Covid-19

Are You (And Your Kids) Using The Right Mask To Prevent Covid-19?

As we head into our second pandemic winter, should you still be using the same cloth mask you bought in 2020?

The weather is cooling, the holidays are almost here, and the pandemic is still with us. Sure your 5- to 11-year-olds are about to get their first dose of the vaccine, but plenty of experts have warned we are in a holding pattern with this virus and it’s not disappearing from circulation anytime soon. That means we’re all headed indoors for school and family gatherings while Covid still circulates. If your kid (and you) are still wearing the same cloth masks you acquired in April 2020, it’s time to reconsider, says Dr. Tom Russo, a professor of infectious disease at the University of Buffalo.

Upgrading masks is at once a personal risk assessment and has wider public health implications. It depends on a family’s risk tolerance, medical vulnerabilities, local transmission, and mask requirements, and the availability of high-quality masks, plus the resources to obtain them. We know more about masks and their importance now than we did in the pandemic’s early days. Unfortunately, there’s still a wide range of official recommendations, competing expert advice, and potential quality inconsistency, which combine to make decisions around face coverings frustrating and fraught.

New standards have been published to ensure the consistency of masks, and some experts recommend respirators, which are more widely available now and may have fewer trade offs than previously-available models. (More on those below.)

Masks Are Still Crucial (Even If You’re Vaccinated)

For anyone 5 and up, vaccination is the best method of protection. But masks are still required by many schools and they significantly decrease the need to quarantine. As long as both the positive case and the other students wore masks, the CDC doesn’t consider those kids “close contacts,” so they may not have to miss school for quarantines.

Daniele Lantagne, a public health engineer at Tufts University, who has previously worked with the CDC on public health interventions and currently advises the WHO on mask guidance, wears a respirator mask when teaching college students precisely so that if there’s a positive case in her class, neither she nor her unvaccinated kids need to quarantine.

Are Respirator Masks Really Much Better?

By now the scientific consensus is clear: A person becomes infected with Covid-19 by breathing in infectious particles from another person. Cloth masks and surgical masks do a better job of blocking larger, heavier particles, while “respirator masks” — KF94s, N95s, and KN95s — are designed to filter particles that linger in the air for long periods.

Neither the Centers for Disease Control and Prevention (CDC) nor the World Health Organization (WHO) recommend that normal people (i.e. non front-line workers) wear respirator masks during their day-to-day activities. However, some physicists and aerosol scientists, notably Lindsay Marr at Virginia Tech, argue that these masks should be worn more widely to prevent Covid-19 transmission.

While no one disputes that respirator masks work, they have traditionally been tested and worn in controlled environments like hospitals or labs. The conventional wisdom has been that these masks are so impractical for the real world that their poor use would negate any benefit their more-effective filtration would create. They need to seal properly around the face so that all incoming air passes through the filter medium. They can be hard to breathe in, making them uncomfortable for long periods of time.

My argument for why we should use respirator-style masks is because we have the technology. There's no reason to not use them.

Lantagne says that kids shouldn’t be compelled to wear properly-fitted respirator masks. If the boat shape of a KN94 is more comfortable for a child, they should wear it without pinching the nose piece to allow for easier breathing.

But the old assumption that respirator masks are always uncomfortable is outdated, says aerosol scientist Aaron Collins. The KF94, which is a general-population standard in South Korea, was formulated to be comfortable and breathable for everyday wear.

Collins has tested dozens of masks in his spare time. He runs the Twitter account Masknerd and publishes his tests on Youtube for people to follow along. He says his testing has repeatedly shown that good KF94s, N95s, and KN95s are easier to breathe in than high-quality cloth masks, ones with three or four layers and filters (not the kind you bought back in April 2020).

“My argument for why we should use these masks is because we have the technology,” Collins says. “There's no reason to not use them.” Collins says most people he knows who wear masks for long periods have switched to good KF94s. “They are very comfortable. And they give you excellent protection to yourself and to others,” he says. “So it's a win, win, win.”

Lab-test data doesn’t always translate to real-world efficacy. A randomized controlled trial in Bangladesh, which is currently undergoing peer review, found that surgical masks outperformed cloth ones. The WHO still recommends a properly made cloth mask for the non-medical community, and while the study in Bangladesh might prompt a reconsideration of medical masks, “there’s no recommendation in the community for respirators,” Lantagne says.

“Very little of the data we have on mask filtration efficiency, or efficacy, or effectiveness in actual community context is on children, particularly children under 12,” says Lantagne. “We have a huge data graph gap on masks’ operational efficiency, and on mask effectiveness in community settings on kids.”

Be Pragmatic And Experiment

Experts agree that the best mask is one you or your child can comfortably wear for as long as you need to. A high-filtration respirator that can’t be tolerated at school isn’t an effective mask. Masks should fit close to the face and cover the nose, mouth, and chin without gaps. Many kids will need to wear a mask during the whole school day, with occasional breaks during lunch or possibly while outside. A mask a kid can’t or won’t tolerate wearing is ineffective

If a kids’ KF94 or N95 fits well, and is comfortable, great. If not, Russo says, “go down the line until you find what works for them.”

Not every child, even in the same family, will be able to wear the same mask. Iowa city dad Jeremiah Kurth has seen this firsthand. One of his 5-year-old twins will only wear a dinosaur cloth mask, while the other wears a child-sized KN95. His 13-year-old wears an adult KN95.

Make Sure Cloth Masks Meet The New Guidelines

Masks are a booming market niche — a research report from earlier this year predicted the face mask market will grow to nearly $32 billion by 2027 — and innovators have rushed to fill it.

If your child is wearing a cloth mask, it should meet the ASTM standard for “Barrier Face Coverings.” Similar standards are how medical face masks are regulated. They’re an important step in standardizing cloth face masks, Lantagne said. All three experts noted that one benefit of medical or respirator masks is that they’re a consistent product, whereas cloth masks carry some uncertainty around their performance.

None of this is cheap. A high-end cloth mask like the Enro costs $16.50 per mask, and kids attending school will likely need at least two or three. A set of three fabric masks from Baggu, which are only two layers thick (so Russo wouldn’t recommend them), costs $32. Disposable kids’ KF94 masks retail for $.70 to $3 per mask, and some of them are very cute. Collins says they can be worn for up to 40 hours without much loss in effectiveness. He rotates a few to let them air out between wearings.

Lantagne has made her peace with the masks her kids wear, and the necessary risks inherent in attending school and work during a pandemic. “We prioritize education, socialization, [and] mental health. We do what we can to prevent Covid,” she says.

Experts:

Dr. Tom Russo, Professor of Infectious Disease at the University of Buffalo

Daniele Lantagne, Public Health Engineer at Tufts University

Aerosol Scientist Aaron Collins