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Different Kinds of Face Masks

Make no mistake about it: Face masks are a critical tool in curbing the spread of the coronavirus pandemic. As a new modeling study concluded, if the majority of a population wore face masks in public — even just homemade ones — transmission of the virus would be dramatically reduced. This would help prevent future waves of the pandemic.

Face masks are especially important since the U.S. Centers for Disease Control and Prevention (CDC) now estimates that some 40 percent of people infected with the coronavirus don’t have symptoms of the disease and the chance of transmission from asymptomatic people is 75 percent. As well, people who eventually develop symptoms can transmit the virus to others before showing symptoms.

Masks work by keeping virus-laden respiratory droplets from being expelled and becoming airborne when an infected person coughs, sneezes, or talks. Inhalation of the virus is believed to be the primary way it spreads from person to person.

Masks may be most effective at preventing people with COVID-19 from giving it to others, but “face coverings also help the wearer because they block out the larger droplets that are carriers of the virus,” says Max Lebow, MD, medical director of Reliant Immediate Care Medical Group, which operates five urgent care clinics and a mobile clinic for COVID-19 testing in Los Angeles.

According to a study in Hong Kong, wearing a mask in public was effective for containing the spread of SARS coronavirus, a virus very similar to the one that causes COVID-19. It found that people who frequently wore a mask in public were half as likely to be infected. This is especially good news for people who with underlying health conditions that make them more susceptible to the effects of the virus.

In addition to those larger virus-containing airborne droplets that can travel when we cough or sneeze, however, it’s now believed that smaller particles emitted simply by talking can go much farther and linger in the air for hours. The spread of these tiny airborne particles, called aerosols, is even more likely in crowded, closed, or poorly ventilated settings. Read more here about airborne coronavirus.

The Most Protective Face Masks

As of now, N95 respirator masks, which are most effective for filtering out viral particles, should be used by health care workers, as they are still in short supply in many places.

While other kinds of masks are still an essential way to reduce the transmission of the coronavirus, they’re not a perfect shield — especially against these smaller, aerosolized droplets.

In a recent evaluation of the effectiveness of various masks in obstructing droplets from coughs and sneezes, results showed that off-the-shelf cone-style masks (like this one; not N95 respirators) proved to be the most effective — they were able to curtail the speed and range of the respiratory jets significantly, albeit with some leakage through the mask material and from small gaps along the edges, reported researchers from Florida Atlantic University. Loosely folded facemasks and bandana-style coverings stopped aerosolized droplets to some degree. (If you’re still on the fence about the value of covering your face, check out the visualizations yourself.)

One notable finding: In the study, uncovered coughs were able to travel noticeably farther than the currently recommended six-foot distancing guideline. Without a mask, droplets traveled more than eight feet; with a bandana, they traveled 3 feet, 7 inches; with a stitched quilted cotton mask, they traveled 2.5 inches; and with a cone-style mask, droplets traveled about 8 inches.

The take-home message: Any step you can take to contain your coughs, sneezes, and regular breaths behind a face mask can help limit how far the virus travels.

Despite the growing evidence of the protectiveness of masks, most of us can do better when wearing them. Check out these common face mask mistakes and follow the expert advice to avoid them.

1. You don’t always — or ever — wear a mask

A recent CBS News poll found that less than half of people say that they always wear a face mask that covers their nose and mouth when they go out; 16 percent of people sometimes wear one and 12 percent of people say they never wear one.

This goes against the advice from the CDC, which recommends that all people over the age of 2 wear a cloth face covering in public settings and when around people who don’t live in your household, especially when other social distancing measures are difficult to maintain. It’s also more urgent than ever to follow this advice, since we’re now seeing a dramatic uptick in COVID-19 cases in most U.S. states.

There are many reasons people choose not to wear a face covering, some of which are based on misinformation. For instance, if you have COVID-19 and are concerned that wearing a mask will increase your level of infection, rest assured, according to Kelly Cawcutt, MD, an infectious disease expert and critical care physician at the University of Nebraska Medical Center, in an article about face mask myths. “There’s no evidence to support this self-contamination claim.”

As for the idea that wearing a mask will cause a buildup of carbon dioxide, that’s also false. “Just as oxygen can get in, carbon dioxide can get out,” Dr. Cawcutt writes. She also assures that we inhale trace amounts of carbon dioxide, a waste gas that’s released when you exhale, all day long and suffer no issues. Surgeons routinely wear masks for several hours during procedures without developing lung problems.

2. Your nose or mouth is exposed when you ‘wear’ a mask

To provide maximum coverage, masks should completely cover your nose and mouth, extending as close as possible to the eyes without obstructing sight to underneath the chin. Two don’ts, per CDC instructions: wearing your mask around your neck or up on your forehead. Lots of people also wear masks under their noses — “I see it too often,” says Dr. Lebow — but the virus is often breathed in that way. In fact, scientists recently identified two specific cells on the inner lining of the nose that are likely the initial infection points for COVID-19.

Tips for Stopping Your Glasses From Fogging

If you’ve taken to wearing your mask below your nose to prevent your glasses from fogging up (condensation can form when your warm breath hits the cooler air), try these tips instead:

  • Use your glasses to seal the top of your mask. “If you wear glasses, put your mask on first and then put your glasses on top of the material that’s over your nose,” Dr. Lebow advises. A secure fit will help keep the warm air from escaping through the top of the mask.
  • Wear a mask with an adjustable fit. If you wear glasses, a mask that adjusts to fit against your nose and cheeks is a must. Buy one that’s equipped with a metal tab over the bridge of your nose that you can pinch into place, or create a better fit with a homemade mask by sewing pipe cleaners or twist ties that mold to fit your nose into the top.
  • Treat your glasses. Borrow a trick published by two British surgeons and wash your specs in soapy water, shake off the excess, and let them air dry or gently wipe off the lenses with a soft cloth before wearing them again. The soap leaves behind a thin film that acts as barrier against fog.

