A few months ago, as the coronavirus outbreak was taking hold in the United States, the Centers for Disease Control and Prevention (CDC) was telling us that most Americans didn’t need to wear facemask out in public unless they were experiencing symptoms of COVID-19.
But at the beginning of April, the CDC did an about-face. Now the agency recommends that everyone wear cloth face coverings in grocery stores, pharmacies, and other settings where social distancing measures are difficult to maintain, especially in parts of the country where there is a lot of COVID-19 transmission.
While some, including President Trump, have pushed back against this recommendation, the practice has caught on. In a May poll from the Voter Study Group, more than four out of five Americans said they have worn a facemask in public in an effort to limit the spread of the coronavirus.
But because policies and attitudes have rapidly shifted, many people are unclear about what they should and shouldn’t be doing when it comes to masks. As lockdowns ease this summer and people head outside, proper mask-wearing is more urgent than ever to make sure the virus does not surge back. Here are some face-covering fundamentals.
First the Government Said Most People Didn’t Need to Wear Masks out in Public, Then They Reversed Their Position. Why?
The recommendation to wear a mask if you have a fever, cough, or other COVID-19 symptoms always made sense as a way for sick people to avoid infecting others.
But as the coronavirus spread, it became clear that an individual could have no symptoms and still be a carrier. A study published May 27 by the journal Thorax found that 81 percent of 128 cruise passengers who tested positive for COVID-19 had no symptoms.
“Most viruses are only contagious when you’re symptomatic,” says Panagis Galiatsatos, MD, a pulmonary and critical care physician with Johns Hopkins Medicine in Baltimore and a spokesperson for the American Lung Association. “This one, however, is contagious when you’re not exhibiting symptoms — so that’s scary.”
The realization that asymptomatic people can spread the disease changed mask-wearing policy because you might have the illness, not know it, and more easily infect others if you don’t wear a mask.
Am I Protected From the Coronavirus if I Wear a Facemask?
Robert Glatter, MD, a physician in the department of emergency medicine at Lenox Hill Hospital in New York City, stresses that the goal of wearing a mask is not so much to protect yourself as it is to safeguard others around you, particularly older people who may have chronic medical conditions such as heart disease, diabetes, obesity, or chronic kidney disease.
“As a result, if everyone is wearing a mask, we are all protecting each other in essence,” he says.
Although facemask don’t provide complete protection for the wearer, research increasingly suggests that infection risk plummets as more people wear masks, practice frequent hand-washing, and follow social distancing rules. A large investigation published June 2 in The Lancet of more than 172 observational studies from 16 countries and 44 relevant comparative studies found that “face mask use could result in a large reduction in risk of infection.”
What Is the Right Way to Wear a Mask? Can I Lower It So It Covers Only My Mouth?
The CDC says that face coverings should fit snugly but comfortably against the side of the face and under the chin, and should be secured with ties or ear loops.
But some individuals don’t wear facemask in a way that provides maximum protection. “Masks need to cover your nose and mouth, but I often see people wearing a mask that is only covering their mouth,” says Dr. Glatter. “This essentially defeats the entire purpose of wearing a mask.”
He has also observed people lowering the mask even more, tucking it under their chin to “take a break” from wearing it. Not only does this leave you more exposed to the coronavirus, but repeatedly touching the mask with unwashed hands can raise infection odds. Plus, “This is a surefire way to contaminate the mask with skin flora and bacteria that reside on the neck and chin,” Glatter says.
Do I Need a Professionally Made Facemask?
A professionally manufactured mask may fit better, but homemade masks can still be highly effective. The CDC says that cloth face coverings can be fashioned from household items or made at home from common materials, and gives detailed instructions on how to make your own.
Dr. Galiatsatos suggests that any tightly woven cotton, polyester, or silk fabric that securely covers the nose and mouth will serve the purpose.
Comfort and style are also factors to consider. “In my view, it seems that when people like the design and comfort that a facemask provides, they tend to be more compliant in terms of wearing it,” says Glatter.
