You Need to Upgrade Your Mask Now: Here’s How
Facing the more contagious coronavirus requires better fit and filtering, or doubling up, and watching out for fakes
With the coronavirus evolving to be more contagious, it might take fewer virus particles to make you sick. Just maintaining the same level of protection you had against the initial strain therefore requires a more effective mask. But the choices are bewildering, ranging from the gold-standard N95s to highly effective surgical masks to a slew of reusable options that range from good to fraudulent.
“We use N95 masks in the hospital, and I’ve taken care of more Covid patients than I can count,” says Abraar Karan, MD, an internal medicine physician at Brigham and Women’s Hospital and Harvard Medical School. “Many of them were not wearing masks and coughed right in my face, and I never got infected.”
Problem is, a year into the pandemic, N95s remain in short supply even for health care workers. Karan and other experts say the federal government needs to fast-track an existing plan to develop standards for testing, manufacturing, and distributing effective masks for the broader public — a plan still thought to be months from fruition.
“We can’t fully MacGyver our way out of this,” Karan tells Elemental. But we can try. In search of a more perfect mask, Karan and other experts offer the latest science-based mask options and clever hacks, from 3D-printed nose clips to doubling up your masks, that MacGyver would surely appreciate.
Filtering material works by forcing air to twist and turn, trapping virus-laden respiratory droplets like leaves caught up in a river strewn with fallen logs and branches. Anything from cloth to nylon will trap some particles, but no single layer of cloth is ideal. After N95s, the most efficient filters are the ubiquitous, disposable surgical masks. As with N95s, surgical masks employ a layer of non-woven polypropylene, made of highly effective, randomly arranged fibers.
“We can’t fully MacGyver our way out of this,” Karan tells Elemental. But we can try.
“Now that we have more transmissible variants, we need everyone to try to add a specialty filter material to their mask setup,” says Linsey Marr, PhD, a scientist at Virginia Tech and an expert on the transmission of the coronavirus through the air. “This could be a surgical-type mask or a HEPA (high-efficiency particulate air) filter. Some microfiber cloths also work well.”
Not all products marketed as surgical masks are created equal, however. See the Food & Drug Administration’s list of surgical masks approved for coronavirus protection under an Emergency Use Authorization. Surgical masks are disposable, raising environmental concerns, and they are prone to fitting loosely. So…
Get the fit right
No matter how good the material, a mask must fit tight to be effective, leaving no gaps for air to enter or exit unfiltered. “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,” Marr says.
Pull it snug: Several hacks can close gaps and improve efficiency, including fastening ear loops back with a hair clip or enhancing the seal with strips of nylons, according to a recent study in the journal JAMA Internal Medicine.
Nose clips: If your mask does not have a bendable nose clip, get a new mask. Or if you’re DIY-inclined, you can measure your nose topography and have a custom clip 3D-printed just for you. In Debugger, Dave Gershgorn explains how he did this to stop his glasses from fogging up.
Rubber bands: Ex-Apple employees Sabrina Paseman and Megan Duong devised the Essential Mask Brace, a contraption of flexible straps that fits over a surgical mask and snugs it tight with head and neck straps. The product claims to eliminate glass-fogging, too. They sell the product and also offer free instructions for making a simple version.
To check fit, look for gaps using a mirror or some selfies from all angles. Or place your hands around the edges and exhale a full breath. If you feel air escaping the edges, fix the fit. Fogged glasses also indicate a poor fit.
“If it fits 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.”
Look for layers
Whether you buy a disposable surgical mask or a reusable designer mask or make your own, it should have two or three layers, Marr says.
“More layers are better up to the point where it becomes harder to breathe through,” she advises. “If it’s too hard to breathe through, then air may leak through gaps around the sides.”
Cotton, silk, and polyester have all proven effective in lab tests. Marr’s advice on what to look for: “Anything that is tightly woven, such that if you hold it up to the light, you can’t see through it, or if you hold it up and spray [water] through it, nothing comes through.” (Georgia Tech researchers illustrate these simple tests here.)
Some reusable masks come with pockets into which a third layer of special filter material is inserted and periodically replaced. While Marr has not tested this setup, she says it should be an effective approach, assuming the materials in all three layers are of good quality.