3. Your mask billows out at the sides

“People are making these cute homemade cloth masks, which is well and good, but they can gap and pucker on the sides,” says Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut. “Even surgical masks stretch after a while, as you keep wearing them.” The upshot: While your mask should be comfortable and allow for easy breathing, you have to keep an eye on the fit.

“Think of your mask as a seal all around your face,” says Dr. Lebow. “You want it to touch your face on the sides to prevent airborne particles from leaking in.” Smooth out any gaps by tightening the mask from above or below.

4. You keep touching your mask

If your mask is harboring germs and you touch it, whether to pull it below your chin if you want to speak more clearly or to push it up or down to give yourself a break, you’re potentially contaminating your face and your hands. Hence the advice to adopt a hands-off policy once you don your mask.

“Once a mask goes on, you shouldn’t be touching it or reaching under it and touching your face,” says Dr. Lebow. “You should put it on and leave it on.”

If you’re constantly adjusting your mask because it’s too tight or loose, consider switching to a mask with ties or elastic loops and an adjustable nose strip to stay securely — and comfortably — in position. Tucking the bottom of your mask beneath your chin can also help prevent shifting. If you do touch your mask, use hand sanitizer or wash your hands with soap and water as soon as possible afterward.

Keep in mind that a second benefit of wearing a mask “is that it keeps you and others from touching your face and the ports of primary entry — the nose and mouth,” says Dr. Lebow. Though it’s not the main way the virus spreads, it’s possible that you can get COVID-19 by touching a surface or object — think countertops or doorknobs — that has the virus on it and then touching your own mouth, nose, or eyes. This is why hand washing and sanitizing is so important for removing virus particles you may have picked up from infected surfaces.

5. You have one of those masks with a valve

 Valve masks, which feature a one-way valve that opens up to allow exhaled air to pass through it, do have several benefits — the key one being that they’re more comfortable. These masks allow easier exhalation than traditional masks, as well as prevent humidity and reduce uncomfortable heat and carbon dioxide buildup inside the mask.

The downside to these masks — and the reason states like California and places like the Mayo  Clinic campuses are banning them — is that the valve design only filters air breathed in, not out.

That means COVID-19 viral particles can be released unfiltered when you exhale — and it won’t protect other people if you’re contagious,” says Dr. Lebow. “Since protecting others is one of the main reasons to wear a mask in the first place, it rather defeats the purpose.”

6. Your mask is dirty

Cloth masks should be washed after every wearing. “Once you’ve worn a mask, consider it contaminated,” advises Dr. Lebow. Wash masks in your regular laundry on warm or hot water and dry thoroughly.

Disposable, blue surgical masks can’t be laundered and — because they’re designed to be worn only once — should be thrown away after a single use. If you have to reuse one, experts advise storing it in a container with good ventilation, such as a brown paper bag, for several days, to allow the mask to air out and help inactivate the virus. Once this type of mask becomes visibly soiled or damaged, be sure to discard it.

7. You put your mask on or take it off incorrectly

When donning or doffing your mask, it should always be handled with clean hands to prevent any transfer of germs. (When washing hands, Dr. Lebow advises concentrating on the fingertips, where germs are more likely to be.) Avoid touching the front of the mask; instead, the CDC recommends grasping the mask by the ear loops or ties.

Some other tips on how to correctly maneuver your mask:

  • If your mask has pleats, they should open downward.
  • For masks with ties, fasten and unfasten the bottom ones first, then the top ones.
  • As soon as your mask is removed, fold it with the outside in and, if washing it, put it straight into the laundry bin, ideally one with a lid you can close to prevent contamination with the virus. Then wash your hands again.

8. You over-rely on your mask at the expense of proper social distancing

A mask is a great safeguard against spreading and contracting the coronavirus, but even the most protective N95 masks — those worn by health care professionals — only block transmission of 95 percent of the very small particles that the wearer inhales (hence the name).

That’s why social distancing — staying at least six feet away from others —  is also so important. When it comes to warding off COVID-19, remember the “three W’s”:

  • Wear a mask
  • Watch your distance
  • Wash your hands

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Cawcutt K. 3 Common Mask Myths Debunked By an Infectious Diseases Expert. Nebraska Medicine. June 10, 2020. https://www.nebraskamed.com/COVID/3-common-mask-myths-debunked-by-an-infectious-diseases-expert.

Considerations for Wearing Cloth Face Coverings. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. June 28, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html.

COVID-19 Pandemic Planning Scenarios. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. July 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html.

How to Wear Cloth Face Coverings. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. July 6, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-to-wear-cloth-face-coverings.html.

Interview with Max Lebow, MD, medical director of Reliant Immediate Care Medical Group in Los Angeles

Interview with Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut

Lau JTY, et al. SARS Transmission, Risk Factors, and Prevention in Hong Kong. Emerging Infectious Diseases. April 2004. Doi: https://dx.doi.org/10.3201/eid1004.030628.

Malik SS, et al. A simple method to prevent spectacle lenses misting up on wearing a face mask. Annals of the Royal College of Surgeons of England. March 2011. Doi: https://doi.org/10.1308/003588411X12851639107313b.

Stutt RO, et al. A modelling framework to assess the likely effectiveness of facemasks in combination with ‘lock-down’ in managing the COVID-19 pandemic. Proceedings of the Royal Society A. June 2020. doi: https://doi.org/10.1098/rspa.2020.0376.

Verma S. Visualizing the effectiveness of face masks in obstructing respiratory jets. Physics of Fluids. June 2020. doi: https://doi.org/10.1063/5.0016018.