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Guide for Wearing Masks: Controlling COVID-19 Transmission

by Michael Johnson

| Updated December 19, 2023 |
When COVID-19 hit our world in 2019, and the WHO declared the highly transmissible virus a pandemic in March 2020, face masks became a visible sign of global efforts to stop its spread.

Of course, most of us had never needed to use a mask before. But, with the pandemic, masking became crucial to staying safe and protecting others from the virus.
Three years down the line, the spread of coronavirus is under control, thanks to effective control measures like vaccination, social distancing, and using masks. However, the resurgence of COVID-19 remains a threat to individuals and the local and global community.

That’s why information about the correct use of masks remains relevant. It is one of the universal precautions we could still adopt to prevent the transmission of the virus, which is why we all should keep the guidelines for wearing masks at the tip of our fingers.
This post is a guide to wearing masks. It has every tiny detail on why people should wear masks during a COVID-19 pandemic. In addition, it tells you how to use masks correctly and which special cases are exempt from using a mask. Let’s answer the why question first.

Do Face Masks Protect From COVID-19?

Along with getting the coronavirus vaccine and observing social distancing, studies have confirmed that wearing a face mask or respirator significantly reduces the odds of coronavirus infection.

Here’s why.

The coronavirus, or SARS-CoV-2, is highly transmissible and can be easily passed among people close to each other through respiratory droplets.

These drops are released by infected persons when they speak, cough, sneeze, sing, or breath with an open mouth.

So, how does a mask help?

If the infected person wears a mask, the respiratory droplets do not find their way into the air and cannot be inhaled by those around. Similarly, the droplets do not land on other people’s mouths, noses, or body parts like the hands from where they can still end up in the person’s respiratory system.

If the healthy person also wears a mask, they block the droplets from a COVID-19-infected person from reaching their respiratory system.

So, wear a mask even though you don’t feel sick.

After all, there’s evidence that people who don’t feel sick or show any symptoms can still be infected and transmit the virus to others. Wearing a mask will protect you around these asymptomatic and pre-symptomatic coronavirus carriers.

That said, the effectiveness of wearing a mask depends on how well we all follow the recommended guidelines for wearing masks. Here’s a quick summary of these guidelines.

General Guidelines for Wearing Masks

Along with knowing the importance of wearing a mask during a pandemic, some general guidelines should be everyone’s knowledge.

●Face masks are most effective in stopping the spread of COVID-19 when worn by everyone. Healthy persons without masks risk exposure and infection. Infected persons without masks are super spreaders.

●Masking goes hand in hand with distancing. Even with a mask, you must stay at least 6 feet away from the person closest to you. Do this especially indoors among people who aren’t members of your household.

●The correct way to wear a mask is to ensure it completely covers your nose and mouth. However, although there shouldn’t be gaps between the mask and the cheeks, a mask should not feel tight on your face.

●COVID-19 transmission is indiscriminate and knows no family bonds. So, if you live with an infected person who has tested positive or shows symptoms of infection, you must wear a mask while at home.

●All persons aged 2 years and above are eligible to use a mask. These people should use a mask every time they are around others not members of their household.

●Wear a mask any time you use public transport means. This could be on a train, plane or in a bus.

●Use a hand sanitizer or wash your hands with soap and water for 20 seconds each time you interact with a used mask. This means after touching a mask on your face or when removing it. If you use a hand sanitizer, confirm it has a minimum of 60% alcohol.

●Adhere to mandatory COVID-19 masking rules in your local area and any other areas you visit. While you are not required to keep your mask outdoors while alone or distant from others, different cities, states, counties, and localities may require you to do so, and you must oblige.

●Not every type of mask will keep you safe from the coronavirus. So, go for one with good performance and effective protection from the coronavirus. We explain below what you should go for and what you should avoid.

The Best Types of Masks for COVID-19 Protection

Masks are the most common personal protective equipment worn on the face by the public to protect oneself and others from the SARS-CoV-2 virus.

