Prominent public health officials have increasingly highlighted the limitations of cloth face masks, pushing for more effective respirator masks such as N95s as omicron engulfs the United States, a shift in messaging from earlier in the pandemic.
Officials encouraged the use of cloth masks in the spring of 2020 as a desperate measure to slow the spread of COVID-19 after previously recommending against masks and continued to boost them in the months after. Now, though, more experts are saying that the masks are not helpful.
“Cloth and surgical masks do absolutely nothing for protection from ambient virus,” said Chad Roy, a microbiologist at Tulane University School of Medicine, referring to the virus spreading through the air. “All this song and dance of wearing cloth masks with some presumption that you’re being protected from ambient virus is completely and positively 100% counter to how masks and respirators work.”
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Evidence of the N95’s superiority to the cloth mask has been well-documented. In 2015, for example, before the onset of the pandemic, scientists from Australia, Vietnam, and China concluded that healthcare workers “should not use cloth masks as protection against respiratory infection. Cloth masks resulted in significantly higher rates of infection than medical masks, and also performed worse than the control arm.”
“The use of an N95 does give you some protection in a bidirectional manner, meaning that if you’re using an N95 without a one-way valve for exhalation … you’re protected from not only ambient aerosol of a particular size, as well as exhalation if you are ill, so it does double duty in that regard,” Roy said.
A cloth mask does not sufficiently filter out the air particles encasing the virus that come into the wearer, but it reduces the number of air particles going out. The 95 in the name “N95” denotes the percentage of air particles that the multiple layers of synthetic material are able to filter out thanks to an electrocharged layer of fabric capable of attracting and trapping fine droplets. Medical masks such as N95s, KN95s (certified in China), and KN94s (certified in South Korea) are best at preventing the spread of most airborne pathogens. Respirators also fit tighter on the face, eliminating air pockets through which air particles can seep.
“The material of the mask is beneficial from that electrostatic perspective,” said Dr. Karl Minges, interim dean of the University of New Haven’s School of Health Sciences. “So it has to do with both the structure in terms of the layers of the respirator masks and then the capability of providing a more secure fit.”
The Centers for Disease Control and Prevention recently updated their guidance for best masking protocols to reflect a growing body of evidence that omicron spreads much more rapidly in the air than previous variants. The agency announced last week that N95s and KN95s offer the best protection against the highly contagious omicron strain and that a respirator “may be considered in certain situations” and “can provide a higher level of protection than a cloth or procedural mask.”
The agency also conceded that commonplace “loosely woven cloth products provide the least protection.” The new guidelines, which had not been changed since October, mark the first time the agency explicitly addressed the varying levels of efficacy with each type of mask.
Still, Biden administration officials such as CDC Director Rochelle Walensky have long maintained that any mask is better than no mask as long as it fits well.
“@CDCgov continues to recommend that any mask is better than no mask, and we encourage Americans to wear a well-fitting mask to protect themselves and prevent the spread of #COVID19. That recommendation will not change,” Walensky said on Jan. 12.
Yet public health experts have mounted pressure on the Biden administration to prioritize respirators over homemade cloth masks given the rapid rate at which omicron can spread. For instance, Leana Wen, the former president of Planned Parenthood and now a professor of health policy at George Washington University who has commented on the pandemic frequently on television, said last month, “Cloth masks are little more than facial decorations. There’s no place for them in light of omicron.”
“This is what scientists and public health officials have been saying for months, many months, in fact,” Wen said in a separate interview with CNN. “We need to be wearing at least a three-ply surgical mask … You can wear a cloth mask on top of that, but do not just wear a cloth mask alone.“
It wasn’t long ago that government health officials were advising people to skip masks altogether. In late February 2020, when the pandemic was just a little-understood virus that people believed could dissipate after a few weeks in isolation, then-Surgeon General Jerome Adams begged people to stop buying masks on the basis that they were not effective at stopping the spread of COVID-19 and that the limited supply had to be reserved for healthcare providers and front-line workers. Vice President Mike Pence also told the public at the time that “the American people do not have to buy masks.” Dr. Anthony Fauci, the top White House doctor, also told people that masks were not as helpful as believed because of poor fits and face-touching. Fauci insisted later that his advice for regular people to forgo masks was meant to prevent mass panic and shortages of surgical and N95 masks among healthcare workers who were in greatest need of them.
The wearing of nonmedical masks was finally recommended by the CDC in April 2020, triggering a series of state-level masking orders that required people to cover their faces when out in public. Masking subsequently became routine in many places as both a public health measure and a courtesy to others.
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The Biden administration announced this week that it would prioritize distributing 400 million free high-quality respirators to be made available through local pharmacies and community health centers. The millions of N95s would come out of the 750 million masks currently stored in the Strategic National Stockpile. The rollout is expected to begin early next month.
