Should You Wear Only N95 Masks If You’re Immunocompromised or High-Risk for COVID-19?

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The media has been buzzing as new mask guidance from the U.S. Centers for Disease Control and Prevention acknowledges that properly fitted N95 or KN95 masks offer “the highest level of protection” against the Omicron variant. The CDC now states that “wearing a highly protective mask or respirator may be most important for certain higher risk situations, or by some people at increased risk for severe disease,” including those who are immunocompromised.

“By recommending these more protective masks, the guidance would focus on decreasing the risk of COVID-19 infection by limiting exposure to respiratory droplets,” says Daniel Hernandez, MD, Director, Medical Affairs and Hispanic Outreach for the Global Healthy Living Foundation (GHLF).

This new guidance raises some important considerations for people who are immunocompromised or high-risk for COVID-19 because of underlying health issues, who have been trying to protect themselves as much as possible — especially from the more contagious Omicron.

Why Cloth Masks ‘Don’t Cut It’ with Omicron

Prior to this change, the CDC didn’t recommend a specific type of mask. They recommended wearing masks that “have two or more layers of washable breathable fabric that completely cover your nose and mouth and fit snugly against the sides of your face and don’t have gaps.” They also recommended that the mask should have “a nose wire to prevent air from leaking out the top of the mask.”

The agency is now urging Americans to “wear the most protective mask you can that fits well and that you will wear consistently,” acknowledging that masks and respirators can provide different levels of protection depending on the type of mask and how they are used.

According to CDC’s website: 

• Loosely woven cloth products provide the least protection
• Layered finely woven products offer more protection
• Well-fitting disposable surgical masks and KN95s offer even more protection
• Well-fitting NIOSH-approved respirators (including N95s) offer the highest level of protection

This revision comes months after many public health and infectious disease experts were questioning the protective nature of commonly worn masks. “Cloth masks are not going to cut it with Omicron,” Linsey Marr, a researcher at Virginia Tech who studies how viruses transmit air, said in a recent NPR article.

This is because Omicron is highly transmittable — spreading three times faster and multiplying 70 times faster inside the respiratory tract tissue than Delta, according to Hong Kong researchers.

Also, N95 and KN95 masks have material with an electrostatic charge, which “actually pulls these particles in as they’re floating around and prevents you from inhaling those particles,” which can then multiply in your respiratory tract, Abraar Karan, MD, an infectious disease physician at Stanford University, told NPR.

If worn properly, they are both designed to filter at least 95 percent of particles in the air — including viruses and bacteria. The main difference between N95 and KN95: N95 masks meet the U.S. standards for respirator masks while the KN95 masks meet standards for China.

What If I Can’t Afford or Access These Better Masks?

Prior to the CDC’s impending change, CreakyJoints and Global Healthy Living Foundation community have had trouble finding these masks. According to a recent poll of our COVID-19 Patient Support Program, nearly 25 percent of survey respondents said they had difficulty accessing N95 or KN95 masks during the surge due to the Omicron variant.

However, the Biden administration just announced that it will make “high-quality masks” available to Americans for free, with more details coming about how they will be distributed, CNN reported. And the CDC’s website also no longer refers to a shortage of respirators.

“Cloth masks are still better than none but now that these better masks are more readily available and variants are still a real part of our life, it is important to protect ourselves as much as possible, especially if you are immunocompromised,” says Dr. Hernandez.

Here are a few considerations to make your mask-wearing more protective.

Be mindful of your setting

If you only have a few N95 masks, consider using them during times where it’s more difficult to social distance or avoid large crowds — in crowded public settings, while traveling, or when you know you’ll be around people who are unvaccinated.

Wear your mask properly

It can’t hurt to take a minute and make sure that you’re wearing your mask correctly — it’s pressed to your face — and that it’s comfortable so you’re not fussing with it all day. Find out common mask mistakes you may be making.

Reuse it, but only a few times

“Although N95 masks are ideally used once and discarded, the CDC recommends that you don’t use them more than five times,” says Dr. Hernandez.

If you are running to the grocery store one day and to a doctor’s appointment the next day, it may be feasible to wear the same mask. But you’ll need to take extra precautions, notes the Navajo Health Command Operations Center, including:

• Pay attention to the condition of your mask — and discard if visibly dirty or damaged; contaminated with blood, respiratory, or nasal secretions, or if you wore it when in close contact with someone who you found out was infected with COVID-19
• Hang used clean and undamaged masks in a designated storage area
• Consider keeping masks in a clean, breathable container such as a paper bag between uses
• Only use one N95 or KN95 mask at a time; don’t combine with another type of mask

Double-mask when you’re not wearing an N95-style mask

While the CDC does not recommend layering a medical procedure mask underneath a second medical procedure mask — nor double masking with two cloth masks — you can do the following to improve fit and filtration: Wear a disposable mask underneath a cloth mask, and position so the cloth mask pushes the edges of the disposable mask against your face.

Be a smart consumer

Shilpa Venkatachalm, PhD, Associate Director of Patient-Centered Research at the Global Healthy Living Foundation and co-principal investigator of ArthritisPower, recommends checking out Project N95, a National Critical Equipment Clearinghouse for personal protective equipment (PPE), which offers low-cost, high-quality masks.

If you decide to go the Amazon route, make sure the mask is legit before you buy it and after it arrives.

Prior to purchasing a mask online, the CDC recommends looking for the following red flags:

• The primary contact email address is connected to free email account
• Bad grammar, typos, and other errors
• Mixed names/logos
• Odd privacy pages, broken links

Once the mask arrives, ask yourself:

• Is it sealed properly — or just in a twist-tied or zipped up bag?
• Does it state where the mask was manufactured — in case you need to contact someone if there is a problem with the mask?
• Is there a brand name on the mask?
• Is there false advertising like “genuine” or “FDA approved”? Note: An N95 mask is approved by the National Institute for Occupational Safety & Health (NIOSH), not the FDA.
• Is there an expiration date on the packaging — to determine when the particle-repelling electrostatic charge will degrade?
• Are there any noticeable defects — is the nose-bridge wire crooked or do the elastic detach easily?

The bottom line: It’s best to wear an N95 or KN95 mask when in crowded public settings if you’re immunocompromised. If you don’t have a N95 mask yet, social distance, double mask with surgical and cloth, get boosted, and get a 4th dose when eligible.

Read more about ​​Omicron and the immunocompromised in this guide for those at high risk for COVID-19.

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