Face masks

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Facial coverings describe devices meant to cover the nose and mouth to inhibit the spread of infectious diseases. They are especially important for medical professionals (though they have been commonly donned by sick people, immuno-compromised people and people living in areas with high pollution) prior to the COVID-19 pandemic.

Scientific evidence shows that wearing masks is one way to impede the spread of COVID-19, primarily because masks reduce the outflow of viral particles from infected people including those who are asymptomatic.[1][2][3][4] There is also some evidence that wearing a face mask also protects the wearer, based on some observational evidence that infections were more likely to be asymptomatic for mask wearers.[5] A hypothesis that explains this is that masks reduce the initial viral load (ID50), making it easier for the immune system to overcome the infection.[5] The importance of initial viral load for immune response has been known since 1938.[5] The CDC now says that even cloth face masks protect both the wearer and those around them.[6]

Types of facial coverings[edit]

Surgical N95 masks[edit]

Surgical N95 Masks

The N95 respirator is the most common of the seven types of particulate filtering face-piece respirators. This product filters at least 95% of airborne particles but is not resistant to oil.[7] These are probably the most prominent, and what most people nowadays think of when they think of a mask. There have been reports of such masks being defective when delivered from China.[8]

These devices usually are light blue in color, with white on the top and bottom of the mask. The top portion of the mask usually has a built in piece of malleable metal or plastic to ensure a seal around the nose. They mostly have elastic on the ends of the mask that secure around the ear to create a snug fit.

Though they seem thin, they have layers of tightly weaved plastic, that is electro-magnetized to catch tiny aerosol particles. This feature however is deactivated if the mask is wet, so it's important to rotate masks frequently. The user is recommended to keep five N95 masks and rotate their use each day, allowing them to dry for long enough that the virus is no longer viable (> 72 hours). Proper storage for this technique requires either hanging the respirators to dry, or keeping them in a clean, breathable container like a paper bag between uses. They are designed to only be worn once. Generally considered the gold standard in protection, they are capable of protecting others in any environment. They are also capable of protecting the wearer in a surgical environment.

Mask decontamination strategies are actively being investigated by the CDC, mask companies, and large academic/industry collaborations. Some of these include:

  • Hydrogen peroxide vaporisation decontamination has been shown in pilot studies to allow multiple cycles of N95 processing with acceptable preservation of function.[9] It is now approved by the FDA as an emergency method for N95 decontamination for healthcare personnel during the COVID-19 pandemic.[10] This method of decontamination can only be used on N95 models that do not contain cellulose, such as the 1860. It is being utilized in industrial facilities such as Battelle (up to 20 cycles) as well as individual hospitals via Sterrad (up to 2 cycles) or Steris equipment (up to 10 cycles).
  • UV treatment of N95 masks requires very specific dosing protocols and a full surface area illumination to ensure proper inactivation of viral particles with minimal mask degradation.[11] Due to the precision required, home UV light use is not recommended, although this method of decontamination has been implemented by some hospital systems.[12]
  • Heating (at 60-70°C and 80-85% relative humidity) has been shown to be effective for flu viruses, but there is limited data on the temperature, humidity, and time required to completely inactivate SARS-COV-2 viral particles. Moreover, the parameters required to kill the virus may adversely affect filtration efficacy of the mask. Due to the dearth of specific data on a protocol to achieve both aims, this method is not currently recommended.[13] Dry heating of the mask at 70°C for 30 minutes has been suggested as a method of decontamination which can adequately kill virus and preserve the filter integrity for re-use.[14][13] Recent tests at the NIH utilizing SARS-CoV-2 specifically indicated that this method can be used for two cycles to kill the virus without compromising fit (although it is yet to be peer reviewed).[15] Research efforts are ongoing to determine optimal parameters (temperature and duration), but this is not yet recommended by the CDC.

KN95 mask[edit]

KN95 masks are also a form of personal protective equipment (PPE) used to protect the wearer from similar hazards though they are not regulated by NIOSH. These masks are often identical to N95 masks in terms of performance and are the “N95 equivalent” for medical usage in China. Their construction is extremely similar to a N95, generally using multiple layers of non-woven fabric (meltblown, spunbound and et cetera) for filtration. These masks are becoming more popular, and were already quite popular in Southeast Asia.

Generally white, although increasingly available in a variety of colors, with the exception of a visible piece of metal on the top of the mask that helps secure the mask around the nose. The majority of KN95s are a cone style, although others are available. They also tend to have elastic loops to secure the mask over the ear. Headband KN95s are available as well through reputable manufacturers, and the headband is generally considered superior by NIOSH (no NIOSH certified N95 has ear loops) as they generally give a better seal, and are more comfortable for long term use.

