This article is based on reporting that features expert sources.
Do Face Masks Work?
HEALTH CARE WORKERS clearly need face masks to protect themselves and their patients from the new coronavirus. The public might also benefit from wearing masks during the COVID-19 pandemic.
If you’re wondering whether to wear a face mask to protect yourself – assuming you have access when supplies are so scarce – here’s what to consider:
- Which type of face mask is most effective?
- How do you wear and dispose of your mask?
- What are current recommendations from the Centers for Disease Control and Prevention on mask use for the public?
Types of Masks
Face-protection options range from hospital-grade surgical masks and respirators to makeshift face coverings like bandannas.
Surgical masks and N95 respirators, often simply called respirators, are regulated by the Food and Drug Administration (with some collaboration with the National Institute for Occupational Health and Safety on respirators). Both types of masks are tested (to be cleared for marketing) for fluid resistance, filtration efficiency, flammability and biocompatibility. N95 respirators offer more protection for health care workers performing medical procedures that expose them to patients’ respiratory secretions, such as placing a tube to open a patient’s airway.
Flat, rectangular surgical face masks are made of thin, paper-like material. The mask fits loosely around your nose, mouth and chin. Surgical masks are disposable and not designed to be used more than once.
If properly worn, surgical masks block large-particle droplets, splashes, sprays or splatters that may contain germs like viruses and prevent them from reaching your mouth and nose, according to the FDA. In addition, surgical masks may reduce exposure to saliva and respiratory secretions.
Some surgical masks include a clear, wraparound shield that provides an added barrier for the eyes, cheeks and forehead. If you need drive-thru COVID-19 testing, for instance, you might see test providers wearing those kinds of masks. They’re also worn in hospital settings where respiratory procedures are performed.
Because surgical masks fit loosely rather than having a tight seal, they don’t provide an absolute barrier or complete protection against tiny particles in the air that may be released by coughs or sneezes.
The World Health Organization offers advice for the public on how to use masks to protect against coronavirus infection:
- Inspect the mask for any holes or tears to make sure that it’s intact.
- Wash your hands with soap and water or use an alcohol-based hand sanitizer that contains at least 60% alcohol before putting on the mask.
- Cover your nose and mouth with the mask and make sure no gaps exist between it and your face.
- Avoid touching the mask while using it. Touching the front of your mask, which is exposed to the environment, can defeat the purpose of using it.
- If you do touch your mask, wash or sanitize your hands immediately.
- When your mask gets damp, replace it.
- Do not reuse these single-use masks.
- Remove your mask from behind rather than touching the front of the mask.
- Discard the used mask immediately in a closed trash bin and clean your hands again.
U.S. health officials are deciding whether to urge members of the general public to wear face masks. Currently, the CDC does not recommend that healthy people wear a face mask to protect themselves from COVID-19 (or other respiratory illnesses). However, people who have symptoms of confirmed or suspected COVID-19 should wear face masks around others to help prevent the virus’ spread, the CDC advises.
WHO has a slightly different perspective. Healthy people should wear a mask if taking care of someone with a suspected COVID-19 infection, according to the global health organization. If you are coughing or sneezing, you also are advised to wear a mask but must know how to use and dispose of it properly. According to WHO, masks are only effective when a person also frequently washes their hands with alcohol-based hand rub or soap and water.
Respirators are made from cloth-like filter material that protects wearers from inhaling infectious organisms. Firmer and more substantial than a surgical mask, the rounded respirator is shaped more like a small bowl. Its edges form a seal around your nose, and mouth and the filtering action removes tiny particles from the air when you breathe in.
Respirators come in several sizes and models. For an N95 respirator to be fully effective, it must be properly fitted to the individual user. Fitting entails an established process including aerosol spray tests – it’s not like trying on a hat. Health care professionals are individually custom-fitted for these masks.
“Health care providers have been trained to use these respirators,” says Dr. Stacey Rose, an assistant professor in internal medicine and assistant dean of clinical curriculum at Baylor College of Medicine in Houston. Training and fitting are done systematically, she says, usually in collaboration with occupational health professionals in a health facility.
One type of mask testing used for health care workers, called qualitative fit testing, uses the wearer’s sense of taste or smell to detect leakage into the respirator.
