Masks are here to stay. Regardless of their rocky status at the start of this pandemic, face coverings are officially a fixture of American life, a visible, enduring legacy of the pandemic that also helps reduce the spread of influenza and as-yet-undiscovered viruses sure to vex us in the future.
“Masks are one of the easiest tools we have for reducing Covid spread, and so we’ll probably need them for many months to come — they’re going to be with us as long as Covid is a problem, and maybe even longer,” says Eleanor Murray, ScD, assistant professor of epidemiology at Boston University’s School of Public Health.
But the evolving science of both face coverings and the airborne transmission of the virus has been befuddling, the explosion of mask choices bewildering. And though manufacturers are wrangling over the development of standards or a rating system for mask effectiveness, any helpful labeling is likely months away.
So to help you develop your mask strategy, we’ve unmasked the latest science and advice on choosing between disposable and reusable options, getting the right fit, overcoming the many frustrations, developing a comfortable routine, and even dealing with people who refuse to mask up.
Do masks work?
Yes. Lab tests show that masks limit the flow of respiratory droplets that can carry coronavirus particles from an infected person into the air. As a bonus, masks can also reduce spread of the flu. “We’ve been seeing dramatically reduced rates of other respiratory diseases in many places” thanks to mask-wearing, Murray tells Elemental.
A properly fitted mask of good-quality material can filter out large droplets, the type that can be visible when someone sneezes or shouts, and also smaller, virus-packing microscopic droplets called aerosols that can remain airborne and infectious for hours.
Research has shown that in countries where mask-wearing is a cultural norm, or where it’s been mandated, Covid-19 outbreaks have been less severe.
One preprint study, not yet peer-reviewed, found that masks were the single most important factor in controlling outbreaks, based on Covid data from 198 countries. “In countries that recommended face masks early on a national level, or those in which the public wore them early based on cultural norms, the Covid-19 death rate has been lower than projected,” says study leader Christopher Leffler, MD, an associate professor at Virginia Commonwealth University’s School of Medicine. “And it’s not just by a few percent, but up to a hundred times lower mortality.” A study in the United States found mask mandates slowed the daily growth rate of Covid-19 infections.
Meantime, anecdotal evidence is piling up to reveal that mask-wearing helps prevent Covid-19 outbreaks at crowded events, like outdoor protests, whereas largely maskless events like the September 26 White House nomination ceremony created a superspreader event. In one case study, an unmasked man infected 25 people nearest him on a flight from China to Toronto. Similar superspreader events have occurred at restaurants, sleepover camps, and churches when people weren’t masked up. Yet when two hairstylists in Missouri worked while sick with Covid-19, none of the 140 clients they had close contact with got infected — the stylists and the clients all wore masks.
The conclusion: Masks are not perfect. But there is overwhelming scientific consensus that they reduce the risk of infection. “The concept is risk reduction rather than absolute prevention,” says Peter Chin-Hong, MD, an infectious-disease specialist at the University of California, San Francisco. “You don’t throw up your hands if you think a mask is not 100% effective. That’s silly. Nobody’s taking a cholesterol medicine because they’re going to prevent a heart attack 100% of the time, but you’re reducing your risk substantially.”
“Masks are one of the easiest tools we have for reducing Covid spread, and so we’ll probably need them for many months to come — they’re going to be with us as long as Covid is a problem, and maybe even longer.”
Does a mask protect me, the wearer?
Absolutely. The knowledge on this has evolved in recent months as scientists gained a better understanding of how the virus spreads, and multiple research groups ran lab tests on various mask types.
“If it fits well with no gaps and you have at least a couple of layers of densely woven material, then it probably protects you against at least half if not 80% or more of the droplets and aerosols that we think are most important for transmission,” says Linsey Marr, PhD, a scientist at Virginia Tech and an expert on the transmission of the coronavirus through the air.
Even if a mask wearer gets infected, they are more likely to experience a milder case of Covid-19 because they were exposed to a lower dose than if they hadn’t worn a mask, some research suggests, though there’s no firm conclusion on this.