Unlike the medical N95, they tend not to be sterilized, so they aren't recommended for medical use, however they are adequate for civilian use and still vastly superior to a standard cloth mask. These are primarily manufactured in Southeast Asia,[16] and there have been reports of orders of these masks being defective when delivered.[17][16] However, steps can be taken to ensure authenticity, and the CDC and NIOSH have tested a wide variety of them, with many performing on par with any N95 rated mask, and receiving emergency use authorization for medical purposes. Some manufacturers now include a hologram or scannable QR code to verify authenticity. If you take the time to find a reputable manufacturer and reseller, these masks can be an excellent option, providing protection on par with the best, for a good price and with high availability. It is worth noting that the Chinese manufacture a great deal of the N95 and FFP2 masks available in the US and Europe without issue, so country of origin is not itself a reason to be worried.

These masks can also be decontaminated by the same methods of N95 masks.

KF94 Masks[edit]

KF94 is a South Korean standard for general, non-medical use. It was specifically created in response to the original SARS outbreak to be used in case of another outbreak, and offers excellent protection against pollution as well. In terms of protection, KF94 is virtually identical to the European FFP2 spec and very close to N95, and many masks exceed the minimum. The Korean FDA keeps a searchable database of approved masks to help verify authenticity, however it is only in Korean. KF94 masks are generally a "boat" style (although other styles do exist) which some find easier to wear and breathe in. Although counterfeiting is still possible, the Korean government regulation puts some people at greater ease than a KN95. It is still a good idea to make sure you're buying from a reputable reseller.

Vented mask[edit]

This style of mask has become particularly popular in the United States, frequently popping up on social media.

The color of these masks varies, but commonly are black, and feature one or two vents located on either side of the mask. They also tend to include space inside the mask to insert a PM2.5 filter. Without the filter, the mask is probably only N75 at most, but the bigger concern is actually the vents. Evidence has suggested that the little space between layers fabric inside the mask and the vent could actually release small aerosol particles, basically defeating the purpose of the mask during the pandemic, and making it even worse than not wearing a mask.[18][19]

Previously these masks had been used for protection from pollution or athletic training because they limited the amount of oxygen pulled in through the vent(s). These masks are not recommended for medical use, and shouldn't be used in public either unless they have the filter installed and the vent(s) secured.

Neck Gaiter[edit]

This type of facial covering has become popular among athletes, worn by MLB players and recreation runners. The covering fits around the neck, and easily allows the user to pull it up over the nose. There is a version of this covering that even has a piece of metal for a nose seal and a slot for a PM 2.5 filter. But a recent study from Duke University found that this type of covering is actually worse than wearing nothing over ones mouth and nose.[20] The coverings are made with a polyester spandex, which is very breathable, and also makes the large particles from the mouth smaller, and hang in the air longer. These type of coverings should not be worn by anyone.

Fabric mask[edit]

This generally describes any type of facial covering that isn't designed for a medical purpose and covers the nose and mouth. Wearing a two layer fabric covering is at best N60, however the CDC now estimates that the chance of being infected is reduced by as much as 70% in common scenarios for even a basic cloth mask[21]. Examples include handkerchiefs, bandannas, scarves and sewn together pieces of fabric. Generally they lack any way to secure them around the nose, leading to condensation buildups for those wearing glasses or eye coverings.

The purpose of wearing these is partly to protect the wearer, but also to protect others. When you open your mouth, aerosols are released on heavy droplets, that get caught in the covering. Even one layer of fabric could reduce 70% of the aerosols coming from the wearer,[22] so if you are infectious and/or asymptomatic, you can stop those around you from catching the infection. This is the primary driver behind governments' push for people to "Mask Up". Your mask protects others, and their mask protects you. CDC Director Robert Redfield admits that if more people complied with facial coverings (let's say 80%) the COVID-19 pandemic could be controlled in the US in about 8 weeks.[23] But it is not recommended for intensive medical use.[24] Research has shown, however, that the addition of a meltblown synthetic filter layer to a snug fitting cloth mask can dramatically increase it's effectiveness, approaching N95 levels and actually exceeding that of a surgical mask. [25] [26] [27] The CDC has also confirmed this with it's latest guidance, and suggests that it is because a meltblown filter creates a triboelectric charge. [28]

Industrial N95[edit]

N95 respirators were originally designed for industrial use in sectors such as mining, construction, and painting.[29] They have also been shown to be effective as protection against engineered nanoparticles.[30][31][32]

