As the COVID-19 pandemic resurges in Europe and other parts of the world, people must stay vigilant and updated on the latest health and safety information. For most people, the advisories sent out from the Centers for Disease Control and Prevention (CDC), as well as the World Health Organization (WHO), remain the same. Everyone, including non-medical personnel, are advised to meet the following safety standards:
- Maintain social distancing in public spaces (approximately 6 feet or three meters apart)
- Wear a mask or adequate face-covering in public spaces
- Limit public outings to necessary activities and locations (grocery store, pharmacy, work, etc)
- Wash hands regularly with hot water and soap
- Carry hand sanitizer with you in the event that you are unable to wash your hands
Perhaps the two most important practices are social distancing and the wearing of face masks. While the former is relatively simple to understand and follow, many people feel confused about mask safety protocol. For example, which kind of mask is best for non-medical personnel? Does a scarf or similar face covering provide the same protection as a traditional face mask? Finally, what is an N95 mask and who can acquire one?
To answer these questions, let’s first take a quick look at some of the different types of masks and face coverings available to consumers:
Face Coverings Available to Consumers
Face shields are meant to be combined with some form of face mask. Without a face mask or covering that protects the mouth and nose, face shields are virtually useless. Particles of any size can come in from under face shields, which means that they offer almost no protection against COVID-19 on their own. However, when combined with a face mask, face shields do offer greater protection against liquid splatter (like a cough or sneeze).
Cloth coverings like scarves, neck gaiters, and balaclavas
These are generally considered make-shift face coverings that provide minimal protection from COVID-19 and similar airborne viruses. Clothing and accessories do not provide medical-grade filtration or protection from liquid splatter. However, the level of protection will depend on the material used, how it is woven, and how you wear it. In any case, a recent Duke University study showed that these solutions are largely ineffective and, in some cases, can even increase the risk of spreading COVID-19.
While cloth face masks are a big step up from non-traditional cloth coverings, it’s difficult to gauge exactly how effective cloth masks are against COVID-19. Some cloth masks are designed for maximum comfort and breathability, which often means that they are less effective at filtering out particles or protecting against fluid splash. That said, the efficacy of a cloth mask will depend on the number of layers, the materials used, how it is woven, and if it allows for an insertable filter.
Due to their reusability (if properly washed), cloth masks are one of the most popular and common options among non-medical personnel. They are generally more comfortable and versatile than medical-grade masks. However, they are not as effective as some other types of masks, as we will outline below.
Medical-Grade Surgical Masks
Medical-grade surgical masks are generally the most effective option for non-medical personnel. These single-use masks are made with a non-woven, double-layered material that repels fluids and absorbs airborne particles. However, medical-grade surgical masks cannot provide 100% protection from airborne particles or fluids. Just like cloth masks, surgical masks can vary in efficacy.
Now that we’ve covered all of the traditional masks, shields, and face coverings, it’s time to look at high-level medical protectors. These face masks are often referred to as “respirators,” because they often include additional features that make them far more efficient than other mask types. The most common type of respirator is the N95 mask.
What is an N95 Mask?
An N95 face mask is a type of medical-grade respirator designed to provide high-level protection from airborne particles and fluid splatter. According to the U.S. Food & Drug Administration (FDA), an N95 mask or respirator is defined as follows:
“An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. Note that the edges of the respirator are designed to form a seal around the nose and mouth. Surgical N95 Respirators are commonly used in healthcare settings and are a subset of N95 Filtering Facepiece Respirators (FFRs), often referred to as N95s.”
As you can see from this definition, one of the primary differences between a medical-grade surgical mask and an N95 mask is the seal around the mouth and nose. A traditional mask leaves a small amount of space around the edges. Since it does not seal around the face, a surgical mask still leaves some space for particles to reach the mouth or nose.
Alternatively, an N95 mask seals tightly around the cheeks and chin so that particles cannot circumvent the mask. Additionally, most N95 masks come with a nose clip that seals the top of the mask tightly against the bridge of the nose. N95 masks can either be valved or non-valved. Non-valved respirators are generally safer, while valved respirators allow for greater breathability.
The N95 mask shares a few similarities with less protective surgical masks. For example, all medical-grade Personal Protective Equipment (PPE) is tested to determine its safety in the following areas:
- Fluid resistance
- Filtration efficiency (particulate and bacterial)
Additionally, N95 masks are single-use only. This means that they are not designed to be used more than once. If someone wearing an N95 mask finds that it has been soiled or somehow damaged, they should replace it and dispose of the contaminated mask immediately.
While N95 masks are generally safe to use for medical professionals, the FDA does provide certain precautions related to the use of N95 masks:
- “People with chronic respiratory, cardiac, or other medical conditions that make breathing difficult should check with their health care provider before using an N95 respirator because the N95 respirator can make it more difficult for the wearer to breathe;
- Some models have exhalation valves that can make breathing out easier and help reduce heat build-up. Note that N95 respirators with exhalation valves should not be used when sterile conditions are needed;
- All FDA-cleared N95 respirators are labeled as "single-use," disposable devices. If your respirator is damaged or soiled, or if breathing becomes difficult, you should remove the respirator, discard it properly, and replace it with a new one. To safely discard your N95 respirator, place it in a plastic bag and put it in the trash. Wash your hands after handling the used respirator;
- N95 respirators are not designed for children or people with facial hair. Because a proper fit cannot be achieved on children and people with facial hair, the N95 respirator may not provide full protection.”