Masks are, however, just one layer — a vital layer — of protection. “Wearing face coverings does not provide 100% protection from infection,” says David Aronoff, MD, director of the Division of Infectious Diseases at the Vanderbilt University School of Medicine. “Protection also depends on maintaining distance from others, avoiding crowded areas, particularly those in poorly ventilated, indoor areas, and paying close attention to hand hygiene.”
Should everyone wear masks?
Yes, with the exception of children under age two and anyone who has trouble breathing, the Centers for Disease Control and Prevention says.
When should I wear a mask?
Anytime you’re around people you don’t live with. “Mask-wearing should just be a thing, anytime you’re in a congregate setting,” says Michael Mina, MD, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health. “Not wearing masks starts to have an ‘eroding effect’ on what others are willing to do. It’s kind of a slippery slope.”
Do I really need a mask outdoors?
Yes, if you’re near others. Risk is lower outdoors, but it’s not zero.
While there’s little risk of catching Covid-19 outside while, say, briefly passing several feet from an infected person who is not talking, the risk rises with proximity, duration, and activity. An hour around a picnic table with an infected person laughing or shouting would raise the risk considerably.
Here’s the common analogy offered up by aerosol experts: Imagine if the people around you were smoking, and think of the smoke as a plume of virus-laden aerosols. If there’s no wind, the smoke would linger and you would not want to be in the plume without a mask. You also don’t want to be downwind.
Should I wear a mask while exercising?
This one is tricky. Because exercise is all about heavy breathing and sweating, the World Health Organization advises against wearing a mask while exercising, because “sweat can make the mask become wet more quickly which makes it difficult to breathe and promotes the growth of microorganisms.” Also, there is some evidence that exercising with a mask can elevate your heart rate more than if you’re maskless, and even cause lightheadedness.
Yet the Mayo Clinic says it’s safe to wear a mask while exercising as long as you do only low- to moderate-intensity activities. (That’s one big vote for long walks, which are really good for the mind and body.) The CDC suggests exercising outdoors and away from other people if possible, so you don’t need a mask. Another option: Work out at home.
Some manufacturers make reusable masks designed for use while exercising, with moisture-wicking and antibacterial properties. Runner’s World offers the top picks here.
How can I organize mask-wearing into a habit?
We humans are bad at forming new habits if there’s no tangible reward, says Wendy Wood, PhD, a psychology professor at the University of Southern California and author of the book Good Habits, Bad Habits: The Science of Making Positive Changes That Stick. Whether a cash payout, a blue ribbon, or a nice pat on the back, rewards release dopamine in the brain and make us feel good, helping form a habit association in the mind, Wood explains.
Since wearing a mask “is not something most people find inherently pleasant or rewarding,” Wood offers three suggestions to help you habitualize the task:
- Make it rewarding: Remind yourself that you’re keeping yourself and others safe. And make mask-wearing more fun. You might buy masks with team logos or fun themes for kids.
- Make it easy: Store masks in a convenient, consistent spot. Install hooks by the door to hang masks along with car keys or your purse. (Entrepreneurs offer many mask-hanging solutions on Etsy; another idea is cheap plastic bins labeled with each family member’s name.) Keep a stash in your car.
- Stack it onto another behavior: Don your mask after tying your shoes, say, or before getting out of your car. Stacking is an excellent way to form a new habit.
Ultimately, habitualizing your mask-wearing will be one less thing to stress about in these stressful times, Wood says. “By forming the right habit, you don’t have to continually remind yourself to wear a mask.”
Face Masks Are Alleviating Social Anxiety
People are reporting that wearing masks make them feel less anxious and more confident
What’s the best type of mask?
“The main thing is that people find a mask that they will wear,” Aronoff says. So find a size, fit, and design that suits you. But also pick one (or more, as we’ll learn below) that effectively blocks respiratory droplets from passing through when you breathe, talk, cough, or sneeze.
Think of a mask as slices of swiss cheese that virus-laden respiratory droplets find sticky. One slice of cheese will allow a lot of respiratory droplets to pass right through some holes but potentially slam into the second layer. The larger the holes, the more pass-through.
