Use a Better Mask for COVID
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Use a Better Mask for COVID

Mar 20, 2023

It's long past time for an upgrade. Here's what you need to know about different types of masks and how to find one that's authentic.

When the Centers for Disease Control and Prevention first recommended that everyone wear a cloth mask in public in April 2020, there weren't enough highly protective N95 respirators to go around. For many months, as COVID-19 spread all across the country, the agency recommended that people save the N95s for healthcare workers who needed them on the job.

In 2022, however, N95s are plentiful, and a new variant of the COVID-19 virus, omicron, is even more contagious than its predecessor, delta. A well-fitting respirator, such as an N95, will provide the highest level of protection against COVID-19 and is a reasonable choice for many people, the CDC now says. The next-best protection is afforded by well-fitting KN95s (respirators that meet China's standards of protections; see more below) and then well-fitting disposable surgical masks, the agency says, followed by layered, finely woven cloth masks. Loosely woven or ill-fitting cloth masks offer the least protection.

While cloth masks can still be useful when layered with other, more highly protective masks, says Consumer Reports’ chief scientific officer, James Dickerson, PhD, "cloth mask use alone is no longer an acceptable tactic." It's time to upgrade, even if you’re vaccinated.

One fact thing true: "Any mask is better than no mask," says Jose-Luis Jimenez, PhD, an aerosol scientist at the University of Colorado Boulder.

Still, cloth masks generally don't work as well as masks manufactured for medical settings, including surgical masks and N95s, according to a 2020 study published by the CDC.

Take, for instance, the cloth masks whose performance complies with the ASTM standards for nonmedical face coverings, which were developed to help consumers determine which nonmedical face masks are more effective. The Level 1 standard means that the mask filters out at least 20 percent of all airborne particles smaller than 1 micrometer, while the Level 2 standard means that the mask filters out at least 50 percent of those particles.

Contrast that with an N95, which must meet a National Institute for Occupational Safety and Health standard of filtering out at least 95 percent of particles of around 0.3 micrometers in diameter. That level of filtration effectively catches the airborne particles that can spread COVID-19.

Surgical masks aren't required to provide the same levels of protection as N95s, but they generally still outperform typical cloth masks. In a randomized controlled trial conducted in a number of communities in Bangladesh and published in the journal Science, surgical masks appeared to provide stronger protection against COVID-19 than cloth masks did, according to one of the scientists who conducted the study, Stephen Luby, MD, a professor of medicine (infectious diseases) at Stanford University in California.

The weaker protection provided by cloth masks matters even more now than it did in previous phases of the pandemic. According to the latest data, almost all COVID-19 infections in the U.S. are due to the highly contagious omicron variant. So even if you’re vaccinated, it's important to mask up, particularly if you or someone you live or work with is unvaccinated (such as a young child) or at high risk of complications from COVID-19.

Here's what to do to level up your mask-wearing game.

Make sure it's comfortable. Whatever mask you choose, make sure it's something that you can comfortably wear on a regular basis. "I could create the best mask in the world, but if it's super-uncomfortable, people just aren't going to wear it," says A.J. Prussin, PhD, a research scientist in the department of civil and environmental engineering at Virginia Tech in Blacksburg.

Understand the types. By now, N95 and KN95 are household names. But knowing the differences between them can help as you’re considering how to upgrade your mask.

An N95 respirator, as it's technically called, gets that designation based on requirements from the National Institute for Occupational Safety and Health for performance and manufacturing. It must filter out at least 95 percent of very small particles. The N95 is intended as a workplace mask, so the NIOSH standards are meant to ensure that it provides adequate protection on the job. To maintain that certification, regular quality control is required, says Anne Miller, executive director of Project N95, a nonprofit organization that sources high-quality and reliable masks and other personal protective equipment (PPE) for healthcare workers and the general public.

Other types of respirators, such as the KN95 (from China), are subject to their country's standards for performance. Like N95s, KN95s must be able to filter out 95 percent of small particles. But they’re not regulated as heavily as N95s, Miller says, requiring a one-time certification rather than ongoing scrutiny. And according to the CDC, about 60 percent of KN95s that NIOSH evaluated during 2020 and 2021 didn't meet the standards they were claimed to.