There are several types of masks available, but not all have the required protection from the respiratory droplets that carry the COVID-19 virus. The protective level of a facemask depends on these factors:

●The quality of material or fabric used to make it.
●The density of material; if it has more than one layer.
●How well it fits.

Before giving details on which face masks provide the most protection from the coronavirus, here’s a summary of those recommended by health agencies and the ones you should avoid.
Recommended Mask Types image

Surgical Masks

Surgical masks are also known as disposable or medical procedure masks. They are the most common type of mask used by the public. You can order these masks online or purchase them from pharmacies and other authorized retailers.

Surgical masks are single-use, and you shouldn't wash them for reuse. Instead, dispose of them safely in a tightly closed waste bin after use. Also, replace a surgical mask if it gets damp or dirty.

While they are easy to wear by fitting the elastic bands behind the ear or fastening the strings at the back of the head, surgical masks must fit well to provide maximum protection.

If your mask is large and fits loosely, you can adjust it to fit. See this CDC video for a quick demonstration of how to adjust a mask to fit.

Health agencies such as the WHO and CDC advise you to prioritize surgical masks with standard certifications like the ASTM F3502 or ASTM F2100. Designated agencies have evaluated these masks for features like breathability and filtration efficiency. You can check the mask’s labeling to confirm its quality certification.

Non-Medical Cloth Masks

Cloth masks are not recommended for use in medical settings unless they have been evaluated and mandated for such contexts. However, they are a common alternative to surgical masks, especially in community efforts to control the spread of the coronavirus.
If you substitute medical masks with cloth masks, ensure they meet the set safety and efficiency standards.

Recommended cloth masks have these characteristics:

●They are made from breathable, tightly woven fabrics like cotton and cotton-blend materials.
●They have more than a single layer, usually 2 or 3.
Instead, cloth masks with these features offer little or no protection:
●Those made from loosely woven fabrics or loosely knit wool.
●Those made with only a single layer of fabric.
Since they are for multiple uses, ensure cloth masks are easily washable before reuse.

Alternative Mask Types and Face Protection Options

If surgical or cloth masks are unavailable, consider alternative options. Just like medical and non-medical masks, these should also be well-fitting for utmost protection.

Alternative mask types and face protection options include:

Respirators

National and global health agencies like the WHO and the CDC and health researchers confirm that respirators offer the best protection from the coronavirus. That’s because they create a tight seal on your face, sealing in and out any respiratory droplets.

Wear a right-fit respirator without air gaps on the edges for best protection. Additionally, the respirator should be the right type and of good quality.

Respirators can be used by the public and in the workplace. However, experts recommend varieties such as the N95 and the KN95 respirators for use among healthcare and first aid providers.

If you go for a respirator, ensure it is a well-fitting size and follow the manufacturer’s instructions for use. These instructions will guide you on how to wear, test for proper fit, store, clean, or dispose of when it’s time to.

Also, check your respirator for an authenticity label. In the U.S., for example, you can tell if your respirator is authentic if it has the National Institute for Occupational Safety & Health (NIOSH) approval labels.

Find out how to tell if your respirator is NIOSH-approved in this video.

Clear Masks

If you work with people who need to see your lip movements to understand you, a clear mask is a great alternative. The mask can be entirely clear or be a cloth mask with a clear panel.

Consider a clear mask if you work with these groups:
People with hearing impairment.
Persons with disabilities who rely on your facial expressions to understand and communicate with you.
Children or adults learning to read.
People in activities that require them to read vowel sounds on your lips. Examples are music classes and those learning a new language.
Consider a clear mask if you work with these groups:

Clear masks must meet the requirements set for all other types of masks. In other words,

If you use this type, confirm the mask's quality approval by the relevant body.
They must be breathable.
They should not collect moisture inside.
They should fit snugly.
If you use this type, confirm the mask's quality approval by the relevant body.