Likewise, two layers of cloth in a mask is better than one, Marr says, and tightly woven fabric is better than a loose weave. A third layer of cloth does not add significant additional protection, her lab has found. A separate study, published in the journal ACS Nano, found that mixing materials, such as a layer of cotton and a layer of silk, can work better than two layers of the same material.
Some masks come with two layers and an interior pocket for a disposable filter. Note that these filters don’t always stay put, as I found with a $20 Outdoor Research mask, and the idea is you’ll need to buy replacement filters, which adds a disposable element that will impact your time, effort, and cost — as well as the environment.
The Best Masks for Every Situation, According to Health Experts
What are epidemiologists, virologists, and doctors putting on their (and their families’) faces in day-to-day life?
How can I tell if the material is any good?
Here are three DIY tests that Marr, the Virginia Tech researcher, says can reveal good or bad material, but consider them reasonable rules of thumb, not definitive scientific experiments:
- Hold the dry mask (or the fabric if you plan to make your own) three to four inches from a mirror and, using a spray bottle to create a mist (not a jet), spray the same spot twice. If the mirror gets wet, the material’s no good. “While this test in no way replaces typical standards, it should help you eliminate fabrics that are completely unsuitable for mask construction,” according to researchers at Georgia Tech who explain the test in detail.
- Try blowing out a candle through the mask or the material from about a foot away. If the flame goes out, Covid can get in. (This idea was popularized in a TikTok video by Bill Nye the Science Guy.)
- Hold the material up to a bright light; large or ubiquitous pinpricks of light indicate inferior fabric.
Comfort matters, too, of course. Cotton is a good choice for the inner layer because it’s soft and absorbs moisture, whereas an outer layer that repels moisture will stay cleaner and drier longer.
Store masks in a convenient, consistent spot. Install hooks by the door to hang masks along with car keys or your purse. Or keep your color-coordinated masks in your clothes closet.
How should the mask fit?
To be effective, a mask must fully cover the mouth and nose and fit tight around all edges. ”It’s important that the fabric is flexible enough that it can conform well to your face” to avoid any gaps or leaks, says Marr. One study estimates that gaps can reduce the effectiveness of a face covering by 60%.
Among the challenges in finding a good fit is the wide range of human noses. For most people, the best fit will involve a mask that covers most of the nose, to just under the eyes. The mask does not need to cover the chin, but that can provide a better seal than a mask that rides just under the mouth.
Also note that facial hair along the edges of any mask will cause leakage. To check fit, use a mirror to look for gaps, or take selfies from the sides, top and bottom. Also, place your hands around the edges and exhale a full breath as you might on whatever activities you’ll be doing. If you feel air escaping the edges, the fit is not perfect. Likewise, you’ve got a bad fit if you feel the air hitting your eyes, or if it constantly fogs your glasses.
The Right Way to Wear a Mask and Gloves
Personal protective equipment is only as effective as the person wearing it. Here’s how to avoid cross-contamination.
What about bandanas?
A bandana will block some respiratory droplets getting in or out, but bandana cloth is thinner than most T-shirt cloth. Doubling it up will help, but still, the material is thin and tests don’t rate it well. Regardless, the way a bandana is typically tied leaves it wide open at the bottom, negating much of its already limited effectiveness.
A controversial study recently suggested neck gaiters, typically made of spandex and polyester, might be worse than nothing for Covid protection, but subsequent research by Marr and a colleague suggests gaiters perform similarly to cloth masks. Again, material matters and some gaiters may be made of a single, thin layer. This is one area where the science is in flux, and face coverings made for the purpose of masking are a safer bet.
Can I still make my own mask, like we were doing at the start of the pandemic?
Sure. Cotton T-shirts work well for this purpose, but not all cotton is created equal. A study published in September in the journal Aerosol Science and Technology found that fluffier materials like fleece, velour, jersey, and French terry are more effective than regular cotton. Coffee filters and paper towels were found to be very effective, too, and could be creatively inserted (and swapped out daily) into a two-layer mask, if you wish to complexify the construction and introduce a disposable element. Detailed mask-making instructions are available here from the Vanderbilt University Medical Center here from the Atlantic Health System, and Johns Hopkins has instruction for adult and child masks. All these require some sewing.
