September 9, 2020
January 24, 2021.
Above: Fraction of the population wearing masks when in public. Source: Carnegie Mellon University Delphi Group COVIDCast.
By this time, most U.S. residents seem to have gotten the memo about wearing masks. And my reading of recent news coverage is that America now seems ready to up its game on masks. And it’s about time.
If you’ll go to Google News and search for N95, you’ll now see a spectrum of articles on a) why you should wear an N95, b) where to get an N95, c) alternatives to an N95. As well as articles telling you to wear two masks, if you can’t get an N95. Or articles giving reasonably useful generic ratings of which masks are better than others. Or introducing you to other high-filtration standards, such as the Korean KF94.
Among which is an op-ed in today’s Washington Post with the straightforward title:
Everyone should be wearing N95 masks now
The Washington Post op-ed itself is pretty good. The comments below it are just pitiful. Either that was a target of the Russian trolls, or Americans have a long was to go in terms of getting educated about masks. I don’t think I’ve seen misinformation and disinformation so heavily concentrated in one place before.
In this post, I’m going to offer three bits of perspective on how far we’ve come on this issue of wearing N95 masks, and then summarize any new practical advice that I can glean from today’s crop of articles.
In short: We’ve gone from “you don’t need one, and you shouldn’t wear one”, and no federal leadership on the issue, to “you need one to avoid aerosols, you should find one wherever you can”. And still no clear Federal leadership on the issue. And still a hard time figuring out how to buy a true N95 mask.
This is an area where the Biden administration could make a real difference in ordinary citizen’s lives. Reading those Washington Post comments, I’d say that pretty much everybody recognizes how hard it is for a citizen to buy an N95 mask and have confidence that it is the real article. It’s not like that’s some secret.
So, anything from cleaning up the marketplace so that we could know what we are buying, to some sort of government-run certification program so we could know what we are buying, to outright provision of certified N95 masks. Starting, as I’ve suggested earlier, with provision of N95s to the elderly via the Medicare program.
This section looks back at where we were on this issue last year. And then contrasts it to the current situation. If you haven’t been following this issue all along, you might not realize how radically the context for wearing N95s has shifted since last year.
First, nobody even questions aerosol transmission of COVID any more. And aerosols are why you need an N95 mask. Everybody just acknowledges that it’s a real problem, and that’s why you need a mask capable of filtering aerosols. Just read any of these articles, and they’ll all tell you that N95s excel at filtering out COVID aerosols.
Contrast this to the struggle to get the WHO and the CDC even to mention aerosols last year. As late as July of last year, a large group of scientists published an open letter to try to pressure the CDC to mention the possibility of aerosol transmission of COVID-19 (Post #745, 7/5/2020). It took until September before the CDC would issue guidance that used the word “aerosol” — which the Trump administration immediately withdrew, claiming it was a mistake (Post #822, 9/22/2020). That was replaced with guidance that was so heavily weasel-worded as to be essentially useless. You could read it and have no clue whether aerosols were a problem or not.
And I think that’s where the CDC’s guidance still stands today — a grudging mention of aerosol transmission, with many caveats. And so, while the CDC remains firmly stuck in the past, everybody else is finally moving on. I’m pretty sure the current CDC guidance still suggests that you wear a cloth mask. (Just looked, that’s the gist of it.)
And this, I think, is pretty much the pattern. The public is moving on despite the CDC, rather than because of it. And that’s a shame. And I hope that’s something the new administration can fix.
Second, the whole “you must reserve 100% of these for health care workers” argument is slowly and quietly falling by the wayside. Here, a CBS news article is illustrative. In that entire article, one wishy-washy sentence addresses that issue: “I generally ask the public to not purchase N95s because the authentic ones are still in short supply for health care workers,” Ranney said”
And I think that’s the model. Nobody will just flat say that there isn’t a critical shortage any more. There may be, in some hospital, somewhere. And the FDA continues to update guidance on safe re-use of N95 masks, with the most recent being a maximum of five total uses of an N95 before disposal.
But nobody’s taking that “critical shortage” argument very seriously, either. It is no longer your patriotic duty to die from COVID rather than use an N95 mask. (And this is coming from a guy who took that do-not-buy-N95 directive very seriously, early on, per Post #594).
