Masks, Masks, Masks! (or rather, Respirators, Respirators, Respirators!)
The devil is in the detail...
It’s taken me a while to get back to writing here, and I’ll admit it’s partially due to depression. Watching the world get fully “back to normal” and leaving the medically vulnerable (and anyone who is fully attuned to the risks of Covid) to fend for themselves through a still-ongoing pandemic has actually been the hardest period of the last three years for me. It’s amazing how humans can still thrive during adversity when there is community and solidarity - and how hard it is without it.
When I left off this past fall, the White House had predicted 100 million new Covid cases this winter (as part of a “tri-demic” of RSV, Flu and Covid) and I had started putting together this short harm reduction post to revisit and update respiratory protection!
Good information on masks (and access to high quality ones) have been hard to come by for much of the pandemic. Not to mention the fact that with so little masking happening in America and Europe these days, those of us who are still masking need better masks than ever to compensate.
As White House Covid response coordinator Dr. Jha finally said in blatant terms: Covid is purely airborne. This means that the virus travels through the air like smoke.
So we know that masks and ventilation/air filtration are where our focus needs to be. Another post soon on #CleanAirForAll. In the meantime, while any mask is better than no mask, at this point in the pandemic, the kind of mask - and the fit - matters A LOT.
Despite the propaganda (“you do you!”) about one-way masking, this method puts an undue burden on those seeking protection - and leaves no room for small leaks or a moment’s error.
Cloth and surgical masks should be well in our past at this point in an airborne pandemic - in fact if we want to be accurate in our language, we no longer want to be wearing masks but respirators, which protect us from a minimum of 95% of airborne particles. The clear difference between the two, and the need for respirators to protect from aerosols of airborne infectious diseases (as opposed to surgical masks which protect from larger droplets) has long been known, as demonstrated by this 2009 video from the Department of Labor. So it is infuriating that it is not common knowledge by now, and that we still see so many surgical masks in medical settings.
A quick note on fakes. Every expert I follow warns against buying respirators on Ebay, Etsy and Amazon because the market is just flooded with fake surgical masks, KN95s and N95s. (KF94s that are exported from South Korea are less vulnerable to this because exports are so strictly regulated, so if you need to order masks on those sites, that would be my suggestion.) Often the fake and real respirators will look the same side by side. Ordering directly from the non-profit Project N95 or directly from the manufacturer is the best option.
Then the big question is fit. There is no one respirator that offers the “best” protection because of the reality of anthropometry: the measurement of every face is slightly different. The best mask (especially once you’re looking at respirators with 95%+ filters) is the one that fits you well.
And here lies the rub.
KN95s (the medical masks with ear loops rather than true N95s which always have headbands) frequently do not provide much better protection than blue surgical masks (which we’ve long known are insufficiently protective). At best, 50% of people will have a good fit with ear loops, many believe significantly less. This is because even if the KN95 filtration material itself is legitimate (and therefore capable of preventing 95% of particles from entering the mask material), it doesn’t filter the air that gets in around the top and sides of the mask - and ear loops provide poor average fit. That’s a shame because there are a ton of cute ones - and the ear loops are often more convenient, I know. But for most people, to get a good fit you’re going to need either a mask with headstraps - or to use tape to seal up gaps on one with ear loops.
You might be one of the lucky few for whom ear loop masks offer good protection right out of the box, but you’d need to do a fit test to know. Since we’re not getting free government fit tests anytime soon and the quantitative fit test devices cost thousands of dollars, here’s some instructions on how to do a qualitative fit test at home. (Assuming you’d rather not pay $150 for a ready-made fit testing kit, this involves purchasing an atomizer or nebulizer for ~$10-25, a fit testing hood ~$25 and Bitrex ~$30. As an alternative to the hood if you’re handy you can make a DIY one out of a garbage bag and two coat hangers, and you can use a homemade sweet’n’low solution instead of Bitrex. This setup could be used to do a whole community’s fit testing. UPDATE: A clever person I follow on Twitter has started selling these mask fit testing kits, they’re $40 and include the nebulizer, fit testing hood and enough solution for 70 full five minute fit tests.) If you can’t do any of that, the minimum would be to do this “poor man’s fit test” which you can do without any equipment - but truly, I was surprised by how my seemingly well-fitted KN95 (as well as a fancy P100 elastomeric mask) immediately failed the qualitative test with the nebulizer, so it’s well worth doing.
If you find the masks you like using don’t fit tightly enough and you don’t have access to different ones, there’s always tape to try and seal the gaps. (I’ve seen people recommend this one.)
Here’s one guy trying on a wide variety of KN95s and N95s (using a fancy fit testing machine most of us will never have access to) - demonstrating shocking differences:
(Imagine if every town had one of these machines so we could all find out how well-protected we were, for free?)
Of course that’s just one face, and each face is so different. But if you’re overwhelmed and don’t know where to start, from what I’ve read the 3M Aura 9205 seems to pass a fit test for a majority of people. (And after a lot of reading and researching on the best masks for breathability and audibility it’s pretty high on everyone’s list. Not to mention that I definitely find it to be pretty comfortable.) After so many disappointing respirator fit test fails (goodbye illusions of safety with ear loop masks), I’ve landed on the 3M Aura as the best all-round disposable protection for myself. Unfortunately they don’t make them in black (whyyyyyyy?!)
There are also P100 elastomeric respirators (usually more intense looking, with the notable exception of the Flo mask) which provide 99% filtration, remembering again that this is not guaranteed unless you’ve done a fit test. Reviewing those is beyond the scope of this post although I regularly see people lauding the affordability and comfort of the GVS SPR457 Eclipse (I might wear this on a plane although I don’t think it’s ideal for speaking in) and the audbility (and more gentle appearance) of the Flo mask (which has both 99% and more breathable 95% filters available and comes in kid sizes as well).
Also a note for folks who struggle to breathe in masks due to asthma etc. I have health issues that make it difficult for me to wear masks for extended periods of time and recently started allowing myself to occasionally wear a 3M Aura N95 respirator with an exhale valve for a few non-essential social events (I always go valveless to medical settings, grocery stores, etc to better protect others, and in solidarity.) But you might be interested to learn that even with an exposed exhale valve, a well-fitted N95 is still providing more protection to those around you than wearing a surgical mask. Here’s a great visual summary of the different levels of protection (and a great suggestion for some guerilla activism to spread the word):
I have to admit that when I see another person still masking in public, I see radical love:
And if you’re reading this and thinking “Wow, Britta, you really have gone overboard with this Covid stuff” - well, here’s a little (very belated) Halloween spookfest for you:
Back soon with more on “so what are you just going to keep living like this forever?”, the pleasure of finding embodied consent in the face of extreme social pressure, and the nonsense that is “immunity debt”.
❥❥❥
I’m going to end all my posts by saying this is a summary of the best practices and research I’ve gathered in extensive time spent following air particle physicists, immunologists and other specialists as well as crowdsourcing information from my COVID Precaution Community on Twitter - but I am in no way qualified to dispense official guidance and I welcome feedback from anyone reading if I’m missing something out or get it wrong. I’m just doing my best to spread the knowledge I have, since I so frequently find that others have not had the same access to information. It takes a lot of time and energy to DIY your way through a pandemic.