Researchers at Colorado State University have created an online app to compare the effectiveness of 29 materials and filter combinations — particularly helpful if you have knowledge of various fabric types. It shows that two-ply flannel works better than two-ply quilt cotton, as one example. A two-layer bandana fares poorly.
Why not just use surgical masks?
The various plastics they’re made of, such as polyester and polypropylene, will last centuries. The United Nations estimates that 75% of surgical masks are ending up in landfills or the ocean, where over time they decay into small bits and pieces that end up in the guts of marine animals.
The environmental impact makes surgical masks an odious option for many people, though they remain important in health care settings, and their ubiquitous availability has been an important factor in getting the country masked up. However, surgical masks may not offer the best possible protection for you. As conceived for the health care industry, they’re designed to be loose-fitting and serve primarily to stop splashes and large droplets from hitting the face of the wearer, according to the CDC.
Plus, unlike reusable masks that sometimes come in various sizes, surgical masks are one-size-fits-all, and that fit is not great for many people, a recent study found. In particular, they tend to bulge out at the cheeks, leaving big gaps. If you can get a tight seal with a surgical mask, great — lab tests find the material itself filters respiratory droplets exceedingly well. If these don’t fit you well, you’re better off buying or making a good-fitting cloth mask.
Also, many people are now making and selling what look like surgical masks, which makes it difficult to know the quality of any given product.
“Most should be okay, but customers should be concerned about poor quality masks if prices seem too good to be true,” Aronoff, the Vanderbilt University doctor, explains. “If masks are purchased online, customers should also read reviews carefully.”
What’s the deal with N95 masks?
Formally called N95 respirators, these bowl-shaped masks with two elastic straps that go over the head and below the ears are the gold standard. They’re designed to fit the face tightly and rated to block 95% of airborne particles down to 0.3 microns in diameter, which is smaller than the roughly 1 micron lower limit for virus-packing respiratory droplets. They’re used in hospitals and many industrial settings, too.
N95 production and quality is regulated by the federal government, and they are indispensable for health care professionals who are at extremely high risk of contracting Covid-19. However, they continue to be in short supply, so the CDC asks the general public to not use them. Importantly, experts say other well-designed face coverings, as we’ve detailed above, can be nearly as protective as N95s at filtering the virus.
Note that some N95 masks have exhalation valves to make it easier to breathe out. These protect the wearer but are not useful in protecting others and definitely should not be used for public Covid-19 prevention.
How do I care for my reusable mask?
Approach mask hygiene as you would underwear. “I recommend washing masks after each day of use or sooner if the mask becomes wet or soiled,” Aronoff says. “Always good to have some extra masks on hand.”
As with underwear, toss the dirty ones into the laundry and wash and dry them the same as you would any similar fabric, an approach the CDC recommends. Or you can wash masks by hand with soap and water and lay flat to air dry — ideally in sunlight, which is a natural disinfectant, though that seems like overkill since the CDC says soap and water will do just fine.
If you purchased the mask, look for manufacturer care instructions and any limits on the number of times it can be washed and reused.
Can I reuse a disposable mask?
The CDC and other health organizations discourage using disposable masks for more than a day, and in hospitals where the risk of infection is higher, they’re viewed as single-use products and may get tossed after each patient interaction (though the guidelines are often bent these days due to short supplies).
For you? “A disposable mask can be used throughout the day as long as it remains clean and dry,” Aronoff says. “If the mask becomes moist or soiled it should be exchanged for a fresh mask.”
Just remember to wash your hands when you remove the mask, and again before you put it back on, to prevent passing virus particles from your hands to the mask and on to your face.
Approach mask hygiene as you would underwear. “I recommend washing masks after each day of use or sooner if the mask becomes wet or soiled.”
