When Can We Leave Our Masks at Home?

The short answer is not anytime soon.

The world is yearning to return to normalcy and “COVID-19 fatigue” is impacting many individuals; however, the recent news about vaccines and treatments is not an indication that it is time to leave your mask at home. COVID-19 cases continue to increase around the world, including here in the United States where COVID-19 hospitalizations are at an all-time high.

One highlight is this battle is that this is the first time in history we will have vaccines with high efficacy and therapeutics quickly and safely developed during an ongoing pandemic by Operation Warp Speed. While this is exciting and positive news it will take time for these interventions to be delivered to the general public, which is not likely until spring 2021. And that is only if a vaccine goes through the emergency use authorization process without any hiccups.

There is finally light at the proverbial end of the COVID-19 tunnel, but we are not out of the woods yet. It is imperative that everyone continues to wear a mask, washes their hands or uses hand sanitizer, and practices social distancing. We must not let our guard down nor forget the importance of these three safety measures to protect ourselves and our communities.

Is my cloth mask really helping?

The ideal mask is a N-95 that is fitted on your face. However, these masks are only available for healthcare providers who are at the frontlines fighting the virus. The surgical, double layered cotton-fabric masks and multi-layered plain cloth masks both help to decrease virus circulation. A group at Duke University conducted a study testing 14 different types of face coverings, from folded bandannas to N-95s. The study found that surgical masks and cotton homemade masks were effective in preventing the spread of the virus. The basic homemade cotton mask can reduce the number of respiratory droplets a person releases into the air when talking, coughing, or sneezing.

Can my winter apparel (e.g., scarfs and turtlenecks) be used as a mask?

Neck fleeces, knitted scarfs, and bandannas are not effective at all because the material is too thin and porous. Moreover, if they become saturated with germs, they can be worse than wearing nothing. So, avoid them.

Remember that the construction of the mask impacts its effectiveness. Fabric has different sized spacing (i.e., “holes”) between individual fibers and that makes a difference. The smaller the ‘hole,’ the more difficult it is for the virus to pass through. Thus, dense and tightly woven fabrics offer the best chance of protection.

Similarly, masks made from t-shirts or any knit materials should be avoided. Over time such masks stretch due to pulling and tugging if it is too tight on the face. This causes the pores in the material to expand, making it easier for the virus to get through. Such masks easily allow aerosols to pass through, so avoid them. Also avoid any masks that have exhalation valves or vents, they can do more harm than good.

What should I look for when buying a surgical or cotton mask?

When buying a mask there are four things that must be considered. It:

• Has to be secured with ties or ear loops;
• Must include multiple layers of fabric (a minimum of two);
• Must allow for breathing without restriction; and
• Must be washable without causing damage or change in shape.

The fit factor is very important. A mask must fit snugly on the face, covering both mouth and nose with no gaps. Any space between the face and mask is a potential opening for the virus to enter your breathing space. Your mask should also have at least two layers of fabric to increase the effectiveness of the filtration of virus particles. CDC recommends non-valved, multi-layer cloth masks for the general public. The CDC also offers advice on how to choose a mask and how to care for it.

Should my mask have a filter?

Not necessarily, a filter provides the same amount of added protection as a second or third cloth layer would. The filter usually sits in-between the two outer layers of the mask and is used to further filter out particulates in the air. Theoretically, a face mask with a filter should increase its effectiveness in filtering out air particulates. A filter can range from a basic piece of cloth to carbon filters and HEPA filters. However, most face masks do not come with a filter. There is limited information about the effectiveness of inserting a HEPA filter into a manufactured or a cotton face mask. Carbon filters may help purify the surrounding air but don’t increase the efficiency of filtering out viruses. For homemade masks a high thread count filter (i.e., thread count of at least 180) may be useful. However, do remember to change the filter at least daily.

Is there an incorrect way to wear a cloth mask?

One of the biggest mistakes people make is just covering their mouth and not both their mouth and nose – you need to cover both. It is also important to not the touch the outer surface of the mask as it is contaminated. Always take off your mask using the elastics or the ties around your ears after washing or sanitizing hands. The same practice must be followed for putting the mask on. Never place a mask on surfaces after use. Store them in a Ziplock bag, or if the mask is washable put it in the laundry. Wash your hands again once the mask is stored away or in the wash.

Should my young children be wearing a mask?

CDC recommends that children age 2 and older should wear masks in public settings and when around people who don’t live in their household. For kids, two-layered cloth masks are the best option. It is also important to assure that the mask fits the child’s face and they are not touching it constantly to adjust it. Above all it is critical that the mask you buy for your child is made of breathable fabric that fits snugly to their face. Pick a mask decorated with your child’s favorite television character to help increase their willingness to wear the mask and keep it on. Also leading by example is important, if your child sees you wearing a mask, they will be more willing to wear one.

Do I need to put on a fresh mask every time I go out?  

Disposable masks should typically be thrown away after every use. However, if it is not being used in the medical field, it is recommended to replace them at least once a day. Cloth masks must be washed every day. If you are using a washable mask, put a clean one on before leaving home and put it in the laundry upon returning. Pay attention to any wear and tear on your mask and check if the nose bracket inside the mask is in good condition. If the mask is soiled due to sweat or something on it, and it is not a washable mask, throw it away.

In closing…

The primary purpose of masks is to reduce the emission of droplets from the mouth or nose that might contain COVID-19. We now know that most people infected with the coronavirus are asymptomatic and some who are pre-symptomatic are unaware as they have no symptoms or have not yet developed symptoms. Studies have shown that this population of asymptomatic and pre-symptomatic individuals account for more than 50% of transmissions. Wearing a mask helps an individual using it to reduce the potential of inhaling the virus laden droplets from someone with the active disease.

Better days are coming. Until then, we need to do our part in curtailing the disease until a vaccine is widely available. So, please use masks, continue to observe social distancing, and practice good hand hygiene.

Masking can not only save you from acquiring the virus, it can also protect your family, friends, and community. Everyone must make this small sacrifice if we want the number of cases and deaths to decrease. Without these non-medicinal interventions, the United States could see over 450,000 deaths by March 1, 2021.

Disclaimer: CDC is currently studying the effectiveness of various cloth mask materials. We will update this piece as we learn more.

Rashid A. Chotani, MD, MPH, IEM’s Chief Medical/Science Director
Dr. Rashid Chotani has spent over 20 years providing biodefense, infectious disease (with a focus on influenza, coronavirus, zika, Ebola, CCHF, dengue), and public health expertise to public agencies, private industry, academia, and non-profits.  He is a recognized expert in medical countermeasure (MCM) development, biosecurity, healthcare management, health surveillance, and the diagnosis of human and zoonotic diseases.