As we’re still struggling with the pandemic of COVID-19, the need to wear a mask for protection has become a new normal. The CDC and the WHO have now declared masks as a primary safety measure (alongside handwashing and social distancing). However, with scarce research and very little explaining, people are still confused about the types of masks and their effectiveness.
The effectiveness of the masks at this point has become anecdotal in some countries, as people are becoming more unsure whether wearing a mask can do anything for our safety from the virus. So, to clear some air, we’ve decided to compare and explain surgical and cloth masks for you. These masks are widely used, so it is safe to say that if you’re wearing a mask, it’s one of these two. So, let’s get started!
But, before we start, make sure to check out this video, where dentist Olivia Cuid, MD explains how to make your mask better fitting and more protective!
Cloth Mask Vs. Surgical Mask: Which Works Better For Me?
1. Testing And Approval
Cloth mask – Cloth masks are not tested nor are they FDA approved. These masks simply act as an alternative to masks like N95, surgical masks, etc. Masks like N95 and surgical masks are intended primarily for healthcare staff and first responders since there is a shortage of these masks. Anybody can make a cloth mask at home, or buy ready-made masks online or in shops. There are no official studies and research (conducted by health organizations and approved by the WHO and FDA), so the masks can currently only be tested through independent studies. Also, since 2006, FDA hasn’t tested or approved any cloth mask brand or design (apart from the regular mask design).
Surgical mask – Unlike cloth masks, surgical masks are FDA tested, regulated, and approved for medical use. In Europe, surgical masks are certified through the CE marking process, so they conform with health, safety, and environmental protection measures. These masks are designed to ensure protection against hazardous bodily fluids and intended for use by health care staff and first respondents. Due to the shortage of these masks, citizens are advised to not use surgical masks as their primary protection, but rather turn to cloth masks.
2. Standardization
Cloth mask – There are currently no regulatory standards for cloth masks. Because of this, anybody can make a cloth mask. Moreover, since there is no standardization with these masks, their efficiency is still questionable, especially when it comes to filtration efficiency.
Surgical mask – Surgical masks need to conform to several standards in the USA and Europe. For example, the masks need to conform to the ASTM F2100 and EN 14683 standards. This means that the standardization ensures Bacterial Filtration Efficiency (BFE) that is higher than 95% (for particles larger than 3.0 μm).
3. Purpose And Use
Cloth mask – The purpose of a cloth mask is to protect people from virus-laden droplets in cases of epidemic and pandemic situations. The mask should lower the risk of getting infected or infecting others through coughing and sneezing. It should also protect from airborne particles that can easily enter our mouth and airway. Cloth masks are currently recommended for everyone; this means that every citizen should use cloth masks instead of other masks that are primarily intended for medical use.
Surgical mask – The purpose of a surgical mask is also to protect people from virus-laden droplets, not only in the cases of epidemic and pandemic situations but also during procedures and surgeries. Surgical masks are supposed to reduce the risk of exposure to saliva, contaminants, and respiratory secretions of others. It should also prevent infected people from spreading contaminants to others.
4. Design
Cloth mask – Cloth masks are usually made from common fabrics, like 100% cotton for example. They should be made in such a way to cover the nose and the mouth, as well as to be secured around the ears or tied in the back of the head. According to the WHO recommendations, cloth masks should have at least 3 layers of fabric to increase the protection levels; the inner layer of the mask is supposed to absorb, the middle layer to filter and the outer layer to act as a shield since it can be made from non-absorbent materials like polyester.
Surgical mask – Surgical masks are usually made from nonwoven fabric through the melt blowing process. However, not every surgical mask is made the same and they often have different thickness levels and protective efficiency. Nevertheless, a standard surgical mask is often three-ply, meaning it has 3 layers. The three-ply material is made from melt-blow polymer and is placed between the nonwoven fabric of the mask. Just like the other masks, the surgical mask is also secured to the head with head ties (or elastic straps) and covers the area from the nose to the chin.
5. Intended Wear
Cloth mask – The WHO and Departments of Health across the US advise cloth masks should be worn by asymptomatic people, people who are not infected, or have no signs of infection whatsoever. Everyone should wear a mask in public, closed facilities, and generally among people.
Surgical mask – The WHO and CDC advise surgical masks should only be worn by health care staff and first responders during the evaluation and care of suspected or confirmed COVID-19 patients. However, if citizens do have surgical masks, they can wear them. But, we shouldn’t be intentionally buying surgical masks for ourselves due to the global shortage of masks for the health care staff.
