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Dr. Karan Shukla

The science is clear: Masks, along with hand hygiene and social distancing, are the most effective way to curb the spread of the novel coronavirus. In fact, until there’s a vaccine, they’re really the only tools we have, said Dr. Karan Shukla, a family physician at Novant Health Randolph Family Medicine in Charlotte.

“Masks protect in two ways,” he said. “They protect the general population from an asymptomatic or pre-symptomatic carrier, and they protect the mask wearer from the ambient environment.”

Neck gaiters can be effective

Yet there’s a lot of confusion surrounding masks. Neck gaiters got an undeserved bad rap this summer when some media outlets misconstrued results from a Duke University study and cited gaiters as worse than no mask at all.

A gaiter is better than no mask at all, Duke scientists concluded. Shukla agrees: “No previous study had identified no face covering as preferable to some face covering. And recent follow-up studies of neck gaiters have been favorable. A Virginia Tech study showed the two-layer neck gaiter was quite effective in blocking 90% of aerosolized particles.”

But he makes one thing clear – the gaiter (or any covering) must fit well to be effective.

Most research into masks is terribly dated. Not a lot has been done since the 1918 flu pandemic, Shukla said. “Recent research is on single-use masks,” he said. “There’s not a lot of up-to-date science on reusable masks.”

The guidance may evolve as more studies are completed and published. For now, here’s what doctors know about how to wear and care for a mask and which types are most effective:

  • Nearly everyone should wear a mask in public. The only people exempt, Shukla said, are children under the age of 2, anyone with breathing difficulties and anyone who cannot take a mask off without assistance.
  • The material matters. Cotton is good. “A tightly wound 100% cotton mask outperforms most synthetic masks,” Shukla said.
  • Multiple layers are better than a single layer. A multilayer mask with a cotton layer and a synthetic layer works extremely well. It can even be as effective as the gold standard N95 mask, Shukla said. “The tightness of the weave is crucial. The higher the threads per inch (or TPI), the better.” Just as with bed sheets, a higher thread count indicates a superior product. “Three layers are better than two, and two layers are better than one.”
  • Size and fit matter. “No fabric combination works if the mask doesn’t fit well,” Shukla said. “There’s no perfect mask shape, because what works for you depends on your face. It’s important to choose a mask that stays put.”
  • Cover your nose. Make sure your mask covers your mouth and nose. It should be tight-fitting, but you should be able to breathe and speak easily. A mask that moves and slides down your face is not doing its job. A face mask with a nose wire to keep it in place helps avoid that problem.
  • Bandanas aren’t the best. “They allow for a lot of leakage of aerosolized droplets,” Shukla said. “But I’d rather see someone wearing a bandana than wearing no mask at all.”
  • Masks with exhalation valves are not recommended. According to data from Duke University, the one-way valves have filters that are functional only in one direction. As you breathe in, the incoming air is filtered. But as you exhale, the outgoing mixture of carbon dioxide, oxygen, water vapor and possibly COVID-19 viral particles is released unfiltered. The mask may protect you, but it does not protect those around you.
  • Wash your hands before putting your mask on. Once it’s on, try to avoid touching it. If you do, wash or sanitize your hands right away. Handle your mask only by the ear loops or ties.
  • Don’t share your mask with family and friends.
  • Toss it. If your mask is disposable, throw it away after a single use.
  • Keep it clean. You should wash your reusable mask in the washing machine (preferably) or by hand in the hottest water possible. The Centers for Disease Control and Prevention’s guidance to “wash relatively regularly” is vague, Shukla said. It’s best to wash after each use. You should have enough masks on hand so that when one is being laundered, you still have another.
  • Think of your mask like underwear. “How frequently do you wash your undergarments?” Karan asked. “I’d use that as a guide for how often to wash a mask.”

“The virus doesn’t have a political agenda,” Shukla said. “Its mission is to find a host and reproduce. We are unlikely to have a vaccine that’s widely distributed until well into 2021. Until then, wearing a well-fitting mask is important.”

It’s the most cautious and thoughtful approach. And yet there are still those who resist. “At this point in the pandemic, it’s thoughtless and reckless, at best, not to wear a mask in public,” Shukla said. “At worst, it’s endangering public health.”

Despite wearing a mask and taking precautions, if you are experiencing symptoms of COVID-19, call your doctor or schedule an appointment online for a COVID-19 test.

Act now