Still, if you can confirm they’re authentic (see tips below), they or similarly high-performing masks (such as Korean KF94s) will provide some of the highest levels of protection, Prussin says.

And remember, you can also seek out other types of devices that provide equivalent or better protection than an N95. One good option, Jimenez says, is an elastomeric respirator. Its appearance might seem like something out of a sci-fi series, but these devices, some of which are also regulated by NIOSH and can be used as PPE in the workplace, can be highly effective, particularly because they may be easier to fit properly. A small study published in March 2021 in JAMA Network Open found that when performing mock CPR, a strenuous activity that requires a lot of movement, elastomeric respirators leaked less and provided better protection for healthcare workers than N95s.

A major bonus: Unlike disposable medical masks, elastomeric respirators can be cleaned and reused. If you opt for one, however, just make sure it doesn't have a filterless exhale valve, which would allow your unfiltered breath to escape, potentially endangering others if you’re infected.

Double up. Better than any cloth mask or surgical mask on its own, Prussin says, is a tight-fitting cloth mask layered over a surgical mask. He recommends looking for a surgical mask that meets ASTM standards, which should provide a minimum level of filtration. (More on this below.)

Get a good fit. Although many cloth masks don't perform as well as medical masks, upgrading your mask is about more than just the material it's made out of. A well-fitting cloth mask made from at least three layers of tightly woven cloth (with the middle layer being a different type of fabric), would probably outperform a surgical mask that has gaps on the sides and is constantly sliding down off your nose, Jimenez says.

That's because air takes the path of least resistance. "Any gap between the face and the mask defeats the purpose, because the air has a much easier time going through those gaps instead of going through the cloth of the mask," Jimenez says. This is a potential problem even with highly effective but ill-fitting N95, KN95, and KF94 respirators.

There are a number of strategies you can use to get a better fit, such as double masking, using a mask brace or fitter, or strategically knotting ear loops. For more on how to make your mask fit better, see our guide here.

Different face shapes and sizes may be suited to different types of masks. If you buy one type of mask and find that it doesn't fit and that you can't adapt it well enough to close the gaps—or you just find it to be uncomfortable and difficult to wear—don't give up. Try another brand or style.

Shop smart. It's a good idea to look for ASTM standards not just when you’re buying a cloth mask but also when you’re buying a surgical mask. Surgical mask makers can make products that meet ASTM standards for the material used, which guarantees certain levels of filtration and breathability. (These are different standards from those used to evaluate cloth and nonmedical masks.) Look for masks that are labeled ASTM Level 1, 2, or 3. You’ll still need to make sure the mask fits well to your face, however, because the certification applies only to the mask's filter material and not its overall performance.

Counterfeit KN95 or equivalent face coverings, or products that don't meet U.S. or international standards, have been a problem during the pandemic. But reliable sources for masks and respirators exist, including this list of products tested by the National Personal Protective Technology Laboratory. Project N95 is another resource. And although the FDA revoked its blanket emergency use authorizations for various types of personal protective equipment in 2021, the list of products that received the authorizations is also a good place to look, Miller says.

If you find a product on a site like Amazon and you’re not sure it's authentic, CR's Dickerson recommends that instead of putting it right into your cart, try searching for the brand name's stand-alone site. Look for what's said about the testing it has done and the standards it has met. Be wary of a site that offers little evidence about the effectiveness of its masks. Another good practice is to make sure you’re buying either directly from a manufacturer or directly from an authorized seller for a product, such as that brand's official Amazon or eBay store.

Catherine Roberts

As a science journalist, my goal is to empower consumers to make informed decisions about health products, practices, and treatments. I aim to investigate what works, what doesn't, and what may be causing actual harm when it comes to people's health. As a civilian, my passions include science fiction, running, Queens, and my cat. Follow me on Twitter: @catharob.

Make sure it's comfortable. Understand the types. Double up. Get a good fit. Shop smart.