Except, of course, at the U.S. CDC, where all eyes remain firmly fixed on the rear-view mirror. The CDC mask advice cited above is explicit and adamant that you should not buy surgical masks or N95s due to the critical shortage of those for health care personnel. Advice that made great sense sometime around the middle of 2020. But is increasingly irrelevant.
I wish I could get a better objective handle on this “shortage of masks” issue. You still see popular press claiming that there is “a shortage”, but it’s all anecdotes. And it’s mostly about prices being higher than they used to be. (Which, to an economist, is just normal. To economists, “a shortage” means you can’t buy any at the going price, not that the price is high.) So most of what you see isn’t about hospitals being unable to protect workers to established standards, it’s about hospitals being cheap about it. And about (e.g.) the inconvenience of re-using masks according to FDA standards.
I only have two hard data points. As I noted in Post #955, Minnesota appears to have a half-year supply of N95s on hand, and 3M quadrupled N95 manufacturing in the last year. (Reported in this news article on fake N95s). And in Virginia, I haven’t seen any hospital reporting a current or anticipated shortage of PPE for (by my recollection) close to half a year now, though I can’t document that exactly. (That’s reported on the Virginia Hospital and Healthcare Association COVID dashboard.)
In any case, what I’m seeing now regarding N95s seems to reflect the reality of the period of critical shortage being far in the past. No official source will say that. But everybody is acting as if it is, and nobody is talking any more about (e.g.) donating hand-sewn masks to hospitals.
And so, as with the issue of aerosols, we’re left to figure this out on our own, with no useful guidance from CDC. And it seems that we are, slowly, figuring it out, despite the CDC.
Third, the Biden “100 Days Masking Challenge” gets a lot of play, but it’s just a fact-free round number. I would say that the majority of today’s articles framed their pitch, in part, around the Biden “100 Days Masking Challenge”. It’s not clear that these articles would or would not have appeared absent that. But at least superficially, the Administration’s endorsement of mask use seems to be having some impact on endorsement of mask use in the popular press.
But here’s an odd footnote: I can’t find the wording of any formal “100 Days Masking Challenge”. It does not appear to be part of any existing Executive Order. All popular-press references to executive orders on masks reference Executive Order 13991, which mostly directs that masks be worn on Federal property. A few others will also reference Executive Order 13998, requiring masks on interstate and public transport.
As far as I have been able to tell, the “100 Days Masking Challenge” is just an oral statement by the President asking people to wear a mask from now until (or maybe through) April. I don’t think there’s anything more to it than that. And 100 is clearly just a nice-sounding round number, as nobody thinks this is all going to be over by April. There’s really no substantive reason, at all, for anyone to give it any attention. And yet, it’s getting a lot of attention.
Did I learn anything new, in a practical sense?
I read through the first 30-ish articles to show up today when I searched for “N95” on Google News. So that’s my sample. Other than learning that the Washington Post comments were full of clear disinformation, I did learn a few practical items.
First, nobody writing these articles actually knows what a “surgical mask” is. And for sure, nobody bothers to define it. Or to distinguish a surgical mask from a patient’s procedure mask or single-use mask Which, I am afraid, is giving people the incorrect impression that their cheap, disposable ear-loop procedure mask is providing them with significant protection.
For what it’s worth, a surgical mask, meant to be worn in a hospital, will have two rating numbers, as described back in Post #593. Those are BFE and PFE. If it doesn’t have both ratings, it’s not a surgical mask under U.S. standards.
I’m just going to copy in my explanation of BFE and PFE, from that post:
1. BFE (Bacterial Filtration Efficiency): BFE measures how well a surgical mask mask filters out an aerosol consisting of 3 micron droplets containing staph. In order to be certified as a surgical mask, the cloth has to filter out 95% of those droplets. Better grades of mask (mderate and high protection masks) must filter out at least 98% of those droplets.
2. PFE (Particulate Filtration Efficiency): PFE measures how well a mask filters out virus-sized particles. They are supposed to be tested with particles of 0.1 micron size (about the size of coronavirus). The higher the percentage, the better the mask filtration. Apparently, some masks are tested with somewhat larger particles, and can show a misleadingly high PPE.
Note that the actual performance of a surgical mask, in use, will not be as good as these filtration rates suggest, because the mask does not seal up against the face. (See Mask versus Respirator). Air leakage around the edges of the mask compromises the overall filtration. The standards above show the filtering ability of the cloth, not the overall mask assembly as a whole.
