An FAQ on Masks

There is an overwhelming amount of contradictory information about masks out there, so Last Mile has pulled together the most important questions you might have about how to mask up! Our answers will help you not only choose the best mask option for you, but also how to wear and properly maintain it. This FAQ is an expansion of the Mask section in our M.A.D.—Tips for COVID-19. 

Q: What’s the best, most effective option, a KN95 or a surgical mask?

Short answer—choose the most protective mask that you will wear consistently. Do not wear a mask with an exhalation valve.

The long answer is more complicated. Current evidence suggests that you should wear a respirator—a special type of mask that is more protective against small particles (masks marked as N95 or KN95)—if you are in a space indoors OR outdoors that is:

• Crowded

• Humid

• Poorly ventilated (little or no airflow)

• Likely to bring you into prolonged close contact with others

• Likely to expose you to people who are not wearing masks (schools, hospitals,
  indoor restaurants)

Surgical masks should be sufficient in spaces that are not crowded (ie, where physical distancing
is possible) and in spaces:

• With good airflow

• With low humidity

• Where prolonged close contact is limited

• Where others consistently wear masks (eg, office settings, in stores, on mass transit)

Here are some articles to read for more information on types of masks and when to wear them:

• CDC Cloth Mask Guidance

• N95 Masks vs. Surgical Masks: Which Is Better at Preventing the Coronavirus?

• Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019?

• 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings

As with any new disease, it is very hard to make absolute recommendations. Please see the pros and cons below, and make your decision accordingly. The most important point is that a mask will only protect you if you wear it properly and consistently. Any face covering (including a mask or respirator) should cover your nose, mouth, and chin. It doesn’t work if it is on your forehead or your neck (or you position it so intermittently). This can potentially contaminate the inside of the mask, exposing you to virus particles.

The differences between respirators, like KN95s, and surgical masks:

• Pros of KN95s—likely more protective from aerosolized viruses such as COVID-19 and can be reused more easily

• Cons of KN95s—requires proper fit to be more effective than a surgical mask, expensive, more uncomfortable to wear especially in hot/humid weather, difficult for people with asthma, COPD, or other respiratory issues

• Pros of surgical masks—cheaper to replace, easier to wear and tolerate, can be replaced more easily if soiled by sweat/dirt

• Cons of surgical masks—not as protective against viruses or other airborne particulates, may require more frequent replacement from damage/soiling

Masks with exhalation valves are often more comfortable, but that is because the valve allows exhaled air to exit the mask into the world, along with any virus particles it may carry. This type of mask is not recommended for use, as it increases the possibility that you will expose others if you are infected with COVID-19.

Q: What about cloth masks?

Cloth masks are not standardized and can be made of cloth that is permeable even to large particles or that may not properly seal off the nose and mouth. Cloth masks in general are not considered as effective as surgical masks at protecting from aerosols, especially at close distances. However, they may afford some protection to others by catching the droplets you breathe out. So if that’s your only option, please wear it.

Read here for an expert consultation on the effectiveness of cloth masks:

• Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic 

Not all cloth masks give you the same protection, and you want a mask that has a high level of filtration, especially if you are going to be indoors at school or work. Try this DIY hack that makes an easy and protective mask from a hand towel:

• Take a hand towel and 2 rubber bands

• Place the towel on a table and fold both ends inward to meet the middle

• Take each folded side and fold again toward the middle

• Thread each end of the folded towel through a rubber band, so that each rubber band is
  around the folded towel about 2 inches from the end

• Fold the 2 inches on the end of each side back inward over the rubber band

• Pull the rubber bands up like ear loops

• Hold the mask to your face and loop the rubber bands around your ears to wear your new
  DIY mask

  • For a visual demonstration of the instructions, check out this video from the
    CDC: How to Make Your Own Face Covering 

N95 and KN95 masks have a layer in the middle of the filter that repels water from both sides, with a piece of a t-shirt and fabric protectant spray, you can create a DIY version of this layer to insert into your mask:

• Take a t-shirt and cut a piece of it the size and shape of your mask

• Spray both sides with fabric protectant or waterproofing spray

• Hang the fabric to dry for at least a day

• Place the cloth in the middle of your DIY mask with a layer of cloth folded above and below it

Q: How do I wear my mask?

First, wash your hands with soap and water for 20 seconds or use hand sanitizer that’s at least 60% alcohol. If you have a surgical mask or one with ear loops, hold the mask to your face and then secure the loops around your ears. If you’re using a surgical or respirator-style mask (KN95) with head straps, first move the top strap to sit at the crown of your head, then move the bottom strap to sit at the nape of your neck. 

Mold the stiff edge around your nose bridge to close any gaps. Stretch the bottom edge over your chin. The mask edges should lay flat on your cheeks and skin. You can find additional tips on properly fitting your mask here: Surgeon’s Tips: Stop Fogging & Improve Seal on Medical Face Masks #ORTips.

Q: What if I have to eat or drink while I have my mask on?

When removing your mask to eat or drink—if possible, move 6 feet away from others. Ideally, you should eat in a room alone, or 6 feet apart if outside. Breakrooms have the potential to be high-risk areas for spread of COVID-19 infection because they are often small and poorly ventilated. 

Remove your mask completely—hold by the ear loop with one hand or fold in half (so the inside surfaces touch) and store in a paper bag. Sanitize your hands, eat or drink quickly, replace your mask, and sanitize your hands again.

Lowering or raising your mask to eat or drink risks contaminating the inside of the mask with virus particles on your skin. Instead, remove your mask entirely when eating or drinking.

Q: Can I remove my mask while I’m talking?

DO NOT remove your mask to talk. Protecting others from your respiratory droplets while talking is one of the major ways masks prevent transmission. We promise you that your coworkers can hear you!

Q: How do I make my surgical mask fit better?

There are lots of ways to make sure your mask fits your face, which will improve how effectively it protects you from COVID-19. Here are some methods that may work. Some are easy to do, and some have better evidence that they work.

1. Tape—you can buy surgical tape at any pharmacy. Place it where the mask meets the bridge of your nose to close any gaps.

2. Knots—tie a knot on the ear loop as close to the mask edge as possible. This turns it into a “duckbill-styled” mask. Tuck in the edges, and you are good to go! Video explanation here: How to Improve Your Surgical Mask Fit– Covid-19.

   1. For some other quick tips on using knots, check out this quick trick to make your surgical mask fit better from Nikki Sylianteng: Surgical Mask Hack.

Fix the Mask (https://www.fixthemask.com)—use 3 rubber bands and some safety pins to make yourself a DIY mask brace, as seen here in this video: (DIY Surgical Mask Brace – Rubber Bands). You can also purchase a mask brace from Fix the Mask here: (Essential Mask Brace | Secure your loose-fitting mask.).

Q: What if I need to adjust my mask?

If you need to adjust your mask, make sure to wash or sanitize your hands before and after. The outside of your mask should be considered contaminated with virus particles once you put it on, so you must clean your hands if you touch it.

Q: My ears hurt when I wear my mask. What should I do?

There are lots of solutions to this! Fix the Mask suggests using a safety pin to unite the two rubber bands of their DIY Mask Brace. You can also use them to pin the ear loops together at the crown of your head. Paper clips also work well for this. There are many hats/caps and headbands now available with buttons positioned behind the ear over which to hook the ear loops of your mask.

ALiEM is a great resource for many things in emergency medicine, including face mask hacks: Trick of the Trade: Face mask hacks to make you more comfortable.

Q: How do I keep my glasses from fogging when I wear my mask?

This is a tricky one! From experience—the tape method seems to help, or just positioning your glasses outside your mask (so they sit on top of the edge covering your nose). Fix the Mask also claims their mask brace helps with fogging, but we cannot vouch for that.

Q: How can I save my mask for reuse?

If your mask folds in half, fold in half so the inside surfaces touch, and place it in a paper bag. Store in a clean dry place. You can also hang your mask.

DO NOT store your mask in a closed plastic container—moisture will promote mold and bacterial growth.

It is unclear how long or how many times masks can be reused, but you should definitely discard your mask if it is visibly soiled (eg, with dirt, makeup, or sweat).

Q: How can I clean my mask?

Do not use bleach or disinfectant to clean your masks—these can actually stop your mask from working. 

Time is the easiest way to clean your mask. If you rotate your masks daily, it allows time for any virus particles on your mask to break down before you wear it again. It is unclear how long it is necessary to wait, but at least one week is the current consensus.

If you are considering using heat or UV light to clean your mask, here is some helpful information from the Learnly Anesthesia/Stanford AIM Lab (COVID-19 Evidence Service).