The N95 Mask: A Brief History
Before the COVID-19 pandemic, most people had never heard of the N95 mask. However, it has since become common knowledge that N95 masks provide some of the best protection against fluid spatter and airborne particles. Despite their significance in the healthcare world, very few people know the backstory behind one of the most important inventions in modern medicine.
The first N95 mask was developed around 1910, when a mysterious and deadly illness was sweeping through parts of Russia and northern China. Both countries entered a race to track the source of the disease and find ways to combat it. During this period, Chinese doctor Lien-teh Wu worked off the design of existing surgical masks. However, his mask was much thicker and sturdier, as it was made from gauze and cotton. These layers added extra protection against the airborne disease.
Wu’s design eventually drew the attention of doctor’s around the world. While face masks had been in use in the medical community since the days of the Black Death, Wu had finally created a mask that was capable of filtering out airborne bacteria. Over the years, researchers improved upon Wu’s initial design, adding clips around the nose and various other additions. Today, the N95 mask is one of the most important devices in all of modern medicine.
Is the N95 Mask the Best Respirator Mask on the Market?
Technically, no; there are masks that provide even greater protection than the N95 mask. The N95 mask is the standard medical-grade mask for high-risk environments. However, there are even better masks available to medical personnel. For example, there are the N99 and N100 masks.
What is an N99 Mask?
An N99 mask or respirator is a variation on the traditional N95 model. It provides high-level protection due to its thick, non-woven material, sealed edges, and filtration technology. However, N99 masks provide even better filtration. While an N95 mask provides approximately 95% filtration of particles and bacteria, an N99 mask provides 99% filtration. As you can see, the numbers in the names refer to the level of filtration each mask provides.
What is an N100 Mask?
The N100 mask is the highest-level medical-grade safety mask. It provides approximately 100% (or 99.9%) filtration. This is mostly accomplished through the hardness of the material and the strength of the filtration device. N100 masks are rarely used outside of medical environments.
How is the N95 Mask Regulated?
There are several government agencies and regulatory forces that implement safety standards for medical-grade masks, including the N95 and above. However, the FDA is the primary (and final) decision-maker when it comes to the enforcement of quality assurance for PPE manufacturers. Before the FDA finalizes these regulations, it works along with the CDC, as well as the American Society for Testing and Materials (ASTM).
When it comes to testing and standardizing N95 masks, the CDC conducts the initial research to discover which materials, filters, and devices provide the most protection. Much of this research is overseen by the National Institute for Occupational Safety and Health (NIOSH), a branch of the CDC dedicated to workplace safety. Then, the ASTM creates templates so that PPE manufacturers know how to produce safe, effective equipment. Finally, the FDA uses all of the available data and research (in conjunction with the work done by the CDC and ASTM) to create regulations that all U.S.-based PPE manufacturers must follow.
Is It Possible to Decontaminate an N95 Mask?
Whether you’re wearing a standard dust mask, chemical mask, or one of many other respirator types, it is generally best to use them only once. This rule also applies to N95 masks. Unfortunately, COVID-19 has led to a drastic shortage of N95 masks worldwide. As a result, some medical personnel have had no choice but to try to decontaminate or extend the use of their N95 masks.
In the event that an N95 mask must be reused, the FDA provides the following tips and guidelines for decontamination:
“The FDA has issued Emergency Use Authorizations (EUAs) for the emergency use of decontamination systems for use in decontaminating certain respirators used by health care personnel when there are insufficient supplies of new respirators resulting from the COVID-19 pandemic. New FDA-cleared N95 respirators or NIOSH-approved N95 respirators or other FDA authorized respirators are always the first choice before a decontaminated respirator.
If a used respirator that is FDA-cleared or NIOSH-approved is available and a new respirator covered under one of the FDA Emergency Use Authorizations for respirators is not available, you may consider decontaminating and reusing the used respirator with a decontamination system that has an FDA Emergency Use Authorization, if the used respirator is compatible with the decontamination system.”
Can Non-Medical Personnel Use N95 Masks?
While there’s no law stating that regular citizens cannot use N95 masks, they are currently being reserved for medical-personnel due to the COVID-19 pandemic. In fact, the CDC and other government agencies recommend that anyone in possession of N95 masks donate them to their nearest healthcare facility. Though some forms of N95 masks are approved for workers in hazardous environments (chemical plants, certain construction sites, etc.), the vast majority of N95 masks are being sent to the medical workers on the frontlines of the pandemic. Therefore, it is not advisable to use an N95 mask unless you are directly working with COVID-19 patients.