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A fan wears a neck gaiter as he watches the L.A. Dodgers play the San Francisco Giants in Los Angeles.
Gina Ferazzi/Los Angeles Times via Getty Images
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Gina Ferazzi/Los Angeles Times via Getty Images
A fan wears a neck gaiter as he watches the L.A. Dodgers play the San Francisco Giants in Los Angeles.
Gina Ferazzi/Los Angeles Times via Getty Images
Each week, we answer “frequently asked questions” about life during the coronavirus crisis. If you have a question you’d like us to consider, email us at goatsandsoda@npr.org with the subject line: “Weekly Coronavirus Questions.”
Between face shields, neck gaiters and goggles, the options for protection are getting more complex. What face covering setup offers the best safeguard from the virus?
There’s been a lot of face covering news this week. A study from Duke looked at the effectiveness of a variety of coverings and resulted in headlines like this from The Washington Post: “Wearing a neck gaiter may be worse than no mask at all, researchers find.”
Lovers of neck gaiters — those tubes of fabric you slip over your head and that pull up over the nostrils and mouth — were up in arms.
Then the Philippines ruled that you have to wear a plastic face shield when going outside.
One thing is clear from the research: Wearing a face covering can save lives.
But there’s still a lot we don’t know.
The neck gaiter debate illustrates why there’s still confusion.
Outdoor exercisers often like gaiters — they’re easy to pull up and down, and there are no ear loops that might pinch the ears or simply slip off.
But this week, a study from Duke appeared to conclude that wearing a gaiter is worse than no mask at all when it came to protection. (The researcher hypothesized that the gaiter’s porous texture would likely split large COVID-19 particles into many smaller ones, which then can linger in the air for longer.) And the media was quick to jump on the story.
Dr. Michael Edmond, infectious disease specialist at the University of Iowa, has a few points to make about the study.
“One thing to realize is that they [tested only] one gaiter, made of neck fleece — which is a very thin fleece,” Edmond says. That’s a synthetic material. He says: “I’d be interested to know if the gaiter tested was made of a different fabric with multiple layers if it’d be more protective.”
In other words, he’d like to see more data before knowing whether to discount all gaiters.
And that’s true in general about face coverings that seek to protect others from any viral particles emitted by the wearer — and protect the mask-wearer as well.
Dr. Vicente Diaz, who specializes in ocular inflammatory and infectious diseases at Yale Medical School, agrees, He says while Duke’s study provides a good starting point, there are many other factors to consider in assessing gaiters — like testing circumstances and the specific gaiter used.
“What they found was that when the subjects were talking for ten minutes, [gaiters] seemed to allow particles [spewed by the wearer] to break up and even spread faster,” he says. “But that may be a function of the material used, as well as the design of the face covering.”
What’s more, outdoor exercisers are … outdoors … where risks of transmission are lower than indoors. And runners may also be following the guidelines of social distancing, which would further decrease risks to others — which is why some reports have said you shouldn’t be so hasty to trash your gaiter.
One ScienceNews story, by Jonathan Lambert, concedes that there is indeed much to be learned still about masks’ role in helping prevent the spread of COVID-19. But according to Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, cited in the story, the “preponderance of evidence, both for COVID-19 and earlier viruses, suggests that cloth face masks, and that includes properly worn neck gaiters, filter out the majority of viral particles and provide some protection for an individual.”
Then there’s the question of full-on plastic face shields.
Edmond thinks they’re pretty cool.
When it comes to larger viral droplets, he says, a face shield is likely more protective than a face mask.
Furthermore, a face shield covers the eyes — a potential entry point for the virus — he points out. That’s something no gaiter or mask can do.
And while it’s easy to wear a mask incorrectly — letting it slip beneath the nostrils or hang from the chin — that’s not going to happen with a face shield.
The shields are also easy to clean with spray disinfectant, or just soap and water, says Edmond.
Then again, face shields aren’t 100% effective either.