Masks and Face Protection Options to Avoid

Health agencies do not recommend types of masks and face protection gear that provide poor or no protection from respiratory droplets. These types and options include:

Masks with Exhalation Valves or Vents

Masks with exhalation valves or vents are meant to protect only the wearer from external pollutants. However, there’s solid evidence that these masks allow an outflow of respiratory particles through the valve.

As such, those around a COVID-19-infected person wearing a mask with a vent or valve can easily breathe in the particles. It also means that the mask is ineffective in community efforts to stop the spread of the virus.

Face Shields and Eye Protection Gear

Any personal protective equipment worn as an alternative to a mask must cover the nose and mouth. This is not always true with clear face shields and eye protection gear, such as goggles.

Some research has put face shields at the same COVID-19 protection level as masks. However, health agencies do not recommend using these options as stand-alone protective gear from the SARS-CoV-2 virus.

If you must use them, face shields and goggles should serve as additional gear over/with the face mask. In the end, these studies also discovered that using face shields alongside face masks provides better protection, just like using cloth masks over medical masks provides enhanced protection.

Also, despite their wide space allowance, do not use face shields on infants.

That said, health agencies recognize that there are situations where wearing a mask isn’t practical, as when speaking to persons with hearing impairment.

In such cases, use face shields and adhere to the following safety measures:

And now, with a clear idea of the recommended types of masks and those that are not, the next crucial question is who should or should not wear these masks.
Use a hooded face shield with extensions below the chin to the neck and around the face.
Ensure you don’t touch your mouth, nose, or eyes when removing a face shield.
Wash your hands before and after removing a face shield.
Disinfect or clean multiple-use face shields following the manufacturer's instructions or those provided by recognized health agencies like the CDC and the WHO.
Do not clean disposable face shields for reuse. Instead, dispose of them following the recommended safety instructions.
And now, with a clear idea of the recommended types of masks and those that are not, the next crucial question is who should or should not wear these masks.

Should Everyone Wear a Mask During a Pandemic?

You’ve probably heard the phrase that “masks are most effective when everyone wears one.” Going by this, everyone should wear a mask.

While that is the standard rule for stopping the spread of COVID-19, it does not cancel the fact that certain groups of people cannot use masks.

So, who should and who shouldn’t wear a mask?

General consensus supports the use of masks by all adults and children above 2 years of age in these contexts:
When in a public place.
When interacting with people who aren’t part of your household, whether in your home or outside.
In your home, if a family member has COVID-19 symptoms or has returned a positive COVID-19 test.
When using public transportation, be it on a plane, train, or bus, including while in the waiting area or station.
Note that people with underlying medical conditions should also wear masks, even those with respiratory conditions like asthma and other chronic pulmonary illnesses. These are at a higher risk for severe coronavirus disease and should take extra precautionary measures. However, it is important to talk to your doctor about your fears regarding wearing a mask.

Instead, people who fit in the following descriptions are exempt from wearing a mask, even though they, or those responsible for them, should be keen on keeping safe from infection.
Children below age 2.
Persons whose disability prevents them from safely wearing a mask. Such cases include those with sensory processing disorders or persons with facial deformities that would make keeping on a mask impossible.
Persons with disability for whom wearing a mask would be impossible due to issues like drooling or excessive sucking.
Persons with a disability who would be at risk if they fall asleep with a mask on when not supervised.
People who would create a safety, health, or job performance risk at the workplace if they use a mask. Workplace risk assessments determine such categories.
If you are responsible for the safety of a person in any of the above categories, use the following tips to enhance their protection from COVID-19 infection:
Weigh the person’s ability to wear a mask correctly. If the person cannot put the mask on by themselves, cannot keep it on without consistently touching it, or they make the mask damp due to excessive salivating, the person should not wear a mask.
Consult with the person’s health care provider. The healthcare practitioner will suggest alternatives to reduce the person’s risk of infection.
Follow the masking mandates unique to places you visit with unmasked persons under your care. Some places require you to wear a mask, while others may not.