Commonly found on construction sites, this mask is generally constructed using materials that form a cup shape around the nose and mask, In industrial settings where infectious disease exposure is not a concern, users can wear and reuse a filtering face-piece respirator until it is damaged, unless there is a manufacturer-specified duration of use. However, in laboratories at biosafety level 2 and higher, respirators are recommended to be discarded as hazardous waste after a single use.[33] Though not sterilized, they are effective at keeping out most particles, including asbestos and other chemicals common in the industrial setting. Generally also white, they also may feature a "filter" on the front of the mask.[34] Commonly they do have a piece of exposed metal on the top to secure around the nose, and have piece of elastic meant to secure the mask around the head. At the beginning of the pandemic, when PPE was in short supply, many companies donated their extra masks to medical professionals on the front lines.

In terms of actual protection, these masks are totally identical to a medical grade N95, but are not made on sterile manufacturing lines There is only one N95 standard, which applies to both medical and non-medical masks, and so any mask that is N95 certified will protect the same. For "civilian" use, they are perfectly adequate.

Gas masks[edit]

Generally overkill for stopping infectious disease, these come in two forms; a respirator equipped with one or two canisters on the front or side, that covers about a quarter of the face, and a full face respirator with a full plastic shield built into the respirator. The quarter respirator seals around the nose and mouth, leaving much of the face exposed, while the full respirator seals around the entire face. The purpose of both is to force air through the canisters that filter the air for the wearer. More common in industrial and public safety settings, they have been worn by medical professionals, and by paranoid assholes.[35]

Use[edit]

Maintenance[edit]

Most people are generally wearing fabric coverings, and washing with soap and hot water suffices for cleaning according to health professionals. The same can be said for most vented masks, although putting them through a washing machine or dishwasher can sometimes displace the vents. The N95s are where things can get tricky. The medical N95 cannot be laundered, it was only designed for single use. There is currently an effort to explore the possibilities of how these could be treated for additional use, that process is ongoing. KN95s can't really be laundered either, but because of their general structure could probably be reused, if the wearer is careful not to touch the outside of the mask, and wash their hands before putting it on and after removing it.[36] Gas masks each include their own maintenance protocol, though the critical thing would be replacing the canister, typically they are good for about 8-20 hours of use.

Adoption[edit]

A person who refuses to wear a mask, or take any of the basic precautions to help society prevent an air born illness during an epidemic.
—Urban Dictionary definition of "rat-licker"[37]

Trump supporters are more likely to refuse to wear masks.[38] Restaurant owner Bob Palmgren reported that a customer in a MAGA hat flashed a gun at him when Palmgren asked him to wear a mask.[39]

Anti-maskers may feel a sense of group belonging when they refuse to wear masks in public.[40]

A research study found that wearing masks was associated with greater agreeableness (a trait involving caring and helpfulness) and that people who didn't wear masks were more likely to have the dark triad traits of narcissistic rivalry, little care for others (psychopathy factor 1), and Machiavellianism.[41]

Women are more likely to wear masks than men are. While traditional ideas of masculinity are correlated with dislike of wearing masks, researchers also noted that men who had less trust in science and cared less about vulnerable people were less amenable to putting on a mask. Researchers suggested that people frame mask-wearing as an act of positive masculinity for men, describing it as a way to be a guardian and protector.[42]


Controversies during the pandemic[edit]

"No mask, no entry"

Conspiracy theories[edit]

See the main article on this topic: Conspiracy theory

The schlockumentary Plandemic claimed that masks "activate" the COVID virus, a claim that baffled experts for being so ridiculous.[43]

Fox News spread doubts about the usefulness of masks, helping give rise to the anti-mask movement.[44]

After Louie Gohmert contracted COVID, he went on a Dallas CBS affiliate, where he blamed wearing a mask recently on contracting the disease,[45] even though he has made a habit of eschewing physical distancing and wearing a mask,[46] and even called in all the staff in his DC office to personally tell them that he had contracted the disease while not wearing a mask. Apparently, according to his staff, his office has been fully staffed, and wearing masks has been ridiculed.

Some have even gone as far as to link two completely different conspiracy theories together. Apparently an antenna is in the face mask is to help download cat videos, which is of utmost importance to allow 5G to either track you, make you sick, or both, depending on which conspiracy theory you would want to believe. So what you thought was maybe a box of soft masks could in actuality be a box of lethal weapons as social media posts suggested.[47][48][49] Quite a reaction to a bendy metal strip that's been inserted into the mask. And we thought that its purpose was just to bend around the bridge of your nose to help the mask fit better and tighter.

Disability and health[edit]

Anti-maskers began using claims about disability rights to say that masks are injurious to people with disabilities and health conditions.

