Surgical masks are different from clothes masks in lots of different ways. The most important way or area that both kinds of mask differ is the level of protection. Surgical masks are safer and offer more protection than normal clothe masks.
However, it's not easy to just outline the difference between both kinds of masks in this manner. We also need to look at the evolution of public health advisory on face masks, and how cloth masks became clothing item number one in the past few months.
The Evolution Of Public Health Position On Face Masks
In the fight against Covid-19, masks are extremely important. Because the coronavirus is a respiratory illness, it is mostly spread through droplets that are generated during coughs and sneezes. Once these droplets travel from the mouth and nose and land on the mouths and noses of others, the illness is transmitted.
The sensible way to avoid this would be to wear masks. With masks, the droplets can't leave the mouths and noses of the infected (and even if they do, most of the droplets will remain within the mask), and they won't be able to land directly on the noses and faces of the masked individual. Instead, they will land on the mask.
That's why medical professionals have advised us to wear masks. They protect us, and they help limit the spread of Covid-19. However, that's only half of the question. Now that we've seen that masks help slow down the infection rate of Covid-19, the question arises— what sort of masks do we need?
Logic dictates that we would need the mask that can prevent most (or all) viral particles from leaving the nose and mouth. In the same vein, the mask must be secure enough to prevent viral particles from breaching its defenses and landing on the face. A lesser consideration, perhaps, is price. Whatever masks that must be used should be cheap and easily obtainable by the entire population. That way, it would have a more profound effect on the slowing down of the virus.
When the pandemic started, most people started searching for masks to buy. The first option on everyone's mind were surgical masks, and for good reason too.
What Is A Surgical Mask
Surgical masks were specially designed to catch bacteria shed in liquid droplets and aerosols from the mouth and nose of the wearer. Because of this, it seemed sensible to get surgical masks. However, there are some things that people didn't take into consideration. The fact that surgical masks are not designed to protect users from breathing in airborne bacteria and viruses is one. There's also the fact that there are different levels of surgical mask quality.
For example, there are isolation, dental and medical procedure masks. And all of them do not offer the same level of protection. In any case, people stocked up on surgical masks until health professionals told them not to.
The rationale behind this was simple. At that point in the pandemic, regular people were not exposed to the virus (at least that was the prevailing knowledge at the time), so they didn't need to mask up, as it were. Health professionals needed the surgical masks more, and the stockpiling of masks by regular people was dwindling supply.
That was the reason why health experts advised people not to wear masks. However, as the pandemic raged on, and the risk of local transmission increased, it became clear that people needed some protection. As that situation was developing, there was new information coming to light. Studies were proving that surgical masks were not enough to prevent Covid-19 droplets from spreading. They were proving that only masks that can prevent airborne bacteria would be able to 100% protect from the illness.
The N95 Respirators
The masks that could do this were called N95 respirators. These respirators were so tightly sealed that they could help prevent exposure to tiny droplets that could remain suspended in the air. They are so sealed that health care workers who use them have to undergo a fitness test to figure out the right size and model to use. At the beginning of the pandemic (and even now), these masks were in short supply. To conserve supply, and in light of the rising number of locally transmitted cases, healthcare professionals advised regular citizens to use surgical masks.
At this time, several studies started to reveal that even though surgical masks and clothes masks couldn't provide holistic defence against the virus, they helped slow down the spread. After that, it was settled. Health professionals asked people to wear whatever mask materials they wanted, as long as they were able to use it to cover their mouths and noses.
As the pandemic raged on, and more data is collected, it seems the earliest numbers were indeed correct. Masks, of whatever kind, slowed down the transmission rate of the virus. But is there a difference in effects? For example, are clothes masks more effective than surgical masks? Is there a difference between both kinds of masks?
Let's find out.
How Surgical Masks Are Different From Face Masks
First off, it's important to remember that even though the pandemic has raged on for more than six months, we still don't know too much about it. Every day, people are discovering new after-effects of the illness, and new studies are being published on its nature every month. So we don't yet have concrete data about the efficacy of surgical masks as compared to cloth masks.
Despite this, it's possible to come to some conclusions regarding the effectiveness of both kinds of masks based on existing research.
Research By Society for Disaster Medicine and Public Health
A study conducted in 2013 by researchers in the UK looked at the efficacy of cloth masks as makeshift mask materials. The research looked at nine common materials which include a scarf, a tea towel, an antimicrobial pillowcase, a pillowcase, a vacuum cleaner bag, linen, a mix of cotton, a cotton T-Shirt and silk. These nine materials were compared to a surgical mask to test efficacy.