Protective Alternatives When Wearing a Mask is Impractical

For all of us, wearing a mask can sometimes become impractical, requiring us to consider protective alternatives.

Here are some masking alternatives we can all adopt in situations where wearing a mask is impractical:

Protective Alternatives image
In all the situations where wearing a mask is impractical, prioritize other COVID-19 protective measures like social distancing and hand hygiene.

FAQs

What Should I Do if Wearing a Mask Feels Uncomfortable?

Masks can feel uncomfortable for everyone when used for the first time. Practice keeping it on for short moments at home until you can get used to it. Also, test the medical and non-medical options and see what works best for you. Breathing in and out calmly at the beginning can also help. If you have real trouble wearing a mask, talk to your healthcare provider.

Do Masks Create a Carbon Dioxide (CO2) Risk?

Negative! Masks don’t increase CO2 in the air you breathe in. That’s because masks are breathable, meaning they allow the tiny CO2 molecules to escape into the atmosphere. Instead, respiratory droplets are larger particles, which is why they stay in (or out) and protect you from COVID-19 infection.

Should You Keep Masks on in Cold Weather?

You should keep masks on in cold weather. However, if your mask becomes moist from snow or your breath, replace it with a dry one. A wet mask is less effective in protecting both you and others. Also, if you use eyeglasses, ensure the nose wire on your mask fits properly and use an antifogging spray if needed. When using neck and headwear to keep warm, consider that these won’t protect you from the coronavirus, and wear a mask underneath them.

Final Thoughts

Wearing a mask is one of the effective ways we can keep ourselves and others safe from the coronavirus infection. However, correctly wearing a mask is a precondition for utmost protection.

By following the guidelines for wearing masks outlined in this post, you become an ambassador of the universal commitment to stop the transmission of COVID-19.

When in doubt, talk to your healthcare provider about the correct use of face masks.

References

●Andrejko KL, Pry JM, Myers JF, et al. Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–December 2021.

●Ravindra K, Malik VS, Padhi BK, Goel S, Gupta M. Asymptomatic infection and transmission of COVID-19 among clusters: systematic review and meta-analysis. Public Health. 2022 Feb;203:100-109. doi:10.1016/j.puhe.2021.12.003.

●Methi, F., Madslien, E.H. Lower transmissibility of SARS-CoV-2 among asymptomatic cases: evidence from contact tracing data in Oslo, Norway. BMC Med 20, 427 (2022).

●Kang Y, Park J, Park H. Particle leakage through the exhalation valve on a face mask under flow conditions mimicking human breathing: A critical assessment. Phys Fluids (1994). 2021 Oct;33(10):103326. doi:10.1063/5.0067174.

●Varela, A.R., Gurruchaga, A.P., Restrepo, S.R. et al. Effectiveness and adherence to closed face shields in the prevention of COVID-19 transmission: a non-inferiority randomized controlled trial in a middle-income setting (COVPROSHIELD). Trials 23, 698 (2022). 

●Dorfman D, Raz M. Mask Exemptions During the COVID-19 Pandemic—A New Frontier for Clinicians. JAMA Health Forum. 2020;1(7):e200810. doi:10.1001/jamahealthforum.2020.0810

●Brooks JT, Beezhold DH, Noti JD, et al. Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021. MMWR Morb Mortal Wkly Rep 2021;70:254–257. 
Article by
Michael Johnson
I am Dr. Michael Johnson. I am dedicated to providing the best medical care to my patients. In my spare time, I enjoy sharing medical knowledge with a broader audience. Writing has become a major hobby of mine, allowing me to express my passion for medicine. I particularly enjoy writing health-related articles, aiming to provide readers with practical medical advice and information. Through my writing, I hope to help more people understand how to stay healthy, prevent diseases, and better understand medical knowledge.

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