This week, HuffPost UK reader Rita asked: “Are surgical masks better than cloth masks?”
With new and more transmissible Covid-19 variants doing the rounds, Germany has made it mandatory to wear medical-grade masks in public settings, which tells us a lot about how effective cloth masks are considered to be.
Either single-use surgical FFP1 masks – the disposable blue ones you see people wearing and that you can buy from pharmacies – or FFP2 filtering respirators – traditionally worn by healthcare professionals as PPE – should be worn at work, on public transport and in shops, according to the new rules.
France is thought to be considering adopting similar measures, The Guardian reported. Daniel Camus, a member of France’s high council for public health, said category 2 masks, such as fabric masks, only filter 70% of particles, while category 1 masks like surgical masks can go as high as 95% if worn properly.
“As the variant is more easily transmitted, it is logical to use masks with the highest filtering power,” he told France Info. “We are not questioning the masks used up to now … but as we have no new weapons against the new strains, the only thing we can do is to improve the weapons we already have.”
Experts agree medical-grade masks are better than cloth masks – and studies back that up. Cloth masks don’t have to adhere to any safety standards in the UK, so they vary massively in how well they work. You could get a paper thin cloth mask that barely stops droplets from passing through the fabric, or you could get one with the recommended three layers, with a tightly woven material that is more protective.
Professor Paul Hunter, an expert in medicine from the University of East Anglia who has reviewed numerous studies on face masks, says the evidence on cloth face coverings is that their effectiveness is variable. “Some are good and many are useless,” he admits, citing one study that showed higher rates of influenza in health care workers wearing cloth face coverings compared to surgical masks.
How well they work depends on what they’re made from, how they’re constructed and how they’re worn, says Prof Hunter.
An analysis of multiple reviews on face masks by the World Health Organisation concluded that “cloth face masks have limited efficacy in combating viral infection transmission”. As such, WHO recommends people with underlying health conditions and those over the age of 60 wear surgical or medical masks when they can’t socially distance.
“We know from multiple studies that in terms of protectiveness, the available masks are ordered in the following way, from most to least protective: FFP3> FFP2/N95> surgical> cloth masks,” Dr Julian Tang, an honorary associate professor and clinical virologist at the University of Leicester, tells HuffPost UK.
“Early on in the pandemic, the mantra was ‘any mask is better than nothing’. Now, with the recent higher infection, hospitalisation and death rates, if some people want to wear the more protective FFP2/N95 masks (without valves), these are available from most DIY stores and will offer better protection in both directions – to contain outgoing aerosols if you are infected (and unaware of this), as well as incoming aerosols produced by others who are infected.”
Dr Tang says medical-grade masks like the FFP2/N95 masks may be difficult to wear for long periods, however – and should ideally be fit-tested to individual faces, as they come in different designs, shapes and sizes.
A quick check for an effective fit can be done by putting on the mask carefully and then breathing in, he says. If you can feel the edges of the mask clinging more tightly to your face then this is likely to be a good fit.
“If wearing them can be tolerated – at least for short trips to the shops – laboratory studies have shown that FFP2/N95 masks/respirators can offer up to 20-30 times more protection – in both directions – compared to cloth/surgical masks,” says Dr Tang.
But Prof Hunter is a little more wary of respirators. “They do not seem to give better protection and may have more adverse impacts.” He nods to a study that concluded the use of particulate respirators offers no advantage over the FFP1 masks.
If you do opt for surgical masks, you need to make sure they fit properly. Wearing a large and gaping mask won’t do much to keep your droplets in, or other people’s droplets out. If you end up with sagging surgical masks because you have a smaller face, tie the elastic around your ears more tightly.
And, as always, wear a mask over both your nose and mouth. “Unfortunately wearing a mask where your nose or mouth are still showing will not help to protect you or those around you from airborne virus,” Dr Tang concludes.
As it stands, UK guidance recommends for people to wear either cloth or medical masks when in public settings. Ultimately, it’s your choice which mask you wear, but it’s always good to know what offers the best level of protection.
While the medical grade masks are considered more protective, they can prove costly (not to mention bad for the environment) due to their single-use nature, whereas a triple-layered cloth mask might suit people better if they don’t have underlying health conditions and would prefer not to keep buying new masks.
You can find the best and worst cloth masks, as reviewed by Which?, here.
When asked whether the UK was considering making medical grade masks mandatory, a Department of Health and Social Care (DHSC) spokesperson told HuffPost UK: “We have no plans to make it mandatory for the public to wear PPE.
“The most important and effective actions members of the public can take to protect themselves and others are to wear a face mask where necessary, reduce contact with others by avoiding leaving home unless absolutely necessary and if they do leave their home, to maintain 2 metre social distance.”
They added that while our PPE supply is “stable”, such masks should still be reserved for frontline health and social care workers where it is needed.
PPE “is not recommended for use in retail and hospitality settings or by the public,” they concluded.
Experts are still learning about Covid-19. The information in this story is what was known or available at the time of publication, but guidance could change as scientists discover more about the virus. To keep up to date with health advice and cases in your area, visit gov.uk/coronavirus and nhs.uk.