False claims[edit]

Some people, with or without breathing problems such as asthma, have claimed that mask wearing limits their oxygen intake. Yet doctors have tried monitoring oxygen levels and heart rates with and without masks and found no differences.[50]

If you’re not going to wear a mask, you take a paper that has the Americans for [sic] Disabilities Act on it, and no one is allowed to ask you why you cannot wear a mask. So you can say that you have a medical condition. And the medical condition might be that wearing a mask is strangling your sense of free speech
—Dr. Christiane Northrup,[51] who doesn't appear to know what a disability actually is

Unfortunately, this has gone as far as some people faking disability (usually a rare thing) in order to bypass masking requirements. Social media posts encouraged people to lie about having a medical condition and then say that they are not required to disclose what that condition is under the ADA (which doesn't apply to non-disabled people) and HIPAA (which applies to your doctor, not your grocer).[52] One card (which misspelled HIPAA as "HIPPA") warned of a $75,000 fine.[53]

In the US, the ADA website issued a fraud alert over cards with the Department of Justice symbol claiming that the card carrier is exempt from face mask requirements.[54]

Extending the logic of mask freedom…

Disability and reality[edit]

Autistic art urging people to wear masks

However, many disabled people can wear masks — and some who find it hard may choose to do so anyway because it's the decent and smart thing to do if at all possible.[55] It's very rare for someone to be medically unable to wear a mask,[56] and doctors note that sometimes people can wear some types of masks but not others.[57] And the existence of people with serious illnesses or disabilities who can't mask up should be all the better reason to wear masks.

A person with asthma or other respiratory problems is a highly vulnerable individual. If they were to get COVID-19, it’d be a stronger likelihood that they might get a very serious illness, resulting in hospitalization or death. They’re more likely to contract the illness if exposed, so we need widespread masking to protect persons with disabilities.
—Professor Lawrence Gostin[53]

A few people with disabilities truly cannot wear face masks.[58] And anti-maskers are making their lives harder by endangering their safety and throwing them under the proverbial bus for their own selfish reasons.

The backlash against anti-maskers has sometimes hurt people who have real health conditions which prevent proper mask wearing. Many of these people and their families are trying to take extra safety precautions.[59] Unfortunately, some pro-maskers are mocking them, insulting them, and claiming that their needs aren't real. "Stop the ableism, and put that energy into pushing back against actual anti-maskers," writes one autistic person who lives with chronic illness.[60]

Widespread masking and social distancing, just like widespread vaccination, helps protect people with serious conditions.

In a nutshell[edit]

References[edit]

