Illustration by Mell Montezuma

How and When to Use Masks During a Pandemic

The Weekly discusses the proper use of masks—homemade, surgical, and N95—with an expert

In the months since the outbreak of COVID-19, the question of who should wear masks when, and what kind, has been the subject of mixed messages and debate. Until recently, institutions such as the World Health Organization and the Centers for Disease Control and Prevention (CDC) have only recommended masks for use by people who are symptomatic, or for people who are caring for someone who is, on the grounds that masks do not by themselves guarantee protection from transmission of the coronavirus. 

But on April 3, the CDC abandoned its no-mask stance and recommended that everyone should wear a cloth mask when leaving their home, whether they’re symptomatic or not. The same day, Illinois Governor J.B Pritzker recommended that people wear masks or cover their nose and mouth with fabric if they go outside. 

Proponents of the widespread use of masks have argued that the messaging around masks has been confusing. They have said, for example, that the order to only wear a mask when you’re sick doesn’t make sense because asymptomatic people may not know that they are sick. Due to public stockpiling and widespread shortages, masks are also often not readily available, which can be anxiety inducing and provoke panic. 

According to Dr. Evelyn Figueroa, a family physician and professor of clinical family medicine at the University of Illinois at Chicago, the confusing messaging around masks stems specifically from the fact that people often aren’t talking about the same type of mask. The information that follows can help you understand when, where, and how to use a mask.

“A mask is something that can help you and the people around you a lot, if you know how to use it,” said Figueroa. “But if you don’t know how to use it, a mask can give you a sense of false security.”

There are two widely recommended types of mask: N95 respirator masks and surgical face masks. Both are used in hospital conditions and clinics; however, the N95 is applied in specific high-infection-risk healthcare encounters, while the surgical mask is used under regular hospital infection control conditions. The N95 respirator mask is ninety-nine percent effective at keeping out small aerosolized particles such as certain chemicals and viruses like SARS-CoV-2, the virus that causes COVID-19. 

According to Figueroa, the N95 mask is not appropriate for people outside of a healthcare environment. 

“The reason why N95 [use] outrages me is because it’s for [patient care] at a very close range,” Figueroa said, noting that these masks are meant for frontline healthcare providers working less than three feet from a patient. “We only use them in the clinic if we’re literally sampling someone for COVID-19.”

Figueroa said she believes that N95 masks are unnecessary for everyday use outside of medical settings. They need to be fitted properly: this entails an annual fit-test for the healthcare professionals who usually use N95 masks, because the mask becomes much less effective if anything—such as facial hair—breaks the seal. N95 masks also provide incomplete protection: the user would also need to wear goggles or a face shield to cover their eyes.

“If you’re not doing all of these things, then the N95 really doesn’t function better than just a scarf or a [surgical mask],” Figueroa said.

The surgical mask is much less effective than the N95 mask, but Figueroa believes that these masks—along with homemade cloth masks, bandanas, or scarves—are better than nothing. In general, surgical masks lower the recommended space for practicing effective social distance from six feet to three, because they prevent splatter. But while they provide a physical barrier against visible splash or spray, airborne particles and germs can still get through. 

Due to the short supply of readymade masks, people have taken to washing or disinfecting their surgical masks and wearing them again. However, Figueroa said that this doesn’t work. Washing these masks or spraying them with alcohol damages the masks by eroding the fibers, making the masks less effective as a result. Disinfection also often doesn’t get rid of disease-causing viruses that may be present, because for total disinfection the mask would need to stay moist for at least sixty seconds, or would need to be completely soaked in an appropriate disinfectant. 

Reusing a mask multiple times is also risky, because it can make the wearer sick and spread disease. Using the same surgical mask repeatedly also moistens them and ruins their barrier function.

“There’s research that suggests you can actually infect yourself with a [dirty] surgical mask,” Figueroa said. “A lot of people move their masks around, touching the middle of the mask, pulling the mask under their chin to talk. They’re taking contamination under their chin and lifting it to their nose,” and contamination reaching the nose, mouth, or eyes is the main way to transfer the disease. Masks also may provide wearers with a false sense of security; they may lead to people not washing their hands as frequently, or touching their face more to reposition the mask. 

For Figueroa, the mask provides the chance to educate. She has started wearing masks when seeing patients at the UI Health clinic. This often prompts patients to ask why she is wearing a mask and gives her the chance to talk to them about hygiene and when it is appropriate to wear a mask. She does the same thing at UI Health’s Pilsen Food Pantry, which she runs.

“I use [the mask] as a vessel to have discussions about good hygiene and social distancing. It’s sort of the bait to get someone to talk to me about it,” she said. 

Figueroa has created a campaign to make cloth masks, gathering professional seamsters to sew cloth masks. Part of Figueroa’s goal with the campaign is to create a barter system: if any Chicago residents have hospital-appropriate N95 masks, she is hoping they will exchange them for cloth masks. People who want to donate unused medical-grade masks or homemade cloth masks can drop them off at UI Health (914 S. Wood St.), the Pilsen Food Pantry (1850 S. Throop St.), or at a donation box at 2432 N. Mozart Ave.  

Cloth masks need to be three layers thick, with centers made of non-woven fabric, such as fabric softener sheets or baby wipes, said Figueroa. However, she also believes that if thinner masks have the psychological benefit of making people more careful and aware, then they are important to use. Improvised masks can also offer some of these same benefits: last week, U.S. Surgeon General Jason Ward demonstrated how to quickly and easily make a mask with a bandanna and two rubber bands. 

“Addressing people’s concerns is a necessary part of containment and mitigation of this disease,” said Figueroa. 

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Jade Yan is a contributing editor to the Weekly. She last wrote about challengers to Bobby Rush in the March 2020 primary race for Illinois’s 1st Congressional District and their contention that he is disconnected from his district.

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