Coronavirus (COVID-19) and masks: An update on mask-wearing from the experts

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- photo by Markus Winkler on Unsplash

Expert wisdom on mask-wearing during the coronavirus pandemic is changing, again, with the appearance of new variants of the Covid virus.

A little under a year ago, as Covid first began sweeping the globe, experts presented divided opinions on wearing a face mask. (You may view ClearHealthCost’s early coverage on mask-wearing here.) While some encouraged mask-wearing, citing previously observed benefits in preventing the spread of other airborne illnesses, such as influenza and SARS, others advised people to not wear face masks in order to save the limited supply for healthcare workers.

As of April 4, 2020, both the World Health Organization (W.H.O.) and the Centers for Disease Control and Prevention (C.D.C.) websites still stated that “if you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.” Less than a week later, the C.D.C. had updated their site to recommend “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

Political winds affected mask-wearing too; then-President Trump disparaged mask-wearing, as did many of his followers, ridiculing the practice and resulting in deep divides between adherents of masks and their critics.

Now, along with social distancing and hygiene measures like frequent hand-washing, mask-wearing is one of the top ways in which people fight the spread of infection. Mask-wearing has even become mandatory in most indoor and some outdoor settings. As of Feb. 2, 2021, the CDC has issued an order that requires individuals to wear masks “on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and in U.S. transportation hubs such as airports and stations.”

New coronavirus variants

In the past few months, experts have begun to raise the alarm about the emergence of new variants of the coronavirus, caused by mutations in the virus’s genetic code.

A variant that first appeared in southeastern England in September 2020, known as the B.1.1.7. variant, is thought to be more contagious than previous strains. “Researchers have preliminary evidence that some of the new variants, including B.1.1.7, seem to bind more tightly to our cells,” Robert Bollinger, M.D., M.P.H., Raj and Kamla Gupta professor of infectious diseases at Johns Hopkins University School of Medicine, wrote on the Johns Hopkins Medicine website. “There’s some preliminary evidence that it’s more contagious. Scientists noticed a surge of cases in areas where the new strain appeared.”

According to New York Magazine, different studies have predicted the B.1.1.7. strain to be anywhere between 56-70% more contagious than the earlier variant, although these estimates have yet to be confirmed.

Since its first appearance, the B.1.1.7. variant has been found in at least 33 countries, and 21 U.S. states. Other variants have emerged in South Africa (B.1.351), Brazil (P.1), California (B.1.426 or CAL.20C), and other places – all of which have also since been reported in the U.S.

The Association of American Medical Colleges (A.A.M.C.) said there is not yet evidence to indicate that any of these strains are inherently deadlier. However, the A.A.M.C. noted on its website that it is wise to act now against these new strains, as the higher contagion factor alone could be deadly. “Even if people generally don’t get sicker because of the new strains, larger outbreaks can still result in a higher death toll,” the site says. “The more people become infected, the more people will become seriously ill, further straining health systems that are already taxed from COVID-19.”

Better mask practices

In light of these developments, a number of experts have been calling for better mask practices and improved mask quality.

“A year into the coronavirus pandemic, there’s still a good deal of confusion over what type of face covering is best and how to effectively wear one,” the New York Times Wirecutter wrote in a recent piece on cloth face mask reviews. “Until reliable standards for non-medical masks are devised, here’s what we know for sure: Any mask is better than no mask, though some options are better than others.”

Along with the new mask-wearing guidelines for public transportation, the C.D.C. listed the attributes of masks that successfully meet their requirements on their website. Masks, they write, can be manufactured or homemade, reusable or disposable, but must always completely cover the nose and mouth.

“Cloth masks should be made with two or more layers of a breathable fabric that is tightly woven (i.e., fabrics that do not let light pass through when held up to a light source),” the C.D.C. site says. “Masks should be secured to the head with ties, ear loops, or elastic bands that go behind the head. If gaiters are worn, they should have two layers of fabric or be folded to make two layers. Masks should fit snugly but comfortably against the side of the face. Masks should be a solid piece of material without slits, exhalation valves, or punctures.”

Many experts recommend the use of medical-grade masks when possible. “People really need to upgrade their masks,” Ashish Jha, MD, MPH, dean of the Brown University School of Public Health, told AAMCNews in a recent piece. “We have this mental model that there are N95 masks and everything else and that’s not true.” According to AAMCNews, “Jha recommends using KF94 masks, which are Korean-made masks that filter out 94% of particles — slightly less than N95 masks. They’re available on Amazon. Otherwise, he says that it’s a good idea to double-up on cloth masks, especially in higher-risk situations, such as going to the grocery store, riding public transportation, or going to any place that might be crowded.”

Doubling up to increase safety

Other experts have supported double masking for those unable to access medical-grade masks. “Without a medical-grade face covering,” Linsey Marr, a Virginia Tech engineering professor who has researched mask effectiveness, told the Washington Post, “people can get the best, simplest protection by wearing a cloth mask tightly on top of a surgical mask. They can also make a three-layer mask by cutting a high-efficiency filter, such as a vacuum bag, to place between two tightly-woven fabric masks.”

N95 masks and the Korean-made KN95 masks (which are similar to, although not exactly the same as the KF94 masks), according to Rolling Stone, are similar in that they are both made from multiple layers of synthetic material, designed to filter out “95 percent of tiny 0.3 micron particles in the air.”

The difference between the masks lies in the way in which the masks are certified. “N95 is the U.S. standard, and the KN95 is the China standard,” Sean Kelly, founder of PPE of America, told Rolling Stone. “Because of this, only N95 masks are approved for health-care use in the United States, even though KN95 masks have many of the same protective properties.”

Perhaps unsurprisingly, the U.S. lags behind other parts of the world in terms of quality masks available to the public. According to the Washington Post, several countries in Asia, including Singapore and South Korea, have “mass-produced high-quality masks to send directly to residents.” Several European countries, they also reported, including Germany and France, have taken to encouraging and even mandating medical-grade masks in public settings.