by Devabhaktuni Srikrishna, Joseph Buccina, Dan Hanfling, Monica Gandhi, and Donald Milton

The Biden administration’s efforts to promote the wearing of masks to combat the spread of Covid-19 are badly needed. Given the pace of the rollout of vaccines, the U.S. won’t achieve herd immunity until mid- or late 2021. In the meantime, mask wearing is essential to help prevent people from becoming infected. There are three steps that CEOs, mayors and governors can take to maximize the wearing of the right masks.

We couldn’t agree more with the Biden administration’s plea for Americans to wear masks for 100 days and its mandates that people must wear masks on federal property and during interstate travel on airlines, trains, buses, and ships. These actions are crucial to address the surges in Covid-19 cases and hospitalizations that are occurring across the United States this winter.

Although two effective Covid-19 vaccines are being distributed in the United States and others hopefully will be available soon, it will probably take until sometime in mid to late 2021 for enough people to be vaccinated to reach herd immunity and for life to start returning to normal in the United States. Widespread vaccination is expected to take multiple years globally. In the meantime, with the growing concern about Covid-19 mutations, CEOs, mayors, and governors should immediately take three steps to promote the effective use of face masks.

1. Launch an awareness blitz. To increase the utilization of masks and dispel misinformation, an effective campaign is needed to raise awareness of the mask recommendations. With few exceptions, all people should wear masks consistently when sharing airspace with others from outside their bubble of family, friends, and coworkers. They are not currently doing so.

In a U.S. national survey we conducted in December, over 85% of the 466 respondents said they were using masks to protect themselves and those around them (consistent with a similar survey by Pew in August), and 80% said they were using their masks at the grocery store. But only 56% said they used one when with people outside their home, only 48% were doing so at work, and just 33% were wearing them when someone visited their homes.

The usage of masks and the way they are being worn also varies from city to city: Using publicly accessible street cameras, we recently counted how many people were correctly wearing masks in one location in San Francisico (Castro Street) and another in Los Angeles (Hermosa Beach); while 90% of people in the former were correctly wearing masks, only 60% in the latter were doing so.

2. Communicate which mask types people should wear. In our survey, the majority (71%) said they were using basic masks (cloth or surgical masks), which are a reasonable option for people at low risk of contracting a severe case of Covid-19 and have limited exposure to the virus or to people outside their bubble. Regions in Kansas and Germany that required basic (any) masks had much lower rates of infection than regions that did not.

But people at higher risk of contracting a severe case of Covid-19 or who have exposure to others outside their small bubble may require a higher-filtration mask. For example, wearing a basic mask did not stop infections altogether on a long-haul flight in Boeing 777 equipped with HEPA filtration and among workers at a seafood-processing plant and meat processing plants. Surgical masks distributed on an Argentine cruise ship during an outbreak and in a Danish randomized controlled study did not prevent transmission altogether, although these masks may have reduced the severity of symptoms. Germany, France, and other European countries are now requiring high-filtration (medical) masks in public.

New standards being developed by ASTM International, an international standards organization, for labels that display the filtration efficiency of face masks for consumers are coming in the near future. Several options for high-filtration masks are considerably more effective in limiting the spread of Covid-19 than basic cloth masks or consumer-grade “surgical” masks.

A few simple ways to improve masks’ fit and filtration for the general public that have been recently studied include putting a high-quality cloth mask on top of a surgical mask or sandwiching a surgical mask (or higher-quality filter) in-between two cloth masks. Consumer-grade surgical masks can be upgraded with “fitter” add-ons like Fix-the-mask to improve their fit, thereby enhancing the filtration of viral particles.

The N95 respirator is the best-known high-filtration mask in the United States. (Comparable models in other parts of the world include FFP2 in Europe, KF94 in South Korea, and KN95 in China). In our survey, 13% of respondents reported that they were wearing an N95 or the equivalent. In a Finnish study of health care workers, no infections occurred at work while wearing N95 type respirators, but 63% of workplace infections occurred while wearing surgical masks.

Disposable N95s, which have been in short supply during the pandemic, have been largely reserved for health care workers. But N95s are now available at Costco, Amazon, Office Depot, and some manufacturers point out that demand for N95s from the general public will help even out the ebbs and flows of demand from hospitals, allowing them to maintain consistent production. To be effective, N95s also need to be properly fitted, and users need to be trained to wear them correctly. While in a setting like a hospital, a respiratory protection program can ensure that this happens, that’s not feasible for the general public.

As we wrote in October, a U.S.-manufactured, federally-approved option that is not in short supply and is reusable is an elastomeric N95 (eN95) respirator. Since that article was published, a number of organizations — most notably the Fire Department of New York — have begun to use them. In our survey, 9% of respondents reported that they were wearing eN95 masks.

According to the CDC, eN95s have sealing surfaces and adjustable straps that can help achieve a better fit (or lower leakage), and the replaceable filters in some models can be used for one year as long as the filter cartridges remain in good condition. To protect others, many eN95 models also require a workaround to cover their exhalation valve, although the CDC recently reported the maximum particle emissions through the valve are similar to or better than surgical masks or unregulated face coverings. Some manufacturers (e.g., Envomask and MSA) now address this by completely plugging the valve. In addition, valveless, bidirectional, and transparent high-filtration masks designed for public use are also becoming available. As with disposable N95s, fitting and training are essential to ensure that workers get the best protection possible.

Some people with asthma, chronic lung diseases, or heart diseases may not be able to tolerate N95 or eN95 respirators and should consult their medical provider before using one. But for the general public, we expect that wide availability of respirators and low-leakage, high-filtration face masks combined with education on how to use them will significantly reduce exposure to the coronavirus that causes Covid-19.

People might want to keep eN95s on hand even after the pandemic ends for new outbreaks of diseases that spread through the air, intentional bio attacks, and wildfire emergencies.

3. Prioritize the distribution of high-filtration masks to the vulnerable. In addition to upgrading indoor ventilation and air filtration at places where essential workers, older adults, and people with comorbidities live or work, organizations should make providing these populations with high-filtration, low-leakage masks a top priority. They need to be equitably subsidized or provided for free to people who cannot afford them.

In October we proposed providing federal credits to consumers to buy high-filtration masks, and Germany is now sending “vouchers” to all its senior citizens over 60 years old and vulnerable populations that can be redeemed for 12 FFP2 masks (N95-equivalents) at pharmacies and grocery stores. That’s 34 million people. Austria implemented a similar policy.

President Biden has requested Congress to appropriate $30 billion for personal protective equipment and signed the Defense Production Act to boost production of masks. However, until those resources become available, it is up to CEOs, mayors, and governors to implement these three steps to ensure consistent use of the best possible masks for vulnerable groups. These steps will dramatically reduce the spread of Covid-19 and save lives.

Pics: Luis Velasco/ Stocksy