  1. Still Confused About Masks? Here’s the Science Behind How Face Masks Prevent Coronavirus, University of California San Francisco
  2. Considerations for Wearing Masks, CDC
  3. Does Wearing a Mask Protect You from the Flu and Other Viruses?, Healthline
  4. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies
  5. 5.0 5.1 5.2 Forty percent of people with coronavirus infections have no symptoms. Might they be the key to ending the pandemic? New research suggests that some of us may be partially protected due to past encounters with common cold coronaviruses. by (Ariana Eunjung Cha) The Washington Post.
  6. Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2, CDC
  7. NIOSH-Approved N95 Particulate Filtering Facepiece Respirators
  8. Chinese Manufacturer Charged with Exporting Misbranded and Defective Masks Falsely Purporting to be N95 Respirators FDA
  9. Investigating Decontamination and Reuse of Respirators in Public Health Emergencies
  10. Approval of N95 masks by the FDA
  11. Fact sheets on N95 UV decontamination method
  12. UMass Tries Innovative Method To Clean N95 Masks: UV Light wbur
  13. 13.0 13.1 COVID-19 N95 DECON & REUSE HEAT & HUMIDITY
  14. Dry Heat Ovens Can Effectively Disinfect N95 Masks
  15. Assessment of N95 respirator decontamination and re-use for SARS-CoV-2 medRxiv 2020.04.11.20062018
  16. 16.0 16.1 Federal Agencies Have Spent Millions on KN95 Masks, Often Without Knowing Who Made Them
  17. Use of face masks designated KN95
  18. A Certain Type of N95 Mask May Do More Harm Than Good Healthline
  19. Why simple cloth masks without valves are better at fighting the spread of covid-19 The Washington Post 28 June 2020
  20. Emma P. Fischer, et al. Low-cost measurement of face mask efficacy for filtering expelled droplets during speech Science Advances (Vol. 6, no. 36), American Association for the Advancement of Science. 2 September 2020
  21. Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2, CDC
  22. Mask vs. No Mask Demonstration Shows How Important It Is to Wear One
  23. COVID-19 could be controlled in 1-2 months if people wear masks: CDC Director Robert Redfield by Emily Shapiro (15 July 2020, 03:56) ABC news
  24. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers MacIntyre CR, Seale H, Dung TC, et al A cluster randomised trial of cloth masks compared with medical masks in healthcare workers BMJ Open 2015;5:e006577. doi: 10.1136/bmjopen-2014-006577
  25. Quantitative Method for Comparative Assessment of Particle Filtration Efficiency of Fabric Masks as Alternatives to Standard Surgical Masks for PPE
  26. Marketplace tested over 20 different masks. Here's what will best protect you and others during the pandemic
  27. Evaluation of Cloth Masks and Modified Procedure Masks as Personal Protective Equipment for the Public During the COVID-19 Pandemic
  28. Scientific Brief: Community Use of Cloth Masks to Control the Spread of SARS-CoV-2, CDC
  29. Vargas, June (2020-03-26). "From the Industrial to the Medical – Evolution of the N95 Respirator" (in en-US). 
  30. "Building a Safety Program to Protect the Nanotechnology Workforce: A Guide for Small to Medium-Sized Enterprises" (in en-us). March 2016. 
  31. "Respiratory Protection for Workers Handling Engineered Nanoparticles" (in en-us). U.S. National Institute for Occupational Safety and Health. 2011-12-07. 
  32. "Multi-Walled Carbon Nanotubes; Significant New Use Rule (40 CFR 721.10155)". U.S. Environmental Protection Agency via U.S. Government Publishing Office. 
  33. Respirator Reuse FAQs
  34. Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
  35. Rep. Matt Gaetz wore a gas mask on House floor during vote on coronavirus response package CNN 9 March 2020
  36. How to Wear Masks Centers for Disease Control and Prevention
  37. Rat-licker, Urban Dictionary
  38. Poll: Plurality of voters believe Trump's refusal to wear masks in public deters Americans from wearing masks themselves, The Hill
  39. Coronavirus: Why are Americans so angry about masks?, BBC News
  40. Why some Americans won't wear face masks, in their own words, Advisory
  41. Who complies with the restrictions to reduce the spread of COVID-19?: Personality and perceptions of the COVID-19 situation, Elsevier Public Health Emergency Collection
  42. The real reason why some men are still refusing to wear a mask, Fast Company
  43. Debunking the most dangerous claims of 'Plandemic', Live Science
  44. How Fox News helped turn masks into another culture war flashpoint, Media Matters
  45. GOP lawmaker blames mask for positive Covid-19 test CNN 28 July 2020
  46. Louie Gohmert, who refused to wear a mask, tests positive for coronavirus Politico 29 July 2020
  47. Be careful ima sit this here👀** … Masks enable 5G tracking… by 5mooth KKriminal @72tattedup (July 10, 2020) Twitter (archived from 3 Aug 2020 06:40:27 UTC).
  48. Today I "learned" that the nose wire in a face mask is actually a 5G antenna. by Scir Reeve @scirreeve (4:50 PM - 5 Jul 2020 ) '"Twitter (archived from 3 Aug 2020 06:48:16 UTC).
  49. But masks defeat the facial recognition systems that Bill Gates and George Soros are tracking us with. If you wear a mask, then it will be harder for Gates & Soros to find you and inject a microchip into you. by caerbannog666 aka @Djdubya3's little piglet (4:22 PM - 10 Jul 2020) Twitter (archived from 3 Aug 2020 06:44:12 UTC).
  50. A doctor tested her oxygen levels and heart rate while wearing face masks to show they don't make it hard to breathe, Business Insider
  51. Being anti-mask doesn't make you disabled, Newsday
  52. Can People Without Disabilities Use an ADA ‘Mask Loophole’ in Stores?, Snopes
  53. 53.0 53.1 The Hot New Far-Right Trend: Claiming a Disability to Avoid Wearing a Mask, Daily Beast
  54. COVID-19 ALERT: Fraudulent Face Mask Flyers, ADA.gov
  55. I’m Autistic. I’m Not Anti-Masker Ammo, Autistic Dreams
  56. Are some ‘anti-maskers’ falsely claiming Gov. Kate Brown’s face covering order doesn’t apply to them — for medical reasons?, Oregon Live
  57. 'Anti-maskers' say medical conditions prevent them from wearing masks, but doctors say that's not a legitimate excuse, Business Insider
  58. The ADA and Face Mask Policies, Disability Issues Brief
  59. Some autistic people can’t tolerate face masks. Here’s how we’re managing with our son, Washington Post
  60. I can't wear a mask, Autistictic