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January 22, 2021

Is it time to ditch your cloth mask—and replace it with something better?

Daily Briefing

    Face masks, and especially cloth masks, have become fairly ubiquitous in the United States amid the novel coronavirus epidemic—but while experts say wearing a cloth mask is better than wearing no mask at all, some say it's time for Americans to ditch the less-effective masks in favor of masks that offer better protection.

    Are two face masks better than one? Here's what researchers say.

    Why Americans largely wear cloth masks

    As America's coronavirus epidemic started to take hold last spring, public health officials recommended that the general public in the United States wear cloth masks as opposed to medical-grade masks. According to Zeynep Tufekci, an associate professor at the University of North Carolina, and Jeremy Howard, a researcher at the University of San Francisco, that recommendation was intended as a "stopgap measure" to help protect Americans against the novel coronavirus while also preserving medical-grade masks, such as N95 respirators, for health care workers, as those masks were in short supply at the time.

    But manufacturers in several countries since have scaled up production of medical-grade masks, so they now are more widely available. And in many countries, medical-grade masks are now worn by most citizens. For example, Taiwan increased manufacturing of higher-quality masks at the start of 2020 and, by April, every Taiwanese citizen received a supply of high-quality masks weekly, Tufekci and Howard report in The Atlantic.

    Meanwhile, Hong Kong is distributing six-layer masks to its citizens; Singapore is working through distributing its fourth round of free, multilayer, reusable masks to every citizen; and Bavaria, Germany, recently announced that it will require its residents to wear higher-quality masks in certain public places, according to Vox.

    Yet, in the United States, CDC currently "does not recommend that the general public wear N95 respirators," with the agency stating that supplies of the masks need to be saved for health care workers. However, according to Tufekci and Howard, CDC hasn't updated its recommendations on the type of masks Americans should wear since the start of the epidemic, so it's difficult to tell if the agency's recommendation against the public wearing medical-grade masks is "because the shortages are really that dire or because this topic has not been paid sufficient attention."

    Why Americans should be wearing higher-quality masks, according to some experts

    Tufekci and Howard explain that while cloth masks "definitely help reduce transmission of the coronavirus from the wearer and likely protect the wearer to some degree as well," they don't work as well as medical-grade masks. Research has shown that certain medical-grade masks such as N95s, FFP2s, and KN95s are much better at protecting the mask-wearer and reducing viral transmission than cloth and some other types of face masks.

    So now that medical-grade masks are more widely available, Americans should consider upgrading from their cloth masks to better quality masks, some experts say.

    This is especially important in light of the new, more-contagious variants of the novel coronavirus that have emerged in recent weeks, the experts say. For instance, recent research shows that one of the new variants, called B.1.1.7, appears to be about 56% more contagious than the unmutated coronavirus, and researchers have now detected the variant in at least 45 countries, including the United States. On Friday, CDC announced that officials had detected the B.1.1.7 variant in at least 10 states, and the agency predicted that, by March, the more-contagious variant will be the dominant variant of the novel coronavirus circulating in the United States.

    A variant that much more contagious is concerning, according to Marc Lipsitch, an epidemiologist at Harvard University. He noted, for example, that if the variant is 50% more contagious than the unmutated coronavirus, "in less than two weeks, you get twice the number of cases. … And in a month or so, you have four, five times as many cases. But that's very approximate."

    That's why improved mask quality is so important, according to Tom Frieden, a former CDC director. "The fact that [the variants] are so infectious suggests to me having a better mask is a good idea," he said.

    In addition to being more effective at stopping the coronavirus's spread, wider use of higher-quality masks could lead more people to wear masks, overall, because people could be more likely to believe wearing them is worthwhile, according to Tufekci and Howard. Plus, wider use of higher-quality masks could better protect people from those who still refuse to wear any type of mask, Tufekci and Howard claim.

    "[T]he fact that some people refuse to wear masks makes it even more imperative that we distribute higher-grade masks to those willing to wear them," they said.

    What if medical-grade masks aren't available?

    Even if medical-grade masks aren't available to all Americans, there are still measures people can take to bolster the quality of the masks they can access, experts say.

    For example, according to Tufekci and Howard, studies suggest that combining surgical masks with a mask brace could increase their effectiveness. In addition, Americans could improve their cloth masks by adding a nose wire to provide better fit, as well as a filter insert.

    In addition, a tight, well-fitting mask with multiple layers is better than a mask made of a single layer, according to Julie Swann, a professor at North Carolina State University who has studied mask effectiveness. And ultimately, any mask is better than no mask at all, she said.

    Further, it's important to keep in mind that masks aren't 100% effective against contracting or transmitting the novel coronavirus, and it's important that people adhere to other evidence-backed public health measures, as well.

    "[T]he best protection still remains avoiding contact with other people indoors, especially for a sustained period of time," Stephen Goldstein, an evolutionary virologist at the University of Utah, said. "Masks are not 100% effective. Staying away from people is 100% effective" (Tufekci/Howard, The Atlantic, 1/13; Belluz, Vox, 1/15).

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