Now We Should Wear Face Coverings? The Difference Between Cloth and N95 Masks

New recommendations are rethinking the use of masks for the common citizen during the coronavirus pandemic. While some experts think this is a good step for public health, others are not so sure.

• By Amanda Smiley
• Apr 09, 2020

The CDC made it clear at the beginning of the outbreak that it does not fully understand the virus, and that there are still a number of unanswered questions that will come with time and research. However, one recent change in health recommendations is throwing people deeper into fear.

The virus is thought to spread mainly between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs or sneezes. For this reason, the CDC and WHO asked the average citizen to avoid wearing masks and leave them for the healthcare workers who really need them.

As scientists continue to study the virus, however, they are asking if the virus does have potential to be transmitted through the air. Here’s what new evidence they have found about the virus in the air, and the reason the U.S. government and CDC now recommend people wear face coverings out in public.

Sneaky Symptoms

As the CDC continues to research the spread and effects of the coronavirus, we known from recent studies that a significant portion of individuals with the virus lack symptoms (“asymptomatic”) and that those who develop symptoms (“pre-symptomatic”) can transmit the virus to others before showing symptoms. This means that the virus can spread between people in close proximity—like speaking, coughing or sneezing—even if the people are not exhibiting symptoms.

But researchers have been trying to answer the question: can these droplets remain in the air for a period of time and infects someone else, making the virus airborne too? Until now, researchers were fairly certain it could not.

Air Sampling

Researchers Josh Santarpia is one of the many who have been taking air measurements with a device that can detect tiny, invisible particles of mucus or saliva that come out of a person’s mouth and move through the air.

Another device that supposedly looks like a “fancy dustbuster” also sucks up air samples from 11 isolation rooms that housed 13 people who tested positive for COVID-19 infection, all of whom had a variety of symptoms.

In those air samples, researchers found the genetic fingerprint of the virus. “It was more than half of the samples that we took. It was fairly ubiquitous," says Santarpia, “but the concentrations were really pretty low.”

Before you jump to conclusions, it’s important to note that finding the genetic material does not necessarily mean that the virus could infected someone else. Some preliminary evidence indicates that this might be the case, but the team needs to do more work and try and be as certain as possible.

What is a Bioaerosol?

One NPR article explains the contention behind this virus to a “T.”

For a long time, researchers believed the virus was only passed through droplets in a patient’s exhalation—coughing, sneezing, spitting etc.

However, researchers are wondering if it can also be transmitted via bioaerosols—fine particles emitted when someone breathes that can be suspended in the air rather than larger droplets produced through coughs and sneezes.

Still, researchers do not know how many tiny particles in in the air is viable enough to infect another person. Committee experts also caution that uncertainty about all this is almost a given—because “there's currently no respiratory virus for which we know the exact proportion of infections that come from breathing the virus in versus coming into contact with droplets in the air or on surfaces.”

Many health organizations disagree, and there are differences in recommendation between the CDC, the WHO and other health experts.

Even in its technical guidance on how the virus is transmitted, the WHO says that protections against airborne transmission are only needed for health-care workers when they do medical procedures which might be anticipated to produce smaller respiratory droplets that could then be inhaled.

As the article explains, there are a number of differences in droplet size, air currents from coughs and sneezes, particle count in the air and droplet travel trends—all which make pathogens difficult to study and difficult to fully predict.

CDC and Trump Recommend Cloth Face Coverings

On Friday, April 3, President Trump said the Centers for Disease Control and Prevention now recommends that people wear cloth or fabric face coverings when entering public spaces like grocery stories and public transit stations. These face coverings can be made at home, and they are meant to prevent those who have the virus—and might not know it—from infecting others.

Trump emphasized too that wearing masks in public is voluntary, and that he will not be doing so.

These cloth face coverings are not the same as medical-grade surgical or N95 masks, however. The CDC makes it clear that is it better for the common citizen to make their own face covering from household items and not buy masks—as masks are still in short supply for healthcare workers, first responders and other essential members of society.

Dr. Jerome Adams, the U.S. Surgeon General, released a YouTube video of how to make your own face covering—and you do not need a sewing kit or any fancy equipment. You can use a t-shirt, a bandana or even a scarf.

Not So Fast

While the CDC and the US government now recommend face coverings for the common person in public settings, some are not so quick to support the recommendation. In fact, many public health experts say the policy may do more harm than good.

The biggest reason is that cloth masks are not medical masks: they are poorly suited and do not fit the face well to block out air. Furthermore, there is not much real-world evidence to recommend medical masks or backfire if people do not wear their coverings properly or if they are lulled into a false sense of security.

Still, those who like the idea say the cloth masks are more effective than doing nothing at all, and it could still be helpful. They say a cloth mask could help prevent people from touching their faces and convey a sense of severity of the pandemic.

Here are the biggest points from the cloth mask debate, as told by FactCheck.org:

• If there is a benefit to having healthy people mask up, the effect is likely to be small. No one should assume they are protected by a face mask, and you should continue to follow the 6-ft guidelines and wash your hands often.
• Some are worried that mask recommendations could lead people to ease up on social distancing and complicate efforts to preserve surgical masks for frontline health care workers.
• Health care workers should receive priority on medical masks, and ideally should be using N95 respirators when treating COVID-19 patients.
• Depending on the design, masks can limit the spread of a disease from an infected person, and/or they can protect the wearer from becoming infected.
• Respirators, like the N95 mask, do not function like cloth masks. N95 Respirators are disposable, tight-fitting masks that create a seal on the face and include a specialized filter that captures at least 95 percent of the airborne particles that pass through it.
• Surgical masks are not the same at the N95 mask or cloth masks. Surgical masks are not intended to provide protection against aerosols. As a CDC blog explains, surgical masks are “are designed to provide barrier protection against droplets, however they are not regulated for particulate filtration efficiency and they do not form an adequate seal to the wearer’s face to be relied upon for respiratory protection."
• Some experts are worried that even if the virus is sometimes airborne, a cloth mask would not do a whole lot to prevent the infectious particles from going around the ill-fitting mask and entering the air. “I do not believe a mask would reduce transmission prior to being symptomatic because air will never choose a path of more resistance (going through the mask)—it will simply go around the mask,” said Margaret Sietsema, occupational health professor.
• Very little research exists on the effectiveness and safety of cloth masks. A 2015 study suggests cloth masks could actually increase a person’s risk of infection—especially for healthcare workers.

For more information on the difference between different types of medical and industrial masks, read the OH&S article on the topic.

Long Story Short

Basically, there are not many things the health organizations and governments understand fully about the virus. Research is still ongoing; some think cloth masks are a necessary step, but others think they could be harmful.

What we do know is this: social distancing and staying home is working to control the spread, and proper hygiene and hand washing and disinfecting is the best way to kill the virus.