What if my mask gets all yucky inside?
If moisture builds up to gross levels inside your mask, try breathing through your nose more. Also find a mask with an absorbing inner layer, such as cotton. Some reusable masks are marketed as highly breathable while still claiming to filter out the larger-than-air droplets that spread disease, and that’s a reasonable claim from a scientific perspective — just make sure the masks are effective (see “How can I tell if the material is any good?” above).
What if my glasses fog up?
This happens when warm, moist breath condenses on the cooler surface of your lenses. It means your mask doesn’t fit well and is not protecting you or others as well as it should.
Disposable surgical masks and some reusable masks come with a wire over the nose bridge that can be molded. If that’s not working, try a bandage or tape that’s made for use on skin to secure the gap, doctors at the Cleveland Clinic suggest. It may also be possible to pull the mask up higher and pin it into place with your glasses. If none of that works, you need a different mask.
What if my ears hurt?
The website Nurse.org offers several hacks, from securing the elastic around pigtails or a hair bun to wearing a baseball cap or bandana with a button on each side to loop the elastic onto. There are also masks that tie around the head and also the neck, instead of looping over the ears, and some have ties that can be adjusted so they’re not overly snug.
Will I breathe more carbon dioxide with a mask?
No. Carbon dioxide molecules, like oxygen molecules, are tiny and they easily pass through an effective face mask, explains Greg Schmidt, MD, an Intensive Care Unit physician at the University of Iowa Hospitals & Clinics.
Proof? Doctors and nurses have endured them daily for lifetimes. If you really find breathing with a mask difficult, odds are your mask is simply too thick or dense, or you have an underlying medical condition that should be tended to.
What if people have a hard time understanding me through a mask?
This is an underappreciated problem, and there’s a solution: Masks with clear windows so people can see your lips. For older people, these can be a blessing. About half of people older than 60 suffer hearing loss and, even if they don’t realize it, many rely on lipreading to fill in blanks in sounds and words they don’t catch. For the deaf, they’re vital.
“My PhD supervisor brought a whole box of transparent masks so I could lipread,” Alex Lu, a PhD student at the University of Toronto who is deaf, recently tweeted. “I’m crying — inclusivity done right.”
Why do some people refuse to wear masks?
Understanding what you’re up against out there — getting inside the mind of someone whose behavior seems inexplicable to you — can be helpful. Here’s at least some of what’s going on:
“No one enjoys being told what to do, and it’s in our country’s DNA to resist unless we can make a personal connection to a rule’s value or larger purpose,” explains Arianna Galligher, a social worker and associate director of the trauma recovery center at Ohio State University’s Wexner Medical Center.
Misinformation and purposeful pooh-poohing of science from the White House, suggesting Covid-19 is no big deal despite the rising death toll, feeds the anti-mask sentiments of some individuals.
“When the ‘mask dilemma’ is framed as government overreach in an attempt to control its citizens under the guise of protection from a virus that isn’t that serious, it’s difficult for people to accept that,” Galligher explains. “With so many mixed messages being disseminated about whether or not Covid-19 is dangerous, how the virus is transmitted from person to person and how to minimize transmission, it makes sense that some people are adopting a ‘don’t tread on me’ mentality about it.”
What should I do when other people refuse to wear masks?
“The reality is that you’re not likely to change someone else’s mind about the importance of wearing a mask in public — especially if that person is a stranger,” Galligher says. “If you’d like to say something to a non-mask wearing individual, try to stay calm and polite. If your goal is to encourage the person to put on a mask, yelling at them about it is counter-productive.”
What the Seat Belt Backlash Can Teach Us About Mask-Wearing
Americans have long pushed back against safety measures with clear benefits
Wearing a mask serves as a great nonverbal signal to others, Wood says. If you’re confronted with people who don’t wear them, just wear yours, take pride in that, and go out of your way to avoid others.
“Avoiding people who don’t have masks on is often enough to get them to put them on,” Wood explains. “Many people just forget. Wearing your mask is a cue, ‘I don’t want to be around you.’ And no one wants to be shunned.”