We recently read two articles in The Atlantic called "Why Are Americans Still - Still! - Wearing Cloth Masks?" and "Why Aren't We Wearing Better Masks?" and another in Scientific American called "Why We Need to Upgrade Our Face Masks - and Where to Get Them". All three articles discuss why Americans are still wearing cloth face-coverings now that N95 respirators (or the KN95 respirators, these respirators are made in China and are not approved by the National Institute of Occupational Safety and Health (NIOSH)) are more readily available (The NIOSH Science Blog discusses the roles NIOSH, Occupational Safety and Health Administration (OSHA) and the Food and Drug Administration (FDA) play regarding respiratory protection). The articles mention a new study not peer-reviewed yet from Bangladesh which claims that wearing surgical masks decrease COVID-19 symptoms and antibodies by 11.2 percent, while cloth masks only led to a 5 percent decrease. It proceeds to give several reasons why we continue to use face-coverings from public-health agencies not prioritizing surgical masks and N95 respirators to price to supporting one's sports team. Two of the articles describe how face-coverings are far better than nothing and also saying how cloth masks are more eco-friendly (The Covid Crisis Is Now a Garbage Crisis, Too) giving face-coverings a backhanded credit for helping when nothing else was available. The articles, in my opinion, even support the notion that we should be buying KN95 respirators even though they are not approved by NIOSH. If anything shouldn't we be buying American-made N95 respirators so we can increase the demand and hence increase the supply of masks that are made here? This was the subject of a New York Times article "Can't Find an N95 Mask? This Company Has 30 Million That It Can't Sell" and the Washington Post article "In the early days of the pandemic, the U.S. government turned down an offer to manufacture millions of N95 masks in America."
Let us first say as a person, who believes in the use of respirators and their importance in protecting individuals from exposure to hazardous substances (see all our posts regarding 9/11), we agree that N95 respirators or surgical masks would protect people better from SARS-CoV-2 than cloth face-coverings if worn correctly. However, we would need to be able to provide each person N95 respirators (in their size either small, medium, or large) or surgical masks, make sure they had a sufficient supply to meet their needs, make sure the N95 respirator fits each person, make sure they understand how to wear the N95 respirator or surgical masks correctly, and finally, they are provided a means of disposal for the respirators or the surgical masks. As you can imagine that would be a significant cost to the government (or tax-payers) and would require a significant undertaking to make sure every American would be protected by using N95 respirators or surgical masks. Meanwhile, the biggest issue is whether we are talking N95 respirators, surgical masks, or face coverings they must be worn correctly to protect you, and remember facial hair reduces the effectiveness of all these face coverings. See the chart below for various ways of improperly using face coverings. The Centers for Disease Control and Prevention (CDC) website "Types of Masks and Respirators" was updated as of September 23, 2021, and provides information on types of masks and when to wear them and now includes a section on considerations for children.
Both these articles treat surgical masks and N95 respirators as simple items to wear and that anyone can wear them. However, this is not a fact as we mentioned above N95 respirators require medical clearance, fit testing, and training all mandated by OSHA for individuals that are required to wear them. As for surgical masks, we have to remember the ones that are typically sold to the public aren't actually surgical masks. Surgical masks are cleared by the FDA, see the chart below for the difference between the N95 respirators and surgical masks. Note that surgical masks do not provide the wearer with a reliable level of protection from inhaling smaller airborne particles. This is for FDA-cleared surgical masks, which means the ones the public purchases probably aren't reliable either considering they are not cleared by FDA.
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| Surgical Masks vs N95 respirators |
However, the use of cloth face-coverings has been shown to reduce the emission of virus-laden droplets (source control) and help reduce inhalation of these droplets. The CDC website "Use of Cloth Masks to Control the Spread of SARS-CoV-2" which was last updated on May 7, 2021, provides some significant research on how the use of cloth face-coverings block the transmission of respiratory droplets with some face-coverings performing on par with surgical masks as barriers for source control. In the section "Human Studies of Masking and SARS-CoV-2 Transmission" data regarding the "real-world" effectiveness of community masking is limited to observational and epidemiological studies with many of these showing significant levels of protection from wearing face coverings. An example of one of these was "A study of an outbreak aboard the USS Theodore Roosevelt, an environment notable for congregate living quarters and close working environments, found that use of face coverings on-board was associated with a 70% reduced risk of transmission.
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| Note the circled area of the package (which means they are not surgical masks). |
It is our opinion, one of the main reasons face-coverings are better is because they are easier to use, easier to breathe through, light-weight, and because of these things more likely to be used and used correctly. Wearing the face-covering correctly and using the face covering is what is helping reduce transmission of SARS-CoV-2. So follow the CDC guidelines on when to use face-coverings and let's stop the spread!
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