“The downside [with face shields] is that we don’t know how well they work for source control,” Edmond says — in other words, limiting your transmission of viral particles if you’re infected. “That’s another thing we’re waiting on data to really give us an answer for.”
As such, Edmond says the safest approach combines a mask and a face shield to offer maximum protection from viral particles for yourself and for others. He notes that when a face shield is worn over a mask, it can offer the advantage of protecting the mask itself — keeping it from picking up virus particles.
Diaz emphasizes that eyes are another area to protect, if you have the ability to. He says studies have found that when eye protection was incorporated as a part of disease control strategy, it substantially reduced the rate of coronavirus infection.
“When it comes to the eyes, we’ve learned that they do seem to be involved,” Diaz says. “Certainly the virus can get to the eye, and approximately 60% of people who present with COVID infection have been noted to have eye-redness as a presenting symptom.”
Edmond says it’s probably easier for most people to wear face shields than skin-tight goggles when it comes to eye protection. However, it depends on your preference. If you need to protect your eyes and don’t want to wear a shield, goggles would work. Just make sure they are in fact goggles and not safety glasses, which you can tell by their “fairly tight contact to your face” with no gap.
“If fitted appropriately, goggles will be very protective” he says.
Diaz says eye protection can even start from the simplest choices — even just opting for glasses instead of contacts can confer an additional barrier. In the end, the best protection is one you will actually wear — so it’s a good idea to do as much as you’re comfortable with sticking to consistently.
As a general rule, Diaz says it’s critical to consider your own health risk when determining a mask or face covering regimen. If your day-to-day is particularly high-risk — say, you’re a healthcare worker — or you’re immunocompromised, “the more protection the better.”
Edmond says he tailors his personal face gear to the situation.
“If I’m going to the grocery store, where I don’t anticipate that there are going to be people very close to me, I will typically wear a shield, unless the store says specifically I have to wear a mask,” he says. “But if I have to be in a classroom where there are lots of people per square footage — I would probably wear a mask and a shield. And same thing if I’m on a plane.”
Diaz follows a similar setup – wearing a surgical mask in public, and an N-95/face shield combination at work, where he works closely on the eyes of patients. Diaz says the most protective options are masks with respirators that filter out viral particles, or N-95 masks, though for most people, they’re hard to access.
But a mask that has an exhalation valve or vent — making it easier to breathe — gets a thumbs down from the Centers for Disease Control and Prevention, especially if it’s not covered by a filter. In guidance updated late last week, the CDC explains that one-way air vents allow air (and thus, potentially infected respiratory particles) to be released, so valve masks fail to prevent COVID-19 transmission.
However, if the mask has a filter behind the valve — which many cloth face masks with valves have — then it should be OK, says Raina MacIntyre, a leading mask researcher and head of the biosecurity program at the Kirby Institute at the University of New South Wales in Australia.
“For the general public, we’re in consensus that at least a cotton mask is helpful,” Diaz says. “Beyond that,” he says, “the more you do to protect yourself, “the better.”
Pranav Baskar is a freelance journalist and U.S. national born in Mumbai.
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]]>As the number of novel coronavirus cases continues to rise nationwide, the recurring message from many public health experts and doctors has been simple: Wearing masks saves lives.
“We are not defenseless against covid-19,” Robert R. Redfield, director of the Centers for Disease Control and Prevention, said in July. “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting.”
But as face coverings have become increasingly commonplace in American life, so have questions about efficacy — and now a group of researchers from Duke University are aiming to provide some answers.
In a recently published study, the researchers unveiled a simple method to evaluate the effectiveness of various types of masks, analyzing more than a dozen different facial coverings ranging from hospital-grade N95 respirators to bandanas. Of the 14 masks and other coverings tested, the study found that some easily accessible cotton cloth masks are about as effective as standard surgical masks, while popular alternatives such as neck gaiters may be worse than not wearing a mask at all.
“You can really see the mask is doing something,” said one of the study’s co-authors, Warren S. Warren, a professor of physics, chemistry, radiology and biomedical engineering at Duke. “There’s a lot of controversy and people say, ‘Well, masks don’t do anything.’ Well, the answer is some don’t, but most do.”
The search for a way to determine the effectiveness of different masks began with a request from a professor at Duke’s medical school who was working to provide at-risk and underserved populations in Durham, N.C., with the critical face coverings, according to a news release from the university. Faced with so many varieties of masks all claiming to have virus-blocking capabilities, the professor sought help — in the university’s physics department.
Enter Martin Fischer, a chemist and physicist.
Using a simple contraption that harnesses the power of a laser, which can be easily purchased online for less than $200, and a cell phone camera, Fischer created a device that allowed his team to track individual particles released from a person’s mouth when they are speaking. The rest of the setup includes a box that can be made out of cardboard and a lens.
“It’s very straightforward, doesn’t take much resources,” Fischer said in a video produced by Duke. “Any research lab has these things lying around.”
Testing the face coverings was equally uncomplicated, according to the study published Friday in Science Advances, a peer-reviewed journal.
Speakers said the same phrase into the box without a mask and then repeated the process while wearing one. Each face covering was tested 10 times. Inside the device, the airborne particles passed through a sheet of light created by the laser hitting the lens and produced visible flashes that were recorded by the phone’s camera.
“Even very small particles can do this kind of [light] scattering,” Warren said. “We were able to use the scattering, and then tracking individual particles from frame to frame in the movie, to actually count the number of particles that got emitted.”
A fitted N95 mask, which is used most commonly by hospital workers, was the most effective, Warren said, noting that the mask allowed “no droplets at all” to come out. Meanwhile, a breathable neck gaiter, well-liked by runners for its lightweight fabric, ranked worse than the no-mask control group.
“These neck gaiters are extremely common in a lot of places because they’re very convenient to wear,” Warren said. “But the exact reason why they’re so convenient, which is that they don’t restrict air, is the reason why they’re not doing much of a job helping people.”
The high droplet count could be linked to the neck gaiter’s fabric breaking up bigger particles into many little ones that are more likely to hang around in the air longer, Fischer said in the video. This effect makes wearing them possibly “counterproductive,” he added.
“It’s not the case that any mask is better than nothing,” he said. “There are some masks that actually hurt rather than do good.”
Other types of face coverings that may fall into that category are bandanas and knitted masks, the study found. An N95 mask with an exhalation valve also failed to measure up.
“Those relief valves are fantastic if what you want to do is protect yourself from the outside world because air doesn’t come in through them,” Warren said. “If what you’re trying to do in this pandemic is protect the outside world from you, it completely defeats the purpose.”
Still, he stressed that people without access to medical-grade masks shouldn’t worry.
“We’re not as a society going to be having everybody wear disposable N95 face masks,” he said. “It’s not affordable, and it’s not reasonable.” The researchers specifically made note of the effectiveness of common cotton cloth masks, finding that several of the ones tested performed about as well as surgical masks, which come in second to the N95. Experts with the World Health Organization have recommended that fabric masks should ideally have three layers.
Although the study was “not a clinical trial” that involved testing “10,000 patients and seven different languages and all possible conditions,” Warren said its general conclusions still stand.
“We’re very careful not to over-claim here,” he said. “We are not going to try to say our evidence is that this is the thread count you should use on the sheet for the two-ply cotton mask that you’re making.
“But the broad take-home picture — that masks do work in cutting down transmission and that some masks that you can easily get are better than others — potentially has value in protecting everybody and getting us out of this awful situation,” he added.
Warren said he and his fellow researchers are now focused on producing a step-by-step instruction guide for creating the testing device. The team has already been approached by people from foreign countries, including Africa, who have expressed interest, he said.
“It is quite possible for people with a modest amount of scientific training to use this quite safely and quite effectively,” Warren said, noting that he does not recommend that the average person go out and try to construct the device themselves. “The idea is that you could have community centers, groups that are helping to test out different designs. Particularly as we’re trying to provide face masks to a large number of people who don’t have them, you want to be providing ones that work.”
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