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12. Masks. Again.
Mind the gap. Masks are here to stay.
Well, my friend George said I would eat those words. He was right and I was definitely wrong. Masks are still here, and will be for the foreseeable future.
The rise of the omicron variant has, once again, changed the math. While I was once hopeful for improvements, I think precaution is a wiser path.
Here’s what we know: masks of all types work to catch droplets that come from your mouth and nose. They also work by capturing airborne droplets that someone else emitted into the air. Not all masks work well and each has distinct advantages and disadvantages. Let’s talk about why.
Cloth masks are my go-to protection method when I am in locations where I think risk is low. One or more of the following always apply:
There is good ventilation (outside events, rooms with HEPA filtration or outside windows opened), or it is a giant room (like a supermarket).
I’m pretty confident that everyone is vaccinated at that location.
There are very few people at that location.
My cloth masks are three ply flexible material, with elastic ear loops. I toss them in the washing machine each day, and have re-worn my masks dozens - maybe hundreds - of times. When the elastic strap gets loose, I have some of those little silicone cord locks to tighten the strap a bit. The masks cost a couple of bucks and they are definitely not fancy.
This kind of mask blocks most of the droplets coming from me, and blocks some, but not all, of the droplets that are emitted by others that are heading towards me. Science, including some of my own work, shows that this type of mask blocks somewhere in the range of 50-70% of these droplets, and we think that the droplets that get by the mask are mostly leaking through the gaps in the side of the mask.
And I do not agree that cloth masks are useless - this is the wrong message that only confuses the public. Provocative statements might get you a slot on prime time television, but these are destructive statements that are not grounded in scientific understanding and only harm public health. And, for many, cloth masks are their only economically feasible option.
No expert in public health wants the perfect to become the enemy of the good.
These are the pleated masks that are quite inexpensive. The material in these masks is better than cloth masks and really does a great job at capturing droplets. But, like cloth masks, they suffer from leaks around the edges which allows these droplets to sneak in.
Another problem with surgical masks are that they are usually disposable, worn only once. Surgical masks and cloth masks perform similarly to one another - they reduce your risk significantly, but with both, some risk still remains. I rarely wear a surgical mask by itself, in part because it is a disposable item and seems wasteful, so why not wear a cloth mask.
But something magical happens when a surgical mask and a cloth mask are combined. By layering a surgical mask with a tight-fitting cloth mask on top, we can combine forces and take advantage of the superior particle-catching material of a surgical mask with the tighter-fitting coverage of a flexible cloth mask. This almost surely reduces the number and size of mask gaps, forcing these droplets to go through a layer of cloth, followed by a layer of surgical mask, before they get to you.
It’s the way to go if you find yourself out and about, and suddenly in a situation where you view risk as unacceptable. Maybe some new people who you don’t know showed up in your office? Or there was an unplanned meeting scheduled in the cramped conference room? This is the case where I pull out my spare surgical mask to go under my cloth mask.
KN95, P2, N95, and FFP2 respirators
This is where it can get confusing. Many nations create standards for mask performance - KN95 is the Chinese standard, P2 is the Australian standard, N95 the US standard, and FFP2 the European one. There are some differences in how they are tested, but for you and I and Covid, they’re all pretty much the same.
They offer outstanding protection to wearers, both because the material they use is well engineered, and they are designed to create a tight fit to your face. Blocking at least 95% of droplets, they are your best option when risk is highest.
With the rise of omicron, I have made a decision that, for me, it is time to wear a KN95 mask when I’m in higher risk conditions. I generally avoid crowds, but can’t always do so. I often teach in large lecture halls with hundreds of students - a textbook case (terrible pun intended) where exposure risk could be much higher. For me, KN95 masks are part of my lecture preparation.
You might be wondering why not N95 masks, the ones certified in the US. There is nothing wrong with them at all and if you have them, use them. But N95 masks should be reserved for at-risk workers first, and every N95 mask I avoid means there is one more that is potentially available to a clinician or other worker who really needs it.
And do be careful with deceptive marketing. There are many vendors who sell counterfeit masks, or label their masks with made-up credentials (such as M95) or are simply lying about having government approvals. Research last year showed that some counterfeit KN95 masks were awful, and just a little better than a single-ply bandana.
Lastly, there is no reason to toss a KN95 or N95 respirator after worn for a few hours. I hang mine up, and let it air out for at least 24 hours, and wear it again. I suspect I can get the better part of a full semester from an alternating set of KN95 masks.
And if you set up a weird indoor mask clothesline like me, be sure to wash your hands when you hang them. Regular soap and water work just fine.
Which One to Choose?
All masks work to some degree, but we now need to make a decision similar to how one might decide whether to bring a rain coat to work.
Most of the time, a cloth mask does what I want it to do. I employ risk reduction measures by keeping a social distance, working from home as much as I can, or making sure people I engage with are vaccinated. It’s a mostly sunny day.
But there are times when unexpected events - like surprise rain storms - suddenly appear. In these times, I have a surgical mask tucked away in my bag, just for these passing events, to give me the protection I need.
But when I know it’s going to rain - there is a 100% chance of Covid showers - I am sure to bring the heavier gear. KN95 masks do the trick when I’m in crowded lecture hall, at my local movie cinema, or outdoor events where there might be lots of people.
I’m pretty sure Covid and its variants will be around for years. I’d expect masks to be part of our ensemble, at least until this summer, and vaccine boosters every year, probably forever.
That stinks. But that’s what I see.
And I’d love to grow free Up in the Air subscribers! Sign up any time. /rep
Got a question I didn’t answer? Feel free to leave me a comment! I’ll do my best to respond.