Note that N95 masks, the kind that still need to be reserved for healthcare workers and other medical first responders, can be challenging to wear properly. An investigation published May 19 in JAMA Network Open found that only about 13 percent of 90 nonmedical professionals could pass an N95 mask fit test. “N95 mask use by the general public may not translate into effective protection but instead provide false reassurance,” wrote the study authors.
How Often Do I Need to Clean My Mask?
Unless it’s a disposable mask, it will need to be regularly laundered.
“Once a day or every other day is probably a good guideline,” says Dean Winslow, MD, an infectious disease specialist and professor of medicine at Stanford University Medical Center in Palo Alto, California. “You can just throw a cloth mask into the wash with your other clothes and that will be more than effective. You could also hand wash it in a sink with warm water and a liquid detergent.”
Do I Have to Wear a Mask Every Time I Go Outdoors?
That depends on how densely populated the outdoor area is. In parks, busy sidewalks, and other public areas, it can still be difficult to maintain a safe social distance, so wearing a mask is advised.
“My biggest fear with public spaces is that all you need is an infected person to go out, take a phone call, and the particles may be sent to the next person [if they are near enough to each other],” says Galiatsatos.
Wearing a Mask When I’m Hot and Sweaty Irritates My Skin. What Can I Do?
Carrie Kovarik, MD, an associate professor of dermatology at the University of Pennsylvania in Philadelphia and a spokesperson for the American Academy of Dermatology, says that in hot weather, face coverings trap more sweat, bacteria, dust, and dirt against the skin, which increases irritation.
“Saliva and moisture from your breath are also irritants,” she says. “The friction from the mask will tend to dry your face out as well.”
InStyle magazine warns that some individuals develop “maskne,” a term coined for acne that can erupt beneath the mask.
Dr. Kovarik offers these tips for protecting your skin:
- Wash with a gentle, fragrance-free soap. “You want to make sure you wash your face after coming home and taking the mask off,” she says. Regular washing helps clean the skin of substances that block pores. Kovarik notes that soaps with fragrances may further irritate the skin.
- Apply a mild moisturizer. Salty sweat actually dries out the skin. Kovarik recommends moisturizers with dimethicone because these create a barrier that can help protect against friction caused by face coverings.
- Minimize use of makeup and other products. “Some women are putting on a full face of makeup under their mask, and the mask is pushing the makeup into their skin and clogging up their pores,” says Kovarik.
- Find a comfortable mask. Kovarik encourages patients to try on masks in different sizes and find one that fits well, since ill-fitting coverings create more friction. She adds that uncomfortable masks can also chap lips, and tight loops on some masks can chafe the skin around the ears. Kovarik advises patients to take 15-minute breaks every four hours. “It’s important to let your skin breathe and air out,” she says.
- Wear a fabric that doesn’t irritate. Kovarik suggests that cotton masks tend to be less irritating than other types made with rougher fabric.
Galiatsatos adds that some people may be reluctant to wear masks in the summer because they’re afraid they’ll develop an odd tanning pattern. Kovarik has the solution: “Wear sun block or a moisturizer with SPF 30 all over your face.”
I’ve Read on the Internet That Facemask Can Interfere With Breathing and May Even Be Dangerous
Galiatsatos says that many of his lung patients use face coverings made with breathable fabric and none have had any issues. “They want to make sure they’re doing everything possible to not get COVID-19,” he says about this high-risk population.
Glatter confirms that face coverings are safe for adults to wear despite social-media rumors, reported in outlets like Euronews, that mask-wearing can cause hypercapnia (an elevated blood level of carbon dioxide) from rebreathing carbon dioxide.
The CDC warns that masks are not suited for children under age 2. “In a nutshell, babies could suffocate from wearing a mask, or even choke on the mask,” says Glatter.
For everyone else, face masks are an essential for life after lockdown.
“Everyone going into public areas should wear face masks if we want to stop the spread of this virus,” Galiatsatos says. “I think they can help us approach an assimilation back into public life in a smart and practical way.”