The mask dilemma for employers: Will they keep employees safe?

As employers plan out their return to work strategies, many are wondering what to do about masks. Will masks truly keep their workplaces safer from COVID-19 transmission? Should employers provide masks to employees and if so, in what settings? What types of masks should they provide? Publicly available information has been confusing and meanwhile the number of mask vendors has proliferated. Questions and concerns about personal protective equipment are mounting each day. Here are some considerations to think through when choosing a mask for your workers.

Masks should be part of a multi-pronged approach
Since the pandemic began, there have been a lot of mixed messages related to masks, with health organizations like the Centers for Disease Control and Prevention and World Health Organization initially stating they weren’t necessary, but then later recommending their widespread use.

That change occurred