The researchers measured filtration efficiency and pressure drop in all the fabrics. They used a single and double layer of material, and then the materials got sprayed with organisms that are comparable in size to the influenza virus. The filtration efficiency test tested how well the mask filtered out these organisms, and the pressure drop test measured how easy it was to breathe in the masks.
The vaccine cleaner bags and the tea towels used in single and double layers performed well in the filtration tests. However, they performed badly in the pressure drop tests. The study claimed that sucking air in through the masks was so difficult that the air the wearer breathed in came from around the mask, rather than through it.
After the tests, the researchers came to one conclusion. Pillowcase materials and 100% cotton t-shirts were the best material to use for makeshift masks. Although they didn't perform as highly as other materials on the filtration efficiency test, they performed well enough to be viable masks. The rest did not. They also figured out that the flighty stretchy nature of the cotton T-Shirt material made it the best choice for a mask. This study also showed that surgical masks performed better than cloth masks in both filtration efficiency and pressure drop.
Wake Forest Institute of Regenerative Medicine
A peer-reviewed study at the Wake Forest Institute of Regenerative Medicine published in April, says that properly made cloth masks may even be more efficient than the typical surgical mask. According to the study, cloth masks offer better filtration on a whole than surgical masks. The study says that cloth masks just offer about 79 per cent filtration, and surgical masks offer 62 to 65 percent filtration.
The study further went on to say that the best masks were made of heavyweight quilter’s cotton with a thread count of 180 or more. Masks that had even thicker thread that were woven tightly and ones with basic cotton outsides and flannel insides also proved very effective. It's important to note that this study compared cloth masks to the regular surgical mask, not the heavily filtered ones like the N95 mask.
That's not all. The study's originator, Dr Scott Segal said: “We don’t want people to think that just any piece of cloth is good enough and have a false sense of security”. This means that only specific kinds of cloth mask even approach the level of protection that the basic surgical mask offers.
To come to this conclusion, the research team used particulate filtration to put about thirteen designs from four hundred masks to test.
The tests discovered that single- and double-layer masks made out of threadbare and lightweight cotton were the least effective. The tests also discovered that gaps at the edges of the masks decreased filtration efficiency by about 60%
N95 Proven To Be The Best Mask Type
All studies have proven that the N95 masks are by far the most effective surgical mask we have. And this isn't gainsaying either. In August, a Duke University study revealed that the strongest protection against Covid-19 was the N95 mask, followed closely by a cotton-polypropylene-cotton mask. One of the reasons this is so is the heavy regulations that manufacturers of N95 masks (and other surgical masks to a lesser degree) have to go through.
In the US, the production of N95 masks is under strict regulations by the National Institute for Occupational Safety and Health. The mask must meet a standard level of requirements, and some of them concern flow rate, total inward leakage, filter performance and exhalation pressure drop.
The filter performance metrics is perhaps the most important as it measures the maximum concentration limit in the filtering of hazardous materials. The PFE rating determines this, and it describes the percentage of 0.1-micron particles that can be filtered through the mask. Amazingly, the N95 mask has a rating of 99.9%— which is the highest rating of any mask.
The N95 respirator mask protects the wearer from large particles and small particles. It also helps to filter out about 95% of airborne particles. The effectiveness of this mask depends heavily on the fit it has around the users' mouths and nose. That's why there are different sizes made to accommodate people with different size requirements.
It's important to note that cloth masks— of any kind, are generally not held to any specific filtration standards. They can be made by anyone, and may even be made for purposes other than to prevent the spread of disease-carrying organisms. These masks are a makeshift solution to problems, and as such, they have no standards and no regulating authority.
For example, you could be fairly certain that an N95 mask you buy will offer you the same level of protection universally. That is not so with a cloth mask. From a strictly medical standpoint, the N95 surgical mask is the best option for prevention of coronavirus and is a better option than either cloth masks or regular surgical masks.
A lot of people have been making their cloth masks from home. While that is a good idea if you have limited choices, it's not worth it if you have the choice of a proper surgical mask or even an N95 mask.
Sure, it may be more comfortable to wear, but in the end, it doesn't offer the maximum level of protection that you'd like. However, if you absolutely must make your face masks you should follow the best available advice. For example, this instruction manual from John Hopkins tells you how to make a good face mask.
So, if your question is should one wear a surgical mask, the answer is yes. You should wear a surgical mask.