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Everything You Need to Know About Masks

All of your questions about how, when, and where to wear face coverings, answered

With Panagis Galiatsatos MD, MHS and Robert Glatter MD

A young woman correctly wearing a filtered cloth mask. Photo from Unsplash by Gayatri Malhotra.

The CDC recommendation to wear facial coverings in public, at work, and in all shared communal spaces is being enforced across the nation. Unfortunately, with summer just around the corner, complaints over masks have risen as much as temperatures. While no one quite enjoys the sweaty discomfort of a mask in hot weather, health experts unanimously agree that it is nothing in comparison to the discomfort and danger of lung complications brought on by COVID-19.

“If you have an endocrine condition such as diabetes that puts you at higher risk, make sure you’re doing everything you can to minimize that,” says Panagis Galiatsatos, MD, MHS, a lung disease expert at Johns Hopkins Bayview Medical Center who has been treating patients with severe and life-threatening cases of COVID-19.

In this new world where masks have been added to the list of home-exiting essentials, it's important to know what works and what doesn't. Here, what you need to know to keep yourself and those around you safe when you are outside of your home or private outdoor space.

Masks that work to create a protective layer against the Coronavirus:

  • N95 and KN95 Masks: These are the US and Chinese standards for respirator masks. While they do have a few differences, such as N95s being designed for slightly easier breathing, they both catch about 95% of particles, making them equally effective. Due to a deficit of personal protection equipment, these should be reserved for medical personnel.
  • Procedural Masks: These are the breathable, pleated fabric ones. They, similar to respirator masks, are effective in their purpose when worn correctly, with the metal adjustment strip over the nose, the colored side facing outward, and the white filter side against your face.
  • DIY and Filtered Cloth Masks: Not everything can be made into a mask. Some materials and fabrics are not effective. For example, a sock of average thickness would be too porous for a decent mask. Bandanas should be doubled over at least once to be worn as an adequate face covering. You can also sew your own mask from a thick, dense material such as cotton. Here, you can find the CDC's instructions on how to make your own mask, even with no sewing required.
  • Fashion Masks: As long as they’re made from a thickly woven cloth material and cover your nose and mouth, they’re as effective at containing a sneeze or cough as any other nonmedical face covering.

Masks to avoid because they are ineffective: 

  • Knit and crochet masks are not tightly woven enough to properly protect you and those around you.
  • Masks that are not worn properly are rendered benign. This includes masks that do not cover both your nose and mouth, wearing a mask that is too loose, and reusing a mask without proper cleaning between uses. The effectiveness of masks and respirators is linked to early, consistent, and correct usage.

What about face shields?

Face shields are hard, clear, plastic face coverings that extend past the chin. The arguable pros for face shields are:

  • They’re easily cleanable and reusable, requiring only a wash of soap and water
  • Some find them more comfortable than cloth masks due to the forming of an external barrier rather than the feeling of cloth flush against your face
  • They bar your hands from idly touching your face
  • Shields allow for better visibility of facial expressions and don’t muffle your speech

"One alternative approach that makes the most sense for those who can't wear masks due to physical restrictions such as difficulty breathing, is the use of face shields," according to Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. "While we don't have hard trials or data on the efficacy of face shields at this time, early data from their use in patients with influenza (which is droplet-spread) is promising and definitely preferable to going without any facial protection." 

Do I have to wear a mask when I exercise outdoors?

Wearing a mask may not be ideal, but that doesn’t mean it has to impede upon your day-to-day life. You can even continue pre-quarantine habits, such as exercise. At-home workouts with commonly owned household items seem to be the safest option, but if you leave your home to exercise outdoors, a mask and social distancing are still recommended.

If you exercise outside and alone, chances are you may run into someone who had the same intentions. However, there’s no need to lose sleep over crossing paths with another jogger, hiker, or biker. In fact, even in the absence of a mask, doubling the six-foot rule-of-thumb distance between yourself and those around you when you exercise outdoors is the encouraged protocol as long as the area you are exercising in is not too crowded to maintain this distance.

Can I remove my mask in public?

The Centers for Disease Control and Prevention released the following statement: “CDC recommends wearing cloth face coverings in public settings especially in areas of significant community-based transmission.” As some states begin reopening, the CDC also currently recommends all employees wear masks while inside any place of work or business. The suggestion to wear a face covering in public spaces is both to protect those who are high-risk and to prevent transmission from those who may be asymptomatic.

What about when I’m with my friends and family?

In the age of Facetime and Zoom, you should be limiting in-person contact. A one-time visit is all it takes to contract COVID-19, but in the event that you find yourself at a small, outdoor gathering with anyone who lives outside of your household, masks and social distance should still be in play.

Do I have to wear a mask at the beach?

While the beaches are starting to open again and attract people, and mask tan lines probably weren’t on your 2020 summer bucket list, there is some good news! If where you are on the beach is empty, you can forego a mask. It should still be in your possession, but social distancing is your best friend if you wish to avoid mask tan lines. You should have at least two masks on your person at a time while at the beach, as a precaution should something happen to your first mask. If your mask becomes wet, do not continue to use it, as wet cloth is difficult to breathe through and puts your health at risk. Masks should be clean and dry, if they are to be used, which is why it is good to have a spare when you are near the water.

What about when I'm with my chosen pod?

Between stay-at-home orders being lifted and the Coronavirus showing no signs of leaving entirely, people are beginning to find comfort in small groups or pods of close friends and family who agree on the same quarantine rules. Thus, the use of your discretion going forward will be applicable to many situations.

Risk factors remain relatively low if you remove your mask while maintaining distance in a controlled outdoor setting with a small group of people whom you have verified are following recommended safety measures in advance. As long as you and the company you keep are navigating cautiously and communicating how you have been quarantining, you can socialize outdoors at social distance with relative safety.

For the time being, masks and social distancing are here to stay. Keep an extra mask in your car and at home. Maintain your health through good judgment. Stay informed and up-to-date by checking the current CDC guidelines whenever you feel uncertain about how to proceed.

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Diabetes and COVID-19