“You sit in a chamber and they actually spray some (sugar) particles in the air,” Rose explains. This occurs after the mask is initially adjusted for fit. “If it’s the right fit, when the occupational health person sprays the solution into the air, you should not be able to taste the sugar,” she says. “That tests if we in fact have an intact barrier.”
With the entire process done in advance, Rose says, she can be reasonably certain that when she’s caring for patients she’ll be protected from breathing in airborne respiratory droplets that can transmit disease.
Health care providers now face challenges with N95 respirator availability, Rose notes. In addition, she says, the general public doesn’t have access to respirator fitting procedures or training on how to use them, which could reduce their effectiveness.
N95 respirators have other limitations. Respirators can make it more difficult for the wearer to breathe, so people with chronic respiratory, cardiac or other medical conditions should check with their health care providers before using one, the FDA cautions. N95 respirators are not designed for people with facial hair, or for children, and a respirator may not provide them with full protection.
In an effort to protect themselves, while sparing resources like masks for those who most need them, some members of the general public are fashioning their own face coverings from materials at hand.
Nationwide shortages of personal protective equipment (PPE) – particularly face masks – are placing some health care workers in precarious situations. As an absolute last resort for health care personnel working in settings where face masks are not available, the CDC website notes that these personnel might use homemade masks, such as a bandanna or scarf, for care of patients with COVID-19.
“However, homemade masks are not considered PPE, since their capability to protect health care personnel is unknown,” according to the CDC. “Caution should be exercised when using this option.” Ideally, the agency adds, homemade masks should be used in combination with a face shield that covers the entire front and sides of the face.
As a lay person, using a cloth face mask, or continually wearing a surgical face mask whenever you leave your home, poses practical problems. “If you think about a bandanna or something that’s papery, it’s going to get wet through the day and be uncomfortable, and potentially you’re going to touch it more,” says Dr. Colleen Kraft, associate chief medical officer at Emory University Hospital and an associate professor at Emory University School of Medicine in Atlanta. That reduces the mask’s effectiveness and actually could expose you to possible virus on its outer surface.
It could make sense to use surgical masks if you have a supply that won’t soon be depleted and if you’re disposing of them when they’re dirty and used, Kraft says. “I’m not supporting universal masking, but I still understand the rampant fear that many people are having,” she says. “I don’t want to minimize that. But doing the basic things such as hand hygiene and cleaning the surfaces around us are very helpful, simple things that still are not always done.”
Necessity is the mother of innovation and there’s certainly a dire need to protect against COVID-19 and address the lack of masks. Kraft is conducting ongoing research on solutions for the chronic shortage of disposable respirator masks among front-line health care workers.
In a study published online March 25 in JAMA, Kraft and her colleagues determined that a type of reusable mask called an elastomeric half-mask respirator (already used in some industries) could be an effective alternative to N95 respirators and that health care providers can be rapidly fit-tested and trained in their use. Follow-up research will determine the best mask-cleaning solutions and procedures.
Rose reiterates the importance of following CDC guidance on preventive measures like hand-washing during the COVID-19 pandemic. “We keep saying that – and people are sort of sick of hearing it – but really, that is No. 1, 2, 3 and 10 for how you protect yourself from any infection.”
Although hand sanitizer is OK for prevention, hand-washing with soap and water for at least 20 seconds is best, Rose emphasizes. “You especially want to do this if you’ve been in contact with things like mucus, nasal secretions from a cough or something like that,” she says. “You definitely want to wash your hands after a potential exposure to those fluids.”
Mask or no mask, avoid touching the mucosal surfaces of your face – your mouth, nose and eyes, Rose says. Practice physical distancing to avoid contact with anyone who might be ill. Because the coronavirus can exist on surfaces, she adds, “It’s reasonable to take the additional measures of cleaning and disinfecting your surfaces daily.” It also makes sense to wash your hands after touching your cellphone or computer keyboard – even if you’re regularly wiping them down.
Check the CDC and WHO websites frequently, as well as your local heath department, to stay on top of rapidly changing developments and emerging knowledge throughout the pandemic, Rose advises. The CDC now offers an online Coronavirus Self-Checker tool to help you make decisions about seeking medical care if you think you could be sick with COVID-19.
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