Masks: What works and what doesn't, and why buffs and bandanas may not be as effective
- The most effective kind of fabric face mask is a stitched mask with a tight fit.
- Though bandanas are better than nothing, the fact that it doesn't offer a tight fit at the bottom of the face makes it a poor choice for a face covering.
- If you don't have the skills to stitch a mask and don't want to spend any money, creating a makeshift face covering with a folded handkerchief is a good option.
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Face masks are now the new normal. And we have a pretty big variety of face coverings to choose from including medical-grade face masks to home-made ones. Fabric face masks, in particular, have become widespread and easily available for the general population. But some fabric face masks are more effective than others at preventing your germs from spreading.
Researchers have conducted numerous studies to determine which face masks are most effective. Here, we've looked at the data from various studies and spoken with multiple experts to pinpoint which fabric face masks are best.
Going mask-less offers no protection
Experts across the board strongly advise against going mask-less. Because being uncovered provides zero protection for you and everyone around you from the novel coronavirus, says Iahn Gonsenhauser, MD, a Doctor of Internal Medicine and Chief Quality and Patient Safety Officer at The Ohio State University Wexner Medical Centre.
"Masks are what our recovery depends on. But they don't do any good on the shelf; they have to be on our faces," says Gonsenhauser.
A study published in the Physics of Fluids simulated coughs and sneezes using a mannequin head and air pumps that emulated the force of real coughs and sneezes. The researchers tested different face coverings to see which ones did the best job at blocking respiratory droplets and concluded that any mask — even the least effective — were better than no mask at all.
Buffs are ineffective
A study published in Science Advances found that buffs (also know as neck gaiters) specifically neck fleeces, are relatively ineffective face coverings.
The researchers determined that wearing neck gaiters may actually be counterproductive, because they can cause large respiratory droplets to break up into smaller respiratory droplets, which can stay airborne longer and potentially infect others.
But it's important to note that this part of the study prompted some backlash, with some doctors arguing that gaiters are actually more effective than the Science Advances study claims. Until there is more research, there is no clear consensus as to whether gaiters offer adequate protection.
Bandanas are not recommended
A bandana is not the best face covering, but it's more ideal than going maskless.
Bandanas don't do a great job blocking particles through or around the mask, says Gonsenhauer. In fact, the researchers for the Physics of Fluids study found that a simulated sneeze blocked by a bandana still allowed respiratory droplets to jet out 7cm and 18cm.
The study also found that a single layer bandana was the least effective out of the tested coverings, because it doesn't provide an all-around tight fit for the bottom half of the face.
That said, the researchers did conclude that the bandana slightly reduced the range of respiratory droplets from a cough, making it better than being uncovered.
Folded handkerchiefs are a good homemade option
It's possible to create a makeshift mask by folding up a handkerchief, bandana, or even fabric from an old t-shirt.
In fact, the United States Surgeon General even released a video with instructions on how to create a mask in this way. It involves cutting off the bottom half of a t-shirt, folding it so it has multiple layers, and then securing it with rubber bands.
In the same 2020 Physics of Fluids study, the researchers followed the Surgeon General's folding instructions with a cotton handkerchief and determined this was more effective than the bandana but less effective than a stitched mask or a commercial mask, since a sneeze from behind a folded handkerchief jetted out approximately 38cm.
They noticed the most leakage at the top of the mask since it isn't very tightly fitted around the nose area.
However, despite the fit, one of the benefits of a folded handkerchief, as opposed to a bandana, is that it has more layers. "The more layers there are, the better protection there will be, and the more the cloth will have the ability to prevent the virus from being coughed out onto another person," says Shira Shafir, PhD, MPH, Associate Adjunct Professor in the Departments of Community Health Sciences and Epidemiology at the UCLA Fielding School of Public Health. Gonsenhauser agrees that while droplets can escape from this mask, it's still a fine choice for casual use in non-healthcare environments.
Cone-style masks are effective, but allow for some leakage
The Physics of Fluids study found that a cone-style commercial mask sold in pharmacies was more effective than a bandana or a folded handkerchief style mask. But it still allowed for a 20cm jet of respiratory droplets.
Though gaps along the top of the mask allowed for leakage, it was significantly less than the prior two options. The cone style mask was the only commercial mask that this study examined.
"A cloth face mask is an essential part of ensuring that if somebody is infectious, they keep their virus to themselves. They don't have a chance to cough it or sing it or speak it onto another person," says
Stitched mask offer great protection
The Physics of Fluids study found that this was the most effective face covering and allowed for only a 6cm jet of droplets.
Gonsenhauser is a big proponent of this type of face covering, especially when they fit well around the face. He says in that scenario, they can provide a great reduction in the spread of droplet particles.
"Some modeling studies using computer-generated dynamic models actually showed that these likely provide an even greater control of droplets than commercially produced masks," says Gonsenhauser.
However, it should be noted that — like all studies — there are some limitations in the Physics of Fluids study. Emulating coughs and sneezes from a mannequin is not equivalent to studying the same behavior in real, sick people. Moreover, results can vary based on if the person is wearing a mask correctly or not, as well.
Medical masks are most effective but should be reserved for healthcare professionals
Another study, published in Science Advances, examined two types of medical masks that the Physics of Fluids study did not: Fitted N95s with no valve and three-layer surgical masks.
The researchers found that these two were more effective than stitched cotton masks, with the N95s being the most effective, with 0.1% respiratory droplet transmission when the test subjects spoke with a mask on. The three layer surgical masks (the traditional light blue ones that are very common) were the runner ups.
However, Shafir urges the general public to opt for reusable cloth masks and leave the surgical masks and other medical-grade masks for healthcare providers as well as those who are sick and going into healthcare facilities.
The bottom line
Shafir says the most important thing is that you find a mask that's comfortable for you, so you will be more likely to wear it. The more you wear it, the more you'll be reducing potential spread.
Ideally, that mask should have at least two layers, covering both your nose and mouth, and is washed on a regular basis.
For hot, summer weather, Shafir recommends masks made out of cotton since they are more breathable. Moreover, for most people, making or purchasing a cloth stitched mask is the best, most effective option. Though medical masks may offer the most protection, it's best to leave those for the people who need it most.
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