6. Efficiency
Cloth mask – Since there are no standards and regulations for cloth masks, they usually have low filtering efficiency. Studies showed that between 40% and 97% of all particles can penetrate a cloth mask made from common fabrics like cotton. However, common fabrics alone can block approximately 50% of all particles coughed in the air.
Surgical mask – Collection efficiency of surgical masks varies and can range from 10% to 90%. The range depends largely on the mask manufacturer and the test parameters used by NIOSH (National Institute of Occupational Safety and Health). Surgical masks seem to be effective against splashes and large-particle droplets. However, because of their loose-fitting design, the masks cannot provide 100% protection against germs, bacteria, viruses, and other contaminants.
7. COVID-19 Application
Cloth mask – The WHO and CDC state that cloth masks can lower the risk of being infected or infecting others with the coronavirus. These masks are recommended as a safety measure, combined with handwashing and social/physical distancing. However, it is important to remember that cloth masks are not effective against COVID-19 alone; they can simply lower the transmission risk by blocking large virus-laden droplets.
Surgical mask – Some studies show that surgical masks can be as effective as N95 or KN95 respiratory masks when it comes to COVID-19. However, this is only understandable if the mask is worn properly and if the leakage is minimized. Just like the cloth masks, surgical masks lower the transmission risks as well as reduce hand-to-face contact. They can also reduce the risk of getting infected or infecting someone else significantly.
8. Handling And Disposing
Cloth mask – According to the CDC, cloth masks are washable and reusable. They’re supposed to be washed by hand or in a washing machine. Cloth masks also need to air dry properly (or dry in a dryer) before use. If you’re going to wash your cloth mask by hand, make sure to do so with a bleach solution. In that case, the mask should be thoroughly rinsed and left to dry. Cloth masks should we washed every day, especially after long, several-hour use.
Surgical mask – Surgical masks are made for one-time use only. They aren’t to be used repeatedly and should be disposed of after every use. They should also be handled carefully; before disposing of the mask, make sure to place it in a plastic bag and throw in the trash. Then, wash your hands thoroughly with soap or alcohol-based sanitizer, with at least 60% alcohol.
9. Certifications And Labeling
Cloth mask – As mentioned before, cloth masks are not tested, approved, or certified by the FDA or any other health administration. That is why cloth masks don’t have certification and labeling and can be made and sold by anyone.
Surgical mask – Surgical masks are tested and approved by the FDA and other health administrations. However, the FDA does not issue any kind of certification to show that a certain surgical mask manufacturer complies with FDA requirements. But, certified surgical masks usually come with labeling that accurately describes the product (a list of materials and description of use).
10. Limitations
Cloth mask – Some of the limitations of cloth masks include the fact that these masks are not regulated and standardized as well as that they’re not recommended for people who are already sick. These masks are surely not good enough protection on their own and should be handled as such. Cloth masks are only effective when combined with other protective measures, that include handwashing and social/physical distancing.
Surgical mask – Some of the limitations of surgical masks usually revolve around the limited supply and global shortage as well as the fact that they cannot be reused. These masks have to be safely handled because they can become a source of infection themselves (if you don’t wash your hands or discard the mask properly).
11. Harmful Effects
Cloth mask – The CDC and WHO have not sent out any official warning regarding cloth masks. But, there have been reports stating the extended use and wear of cloth masks can have some harmful effects on our health. For example, people can experience an increased risk of upper airway infections, oxygen shortage, breathing difficulty, moisture retention, skin irritation, self-contamination, even lung issues, and possible heart attacks.
Surgical mask – Studies show that wearing a surgical mask can affect the heart rate, temperature and humidity, and general bodily functions. There can be cases of breathing difficulties as well due to the high breathing resistance of the mask. Wearing a surgical mask for an extended time can result in skin irritation, thermal stress, fatigue due to oxygen shortage, itchiness, and general discomfort.
12.Alternatives
Cloth mask – There isn’t an alternative to a cloth mask since this mask itself is an alternative to other masks, like surgical or N95 masks. However, there are different ways one can make a cloth mask. For example, you can make a bandana cloth mask, or mask from a T-shirt, handkerchief, towel, scarf, etc.
Surgical mask – in place of surgical masks, people can wear cloth masks, though this is not recommended for health care workers and first responders. Moreover, people can also use N95 and KN95 respiratory face masks instead of surgical ones for protection measures.
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I find it helpful when you mentioned that studies had shown the efficiency of 3-ply masks or surgical masks against COVID-19, as long as it’s worn efficiently and have minimal leakage. My husband will be going back to work fulltime soon, so we need to stock up on some masks whenever he goes out to work on weekdays. I’ll buy boxes of 3-ply masks for the family rather than cloth masks since it’s more effective against the pandemic. Thanks!