If one mask is good, can two be better? “This makes sense, particularly if it combines something that filters well, such as a surgical-type mask, with something that fits well, like a tight cloth mask, on top,” Marr says. “More layers add more filtration ability, but it’s important to maintain breathability, too. Too many layers that make it hard to breathe through the mask could mean that you take in more air through gaps, and that air wouldn’t get filtered.”
Even a neck gaiter can serve as a helpful second layer, she says. While the thin, stretchy fabric of a gaiter is not considered ideal as a primary face covering, think of it as a handy, warm backup around your neck that could be pulled over a proper mask to seal gaps and provide an additional layer in situations of high potential exposure.
“I’m all for double masking as a temporary backstop [as a] better fit,” Karan says. “But we need to keep pushing for certified and tested protection with ‘Hi-Fi’ masks as many other countries have already.”
“More layers are better up to the point where it becomes harder to breathe through. If it’s too hard to breathe through, then air may leak through gaps around the sides.”
Check out high-filtration (Hi-Fi) alternatives
N95 masks, also called respirators, must be approved by the National Institute for Occupational Safety and Health (NIOSH). They are tested for a sealed fit and rated to filter out at least 95% of airborne particles. The U.S. Centers for Disease Control and Prevention maintains a list of approved N95s (see also a summary table). Disposable N95s are vital for use in hospitals and by first responders. Essential workers in crowded settings should be wearing them too, experts say, were there enough to go around.
Yet there are several options for Hi-Fi alternatives, for anyone willing to do additional research, says Devabhaktuni Srikrishna, founder of Patient Knowhow, which curates educational health content.
In the Harvard Business Review, Srikrishna, Karan, and colleagues reviewed Hi-Fi mask options that are N95 approved by NIOSH and reusable (the research is summarized with instructive videos here). Some of these look like other masks but have a silicone gel seal. Others, called elastomeric N95 respirators (eN95s), are more expensive and much bulkier — you’ll look like an extra from the movie Contagion, but you’ll be well protected.
“There are also many innovative mask designs that are seeking N95 approval, have published their test results online, and are well along the path to getting N95 approval,” Srikrishna says. “So I would consider those if you have the time and technical aptitude to understand the differences.”
One important caveat: Some N95 and eN95 products have exhalation valves, which make breathing out easier. These protect you but they do not effectively protect others, should you have the virus (and perhaps not even know it).
Also well worth noting: The United States does not have a lock on helpful mask certification. “KF94 from South Korea and FFP2 from Europe are also considered reliable [and] comparable to N95 by many people,” Srikrishna says.
Beware of fakes
Online stores are the Wild West of mask marketing, which means you need to be armed with all of the information above and below to make an informed selection.
The CDC maintains a list of dozens of counterfeit N95s, along with tips on how to determine if a mask has an official NIOSH 95 rating and how to spot fakes. Some of the clues are obvious: No NIOSH label, or NIOSH spelled wrong. The addition of sequins is a NIOSH no-no, too.
“Most masks sold on Amazon or online are unknowns from a safety standpoint.”
Finally, look for well-known brands and trusted resellers. A product made by a company you’ve heard of and sold at your local pharmacy is likely to perform as marketed. On Amazon, you may or may not get what you expect from one of the many resellers peddling similar unbranded products through nonsensical company names like Weezel or Maskmarketeer (those are made up, but you get the idea).
“Most masks sold on Amazon or online are unknowns from a safety standpoint,” Srikrishna says.
Don’t rely solely on masks
Just as masks should be layered, so should your overall prevention efforts, each of which is imperfect on its own — and made even less perfect with a more contagious coronavirus strain that scientists now say might be more deadly, too. The advice: Mask well, then still avoid crowded indoor spaces, keep as much distance as possible from others, limit your time around other people, and ultimately get a vaccine when it’s your turn.
And if you do head out into the big bad world, remember that no mask is fully effective. Even the best ones filter only 80% to 95% of the virus particles — based on lab tests—but don’t account for human foibles like scratching an itch under the mask or pulling it down to eat or talk.
“What happens in the real world is different,” Karan says. “The way that people adjust and fiddle with their mask can change effectiveness drastically.”