionals may use them). Some aren't fluid-resistant. All N95 masks should protect you from airborne particles, though, according to 3M, the manufacturer of most N95s in the U.S.

N95 masks can be notoriously expensive, though. To remove that cost barrier, the White House announced on Wednesday that it would distribute 400 million free N95 masks at "tens of thousands of local pharmacies" and thousands of community health centers.

Last February, scientists from Virginia Tech published research on the inward and outward effectiveness of cloth face masks, surgical masks, and face shields in the journal Aerosol Science and Technology.

The scientists found you don't, in fact, need to wear an N95 respirator and take personal protective equipment away from medical professionals in order to keep yourself safe. But according to their work, you do need to make a few considerations when choosing the right cloth mask.

Look for masks with three layers of filtering material. For the most effective filtration, you'll want to find a mask that has two woven layers of outside material with some sort of filtering material in the middle, whether that's a coffee filter, surgical mask, or vacuum bag.

Opt for a flexible material. Look for masks made of tightly woven material that will cling to your face. Otherwise, you'll have gaps. Bonus points if the mask has a metal prong at the nose, similar to a surgical mask.

Choose ties, not ear loops. You can better control the fit and contour of a mask if it's secured to your head with ties. Ear loops, by contrast, create a larger gap at the sides of your face. They can also hurt with long periods of use and cause headaches.

If you're not feeling secure in your homemade cloth mask, there's an easy solution: double up. While no two handmade face coverings are exactly the same, the least effective ones all have a few things in common: they're flimsy, feature gaps on the sides and at the top by the nose, and have a lack of extra filtering material inside.

With that in mind, the CDC updated its mask guidance last February to include recommendations on how to safely wear two masks at once, as well as how to wear a mask with a proper fit, to help quell the spread of COVID-19.

But does it work? February 2021 CDC research points to yes. The scientists found layering a cloth mask and a surgical mask can help reduce the transmission of SARS-CoV-2, the virus that causes COVID-19.

Once again, it all comes down to fit. In a research letter published last April in JAMA Internal Medicine, scientists at the University of North Carolina at Chapel Hill compared the filtration efficiency of commonly available masks "worn singly, doubled, or in combinations."

They found the best coverage came from wearing a neck gaiter or a bandana over a surgical mask. However, the results were not the same in the opposite scenario: wearing a surgical mask over a neck gaiter. That led the researchers to conclude the magic of double masking all comes down to a more snug fit.

But you shouldn't wear three masks, as the triple layer of fabric starts to make it difficult to breathe, according to Dr. Dave Hnida, the medical editor at CBSN Denver. In a January interview, he said if you don't mind extra layers of material over your mouth and nose, you can opt for a cloth mask that uses filtration inserts for extra protection, instead.

There are a lot of rules to consider here, so if you only remember one thing, make it this: any mask is better than no mask.

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💡 Tip: Beware of counterfeits. Look for masks with three layers of filtering material Opt for a flexible material. Choose ties, not ear loops.
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