The fact is, you pretty much can’t buy actual surgical masks, for the same reason its hard to buy N95s. There is some sort of policy or agreement in place among major manufactures to reserve those for health care providers.
You will see a lot of surgical-style masks that do claim to have a BFE (bacterial filtering) rating. But not a PFE (virus filtering) rating. Most likely, those are Chinese-made single-use face masks. China has standard for those, as shown here. But those are not rated to filter virus-sized particles (PFE).
Second, finding a recommendation for an N95 mask, that you can trust, is difficult if not impossible. Infomercials, sponsored articles, and the like are common. There are now a LOT of articles telling you where you can buy an N95 mask. Again, largely in the context of the Biden 100-day mask initiative. Some appear to be legit news articles (like this one from CBS). Others are more-or-less just infomercials, near as I can tell, or paid articles with links to a single vendor, like this one from Newsweek.
The worst of the worst interspersed ads for masks that they were not recommending, with the links to the masks that they were recommending. You had to stare at the fine print (inevitably in light gray) to distinguish the paid ads from the (presumably) independent recommendations.
Even the ones that were not clearly infomercials made some weirdly specific recommendations on where to buy a mask. I’ll just list a few, with their referencing articles. I am deliberately skipping news articles that were obviously slipshod, and ones where they disclosed (in fine print) that they got a kickback from the mask seller.
Once you make those cuts, there isn’t all that much left. So while you can see a lot of recommendations about where to get genuine N95 or KN95 masks, a lot of those are just ads in disguise. Even with the list below, I’m not so sure these weren’t just paid-for advertising in the form of apparent news articles.
- Protectivehealthgear.com, N95, referenced by CBS news.
- A vendor of FDA approved KN95, referenced by CBS news.
- FDA approved KN95s from Office Depot, referenced by CBS news.
- Amazon, Kimberly-Clark N95s, bag of 50, referenced by BGR (No idea who they are.) I bought a bag of these about six weeks ago. You can also buy that same mask, one-at-a-time, from Wellbefore, referenced by Syracuse.com.
- Wellbefore, N95 NIOSH approved, referenced by SFGATE.
- Makrite N95, box of 20, from Clinical Supplies, referenced by Syracuse.com (Caution: Makrite is the single most-counterfeited mask in the world.)
- 3M 8210 N95, pack of 20, from Clinical Supplies, referenced by Syracuse.com. (This was my go-to dust mask prior to the pandemic.)
- Chinese-made N95s, pack of 20, from N95mask.co, referenced by Syracuse.com.
And here’s an article from Newsweek, listing 11 plausible masks. The advantage of one of these overview articles is that, in all likelihood, they weren’t paid by all 11 mask manufacturers.
Third, the tools you can get to will let you eliminate the obvious fakes. But nothing available to you will let you guarantee that a mask is genuine. You have to take your best guess, based on context.
When it comes to buying a mask that claims to be N95, the first stop probably needs to be the NIOSH-approved list. This is a list of masks approved for use in workplaces. But this is a one-way test. If it’s not on the list, don’t buy it. If it’s on the list, maybe it’s genuine, maybe its a knock-off.
The equivalent for KN95s is maintained by the U.S. FDA. There is a list of KN95 masks with emergency approval for use in hospitals, via the FDA. Again, as with the NIOSH list, this is a one-way test. If it’s not on the list, don’t expect it to filter at the KN95 standard (equivalent to the US N95). If it is on the list, maybe it’s genuine, maybe it isn’t.
Then check out the CDC’s page on how to spot obviously counterfeit N95 masks. E.g., there are no children’s masks that are NIOSH-certified N95. Every NIOSH-certified N95 with have both the NIOSH certification number and a batch number printed on every mask. And so on. It won’t let you tell, for sure, what’s real, but it lets you toss out the obvious fakes.
Want to test your eye? Look at the CDC page of known cases of counterfeits. I think I’ve studied N95 masks pretty thoroughly. I don’t think I would have caught half the counterfeits on that page.
Finally, there’s a lot of buzz about Korean-made KF94 masks. If they are genuine, those should, in theory, come close to the US N95 standard. But many or most are ear-loop masks (rather than strap-behind-the-head masks), and the generally looser fit of such masks tends to compromise filtering ability. And, as with the Chinese-made KN95s, I worry about the potential for counterfeit masks.
Beyond that, you end up relying on common sense and the reputation of the seller. It sure seems like this is a market ripe for some sort of sensible government intervention.