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Making the Most of Masks During Covid-19

Our family practice doctors continue to receive questions about masks to prevent the spread of COVID-19. Since we’ve learned a great deal about masking since the start of the pandemic, and new studies continue to add to our knowledge, we thought we’d provide an update on what we now know.

Masks vs. vaccines

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention (CDC), said last fall that wearing masks is even better than a vaccine to help stop the virus in its tracks. 

He held up a face mask during a congressional hearing and said, “I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine.”

His statement shocked people, because we’ve looked to a vaccine as signaling the end of the pandemic. At the time, no vaccines had yet been tested for effectiveness. But studies of face masks vs. the seasonal flu found no difference in immunity in preventing the flu. 

And when he made that statement, he was assuming coronavirus vaccines would have the same effectiveness rates as the seasonal flu vaccine, about 30-40 percent.

Now that we have two new approved vaccines with effectiveness rates between 90-90 percent, his statement is probably less accurate. But his point was that universal masking can be highly effective. The right kind of mask, properly worn, protects you and the people you come in contact with from the virus.

Which kind of mask?

Which raises the question, what is the “right kind” of mask?

First, let’s do a quick review. The SARS-CoV-2 virus is one of the most transmissible viruses we know of. And the new strains recently discovered in the United Kingdom and South Africa transmit even more readily. They don’t appear to be any more deadly than the original strain we’ve been dealing with for a year, however.

We also learned the virus spreads primarily through droplets and aerosols from talking and even breathing. They can linger in the air for hours in enclosed spaces, such as restaurants and grocery stores.

So the right kind of mask is one that prevents those droplets and aerosols from being discharged into the air, or being breathed in.

Two vs. one?

To be effective, it must fit tightly around the nose and mouth. The problem is, many cheap or homemade masks don’t meet this criteria.

Therefore, many people have taken to wearing two masks for extra protection. This includes President Biden, who often wears a surgical mask over a cloth mask, as well as many NFL coaches.

“The reason for that is you do wind up getting more filtration of viral particles,” Dr. Dave Hnida told CBS Denver. “It becomes more of an obstacle course for the viral particle to make its way from the air into your nose and throat and then into your lungs.” Research backs him up, he said. “Specifically what we’re saying is that two masks may actually equal the protection you would get from N-95 masks, which is considered the best mask there is short of a complete respiratory-type unit.”

Which kind is best?

N-95 masks are the type medical professionals use in a hospital setting. The CDC, among others, warned the public against wearing those at the beginning of the outbreak, because they were needed for front-line health care workers.

Now, however, both France and Germany have recently made it mandatory for their citizens to wear medical-grade N-95s, KN95s, or FFP2s. The more highly contagious coronavirus variant spreading rapidly there caused this recommendation.

The World Health Organization (WHO) still recommends leaving the N95 type for health care workers, those who have coronavirus symptoms and those over 60 or who are at high risk.

It’s up to you whether to opt for an N95 or similar mask. You can also wear two masks for the best protection.

The fit is critical

The key is to make sure it fits closely on your face, covering your nose and mouth completely.

“If the mask is not fitted well and there are large gaps around your nose or to the side of your cheeks or under your chin, then you’ve defeated the purpose,” said Gregory Poland, director of the Mayo Clinic’s Vaccine Research Group.

If it doesn’t cover the nose, there’s no point in wearing one, said Mark Rupp, chief of the infectious diseases division at the University of Nebraska Medical Center.

He explained that the nose is one of the primary entry points for SARS-CoV-2. The ACE2 receptor is a key protein which the virus uses to enter and infect cells. It’s found in higher densities in the nasal membrane than the trachea or windpipe.

What about after the vaccine?

Finally, will we still have to wear masks after receiving the coronavirus vaccine? The answer seems to be yes, at least for a while.

First, it will take several weeks for the vaccine to achieve full effectiveness in the body. And even the best estimates are that both the Moderna and Pfizer-BioNTech vaccines confer 90-95 percent effectiveness. So there’s still a five-10 percent chance you can be infected.

Second, it’s still too early to know whether it’s possible to spread the virus to others even if you’re fully vaccinated. Remember, up to 50 percent of COVID-19 transmission comes from those with no symptoms.

So for now, remember: The tighter the fit and the more layers you have, the better you’re protected.

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