By Rick Ansorge, for UCHealth

At the start of the COVID-19 pandemic, face masks were in short supply.

Masks were reserved for those at highest risk of infection – health care workers and first responders.

For others, the conventional wisdom about face masks has been that any face covering, even a single-layer cloth mask, is better than nothing.

The rationale was pretty simple. Since many COVID-19 cases are spread by asymptomatic people, it was thought that even a basic mask could prevent the wearer’s virus-laden droplets expelled by coughing, sneezing, speaking and laughing from escaping into the wider world. Indeed, early data showed that many types of masks could decrease transmission of the virus.

We knew that the best face mask – the N95, a respirator that provides 95% protection – was in such short supply that it was reserved exclusively for front-line health workers. Among the general public, it was almost impossible to find.

Should I get a better face mask?

Times have changed. Ordinary people now have some access to the N95, which can cost up to $5 each. More readily available at mass merchandisers such as Amazon is the N95’s equivalent: a certified KN95 respirator.

Like the N95, the KN95 is designed to filter out 95% of particles down to 0.3 microns in size. The disposable KN95 costs between $2 and $3 each.  But it’s a vast improvement over most commercially available masks, many of which are more decorative than protective.

Now that COVID-19 is resurgent nationwide, causing record numbers of cases, hospitalizations, and deaths, an increasing number of experts are telling the public that it’s time to banish the bandana and similarly ineffective face coverings and buy a better mask. They say that this one simple step could dramatically improve outcomes as people await the arrival of approved medical treatments and vaccines.

“Ultimately, a comfortable surgical grade N95 mask (or its equivalent) is going to be one of the best options,” said Dr. Ian Tullberg, medical director of UCHealth Urgent Care locations throughout Colorado.

Cloth face masks and multiple layers

Although Tullberg personally finds cloth masks more comfortable than the N95 or its equivalent, he understands why infectious disease specialists won’t let him wear one when he’s in the clinic.

“It just doesn’t protect nearly as well,” he said. “That’s just the porous nature of these cloth masks. They allow much larger particles to go through and that’s exposing you even more.”

The effectiveness of a mask is dependent on its tolerability, he explained. “Masks aren’t just there for droplet protection. They’re also there to help us from touching our face, rubbing our nose, getting our mucus on it.”

Comfortable to wear

If people can’t wear a higher-quality mask without constantly scratching at it, readjusting it, or taking it down, another type of mask that can be left in place for extended periods of time actually may be more protective, he said.

One option is a multi-layered cotton mask, which offers more protection than a single-layer mask. Another option is a U.S. Food and Drug Administration-approved surgical mask – the kind worn by doctors and nurses – not the look-alikes which are essentially dust and allergen filters. A surgical mask with an FDA rating of level two or three can filter out about 60% of viral particles.

Find a secure fit

In general, it’s best to choose a mask with headbands that ensure a snug fit around the face. Masks with ear loops often fit loosely around the face, leaving gaps that cause air leakage.

If you can tolerate a tight-fitting KN95, which is the Chinese equivalent to the N95, or an FFP2, which is the European equivalent, that’s probably your best option, especially when you’re in high-risk settings such as supermarkets and public transportation.

“Certainly the more expensive, higher quality masks will protect you better,” Tullberg said.

The FDA initially granted many KN95 and FFP2 masks emergency use authorization (EUA). But the agency later removed a number of these respirators from the list after the CDC’s National Institute for Occupational Safety and Health (NIOSH) found that they did not offer comparable protection to a certified N95.

You can see if your face mask has emergency use authorization by checking the FDA and NIOSH websites. In addition, the CDC publishes an extensive list (with images) of counterfeit and falsely marketed respirators that may be as little as 5.3% effective.

One of the KN95 masks that has retained its FDA emergency use authorization is the Powecom KN95, which has received favorable reviews.  On Amazon, it costs $22-26 for a 10-pack.

CDC guidelines on doubling up

In theory, wearing two or more masks at the same time may seem to increase your amount of protection, Tullberg said. But most likely that’s a counter-productive strategy.

“The CDC is not recommending doubling up on masks at this point. At UCHealth, we are really encouraging people not to do that. More layers don’t mean more protection. In fact, it could possibly make things worse because you’re messing with your masks way too much.”

“People can have trouble breathing,” he explained. “If you put on too many masks, it is going to cause more constriction against your face. You’re going to get more mucus on it, which causes it to degrade.”

His best advice: “Just use a high-quality single mask.”