N95 masks for all is a pandemic pipe dream, but cloth masks mainly protect others. You should still wear one, experts say

A look at some face masks used during the coronaovirus pandemic

A homemade terry cloth face mask is worn by a Greater Cleveland Food Bank volunteer, April 16, 2020. John Kuntz, cleveland.com

CLEVELAND, Ohio – In an ideal scenario, everyone in the world would have access to a limitless supply of custom-fitted N95 respirator masks so life could maintain a semblance of normalcy during a global pandemic.

Yet without proper fit-testing even those respirators, which have become something of a holy grail during the coronavirus crisis, are only so effective. And they’re in such short supply at the moment that there’s barely enough for frontline healthcare workers, let alone everyone else.

The solution that public health experts have offered is a combination of social distancing, frequent hand-washing and the use of cloth face masks that can be made out of household materials. Even that recommendation comes with a caveat, though, because experts have noted that cloth face coverings mostly protect others, but not the people wearing them.

But if a cloth face mask can help prevent you from passing the virus to someone else, why shouldn’t the opposite be true? Why doesn’t it protect you from COVID-19? It may seem farfetched and even a little confusing that wearing a face mask won’t do much to protect yourself, but there’s science behind the explanation -- and the need to keep wearing one anyway.

Cloth face masks are intended to catch respiratory droplets that emerge from a person’s mouth as they talk, cough or sneeze. Experts say COVID-19 is primarily transmitted through those droplets, so limiting the number that circulate through the air could mitigate its spread.

Once those droplets reach the air, cloth face masks offer little protection. They do not filter the air you breathe, like a respirator, so they do not prevent droplets from reaching your nose or mouth, experts told cleveland.com.

Cloth face masks essentially act as a handkerchief that you’re wearing all the time, said Dr. Amy Edwards, a pediatric infectious diseases specialist at University Hospitals Rainbow Babies & Children’s Hospital. She estimated they will prevent roughly 30 percent of the respiratory droplets from reaching the air.

“The hope is that by capturing at least some of those particles, you can reduce the burden,” Edwards said. “The goal is to reduce the amount of coronavirus that is out there for people to catch.”

If everyone does their part and wears a cloth face mask, it will help protect the entire community, said Dr. Shanu Agarwal, an infectious disease physician at Summa Akron City Hospital.

“In an essence, in an indirect way, you are being protected [by wearing a mask],” Agarwal said. “Let’s say 90 percent of the people out in the community are wearing masks. They’re not spreading the virus.”

Doctors noted that because your cloth face mask is doing little to protect yourself, it’s essential to take other precautions against the coronavirus. Studies have suggested respiratory droplets typically fall to the ground within six feet; that’s why experts recommend maintaining that distance between yourself and others for social distancing. If someone sneezes or coughs into your mask, you’d breathe in those droplets.

It’s also important to wash your hands regularly, and avoid touching your face, Edwards and Agarwal said. If you touch a surface that has respiratory droplets on it and then touch your mask, you could transfer those droplets to your face.

Experts initially said the public did not need to wear homemade masks to mitigate the spread of COVID-19. The tone shifted when Ohio officially recommended the use of cloth face masks in public on April 4, after the U.S. Centers for Disease Control and Prevention made the same recommendation.

The CDC now recommends people wear face masks in any public setting where physical distancing is difficult to maintain, such as a grocery store or a pharmacy. Doctors told cleveland.com that you don’t need to wear a face mask in outdoor settings where you can maintain a six-foot distance from others because social distancing should be enough to protect you.

Dr. Amy Ray, the medical director of infection prevention and employee health at MetroHealth, attributed much of the confusion surrounding face masks to the fact that many people misunderstand their level of exposure to the virus. She noted that most people can protect themselves through social distancing and frequent hand-washing.

“Cloth masks are an adjunctive measure to protect others and [do] not replace any of the practical and effective measures,” Ray said in an email.

Frontline healthcare workers require a high level of protection because they have repeated and prolonged exposure to coronavirus patients. That’s why they wear respirators, such as medical-grade N95 masks, that filter the air they inhale.

Experts do not recommend the general public wear N95 face masks. The devices, like other personal protective equipment (PPE), are in short supply amid the coronavirus pandemic and needed for frontline healthcare workers.

While doctors acknowledged that N95 masks could offer more protection than a cloth mask, they said that’s primarily because they’re thicker and could therefore catch more respiratory droplets. A U.S.-Chinese team of researchers studied the issue in 2012, and found N95 masks do offer more protection than surgical masks against respiratory droplets for flu-like viruses. However, the study found that the N95 masks blocked only about two-thirds of respiratory droplets if they weren’t fitted properly.

Healthcare workers are fitted for N95 masks to ensure the devices are providing a tight seal and preventing small particles from reaching their noses and mouths. If someone buys an N95 mask online or at a store, it won’t offer the same level of protection if it doesn’t fit, Agarwal said.

“Even when they’re wearing an N95 from the store, if it’s not fitted appropriately, all bets are off,” she said.

N95 masks also must be properly sterilized after they’re used, and that requires specific technology. Concentrated hydrogen peroxide is aerosolized to kill 99.99 percent of all pathogens on the 50,000 masks that MetroHealth is sterilizing each day, the healthcare system said recently. Gov. Mike DeWine publicly enlisted President Donald Trump’s intervention in fast-tracking U.S. Food and Drug Administration approval for Columbus company Battelle to use its similar technology to sterilize up to 80,000 N95 masks per day.

Furthermore, an N95 mask can be uncomfortable and challenging to breathe through, Edwards said. Even if they were widely available, she would not recommend the general public use them, because that discomfort could cause a person to touch and adjust their mask frequently. Instead, Edwards recommends people use a comfortable cloth mask, and wear it around their home to get used to it.

“If you go out in public and that’s the first time you’re wearing a mask, odds are you’re going to touch your face more,” Edwards said. “So while you may be protecting the people around you, you may be increasing your own risk.”

Where you can buy face coverings online:

Read more from cleveland.com:

You don’t need to wear a face mask outdoors to prevent coronavirus. But experts say to carry one with you

Coronavirus can live up to 3 hours in air in a lab. But it’s totally OK to share air walking outside

Coronavirus: Where to buy masks, face coverings to protect yourself and others in public

What you might not know about using face masks to protect against coronavirus

Cloth masks in public might be here to stay. Here’s what you need to know.

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