People hate face masks. I hate face masks! But a new study in the BMJ (formerly the British Medical Journal) published on November 18, 2021 reveals that mask wearing works to help prevent COVID-19 infections. The authors note, “Specifically, a natural experiment across 200 countries showed 45.7% fewer covid-19 related mortality in countries where mask wearing was mandatory.” In the BMJ meta-analysis and systematic review the authors screened 36,729 studies. They boiled those down to 72 studies that met their rigorous “inclusion criteria.” The bottom line: mask wearing reduced COVID-19 infections by 53%. They were not able to differentiate between type of mask, but other research suggests N95 masks that fit snugly with elastic behind the head offer the best protection.
COVID Cases Climbing Again!
We are approaching two years of pandemic. It feels like forever. I know that most people want to forget about the coronavirus and get on with their lives. So do we. But as I write this, more than 5 million people have died worldwide and we are approaching 800,000 deaths in the US. The two-week daily average shows that cases are climbing by more than 20%, though states vary in their susceptibility. Over 1,000 people continue to die every day from COVID-19 in the United States.
We are not alone. Germany, the UK, the Netherlands, Belgium, France, Austria, Hungary, Greece, Poland and Italy are seeing cases climb…again. Yesterday, over 8,000 people died from COVID worldwide.
We have heard from a lot of people who just don’t seem to care about COVID. At first they denied that people were dying because of SARS-CoV-2. In their mind it was all a hoax. Many insisted that doctors, nurses and hospitals were inflating COVID cases to make money.
“Why Health-Care Workers Are Quitting in Droves.” That’s the title of an article in The Atlantic (Nov. 16, 2021). Check it out please. If you think doctors and nurses are falsely labeling “normally” sick patients as COVID patients, this article will change your mind.
There was also the argument that COVID was no worse than influenza. Just suck it up and get on with life. That was a message we received frequently. With nearly 800,000 deaths, though, it is impossible to ignore the impact of COVID on this country.
We will soon hit 50,000,000 people in the US who have tested positive for COVID-19. Even though most may not have suffered serious symptoms or hospitalization, a huge number of them are now suffering with long COVID. These persistent symptoms can be life changing! You can read about this condition at this link.
N95 Masks Make a Difference:
Many other people maintained that masks were useless. Some insisted (without data) that face coverings actually made matters worse.
The BMJ study shows that:
“Worldwide, government and public health organisations are mitigating the spread of SARS-CoV-2 by implementing various public health measures. This systematic review identified a statistically significant reduction in the incidence of covid-19 through the implementation of mask wearing and physical distancing.”
N95 Masks Work Best:
Shortly after the pandemic began, people started seeking N95 respirator masks. They were in short supply and the CDC told people to save them for health care workers. 21 months later, N95 and KN95 masks are available, but the CDC says you don’t need them. Why not?
We think the government should be distributing free N95 masks to everyone ASAP! That’s because the latest research suggests that cloth masks and surgical masks are not very effective against the coronavirus. The Delta variant is refilling ICU beds and killing too many people.
The CDC’s Position on N95 Masks:
“DO NOT choose masks that:
“Are specially labeled ‘surgical’ N95 respirators, as those should be prioritized for healthcare personnel.”
We completely get it that nurses, doctors, first responders and all front-line medical personnel should have access to N95 face masks. But how is it possible that almost two years after the arrival of COVID-19 such masks are not widely available for everyone? I personally think the government should be distributing such masks at no or very low cost to the entire population!
Why N95 and KN95 Masks ARE Essential!
The controversy about masking has obscured a more fundamental question. How well do masks work to protect against airborne particles containing the coronavirus? A study published in the journal Physics of Fluids (July 21, 2021) attempted to answer that very concern.
The Canadian scientists simulated human breathing with mannequins used to train students in CPR. They compared different types of face masks, including surgical masks, those made of cloth and those rated N95 or KN95.
Neither cloth masks nor surgical masks were very effective for blocking exhaled particles. Three-ply cloth masks had 12% efficiency while surgical masks did not even achieve 10% effectiveness. The problem seems to be that there are gaps around the edges of both surgical and cloth masks, especially at the bridge of the nose but also at the cheeks and lower jaw.
N95 and KN95 masks are designed to fit the face more snugly. Their filtration efficiency was much better, but not perfect.
The authors summarize their findings:
“The results show that a standard surgical and three-ply cloth masks, which see current widespread use, filter at apparent efficiencies of only 12.4% and 9.8%, respectively. Apparent efficiencies of 46.3% and 60.2% are found for KN95 and R95 masks, respectively, which are still notably lower than the verified 95% rated ideal efficiencies.”
“The present results provide an important practical contrast to many other previous experimental and numerical investigations, which do not consider the effect of mask fit when locally evaluating mask efficiency or incorporating mask usage in a numerical model. Nevertheless, if worn correctly, high-efficiency masks still offer significantly improved filtration efficiencies (apparent and ideal) over the more commonly used surgical and cloth masks, and hence are the recommended choice in mitigating the transmission risks of COVID-19.”
The Bottom Line On This Study:
Fit is really important when it comes to face masks. If your glasses fog up when you are wearing a mask, air is escaping. If the mask keeps slipping down below your nose, it does not fit! If there are gaps around your cheeks or under your jaw, you are either spreading virus (if you have COVID-19) or you are breathing in virus if someone around you has COVID 19.
Most of the masks that people fasten around their ears will not fit snugly. Face masks with elastic that goes behind the head are far more likely to create a good seal. N95 and KN95 face masks that fit correctly are far more likely to prevent viral particles from exiting or entering your nose or mouth.
What About Availability?
“The Biden administration has invoked the Defense Production Act to prioritize production of N95s and other medical supplies. But even with those measures, U.S. hospitals remain worried about their supply of these medical masks — more formally called respirators — despite efforts by factories to churn out billions more.
“‘In most of the hospitals, nurses are wearing their N95s for five shifts,’ or up to 60 hours, says Mary Turner, president of the Minnesota Nurses Association and an intensive care nurse working with COVID-19 patients. ‘It’s becoming the norm to not wear N95s the way they’re supposed to be used.’”
Today, KN95 and N95 face masks are widely available. The Wirecutter.com website of the New York Times highly rates the Kimberly-Clark Professional N95 Pouch Respirator (53358), NIOSH-Approved mask. You can read the review at this link. The review also gives high marks to the Powecom KN95 respirator mask with headbands.
I personally have found the 3M VFlex 9105 N95 Particulate Respirator doesn’t fog my glasses when it fits snugly around my nose. The wire nose guard facilitates a good seal.
What’s the Big Deal About N95s?
By now you know that the Delta variant of the SARS-CoV-2 virus is highly contagious. That is why we need the very best masks there are. This is especially true as people get ready to travel during the holidays while COVID cases are climbing.
What makes N95 respirators so important? First, N95s are certified by NIOSH (National Institute for Occupational Safe ty and Health). They are designed to fit snugly with rubber bands that go behind the head rather than around the ears. N95s and KN95s are far more efficient than cloth or surgical masks when it comes to trapping small particles.
If I see one more person wearing a loose fitting cloth mask under their nose, I fear I will lose it. And then there are all those folks who refuse to wear a mask inside. Sorry folks, COVID is not done with us.
“…have demonstrated that they can filter out a minimum of 95% of airborne particles under worst case test conditions.”
The latest study from Canada calls the 95% effectiveness number into question, but clearly demonstrates that both N95s and KN95s are better than most other face coverings.
Airlines and Other Countries Are Tightening Mask Requirements:
Many organizations around the world are tightening their mask requirements to limit transmission of the Delta variant of the SARS-CoV-2 virus. Some airlines are now mandating higher-quality face masks for their passengers. The German airline Lufthansa is preventing passengers from using bandannas, gaiters, scarves, cloth face masks and masks with valves. Passengers on Lufthansa airlines will be required to wear surgical, KN95 or FFP2 masks.
Finnair and Air France are also banning cloth masks or those with exhalation valves. Some American airlines are also instituting more rigorous requirements, but most have not yet banned cloth face masks.
In France, the Ministry of Health is now calling for surgical masks when people leave their homes. Their position is that standard fabric masks are inferior to surgical or N95 masks.
Other countries have made it easy for their citizens. For example, Hong Kong has sent six-layer masks to everyone. In Austria, people over 65 have been provided with medical masks similar to N95s. Next door in Germany, people are required to wear medical grade masks on public transit and in stores.
What’s Wrong with the US?
The CDC maintains that N95s are not necessary for the American public. The leadership does not recommend two masks, even though Dr. Anthony Fauci has been seen wearing double masks.
The head of the CDC states that N95 masks are “hard to tolerate all day, every day.” But that is not the point. Most people do not wear their masks all day every day. They wear a mask when they go to the grocery store or the post office. If they get a haircut, they need a highly effective mask for 30 minutes to an hour.
Dr. Linsey Marr, an expert on aerosol transmission, suggests that wearing a second mask makes sense. She specifies a disposable nonwoven mask covered by a tight-fitting cloth mask to trap about 90 percent of virus particles.
Why Not Wear an N95 Mask?
Dr. Joseph Allen is an associate professor and director of the Healthy Buildings program at Harvard’s T.H. Chan School of Public Health. He wrote an opinion piece for the Washington Post (Jan. 26, 2020) titled:
“Everyone should be wearing N95 masks now”
Dr. Allen points out that
“A typical cloth mask might capture half of all respiratory aerosols that come out of our mouth when we talk, sing or just breathe. A tightly woven cloth mask might get you to 60 or 70 percent, and a blue surgical mask can get you to 70 or 80 percent.
“But there’s no reason any essential worker — and, really, everyone in the country — should go without masks that filter 95 percent.”
In his Washington Post article Dr. Allen points out that a mask must fit really well. If air escapes out the top or sides, the mask is not really doing its job. It also has to fit snugly around the nose and chin.
Here is his take-home message:
“To see the true power of masks as a public health tool, we have to examine them in the context of everyone wearing them, where the power of each mask doubles. That’s because the particles have to pass through the material twice — once after being emitted and again before someone breathes them in. Take the example of two 70 percent efficient masks, which combine to reduce 91 percent of particles. Not bad. But two N95s result in greater than a 99 percent reduction in exposure.”
The People’s Pharmacy Perspective:
Many visitors to this website complain that face masks don’t work. In some ways they are right. When people wear masks under their noses, they won’t work. When people wear a face mask as a chin strap, it won’t work. When people wear loose-fitting cloth masks that keep gapping at their cheeks or slipping down below their noses, they won’t work.
If the government can spend tens of billions of dollars on vaccines, we think it can contribute to affordable or free N95 or KN95 masks. Health workers should not have to scramble to find highly efficient face masks. Grocery store workers, bank tellers and everybody who comes into contact with the public should also have access to highly effective masks.
And finally, we think the public should be able to access N95 masks at a fair price. Better yet, they should be free!
We hope that the implementation of the Defense Production Act will lead to adequate supplies of N95 respirators for health care workers and the public. The sooner we can reduce exposure to the Delta variant the better!
You can read about aerosol transmission of COVID-19 and why plastic COVID barriers were a mistake at this link. It will reinforce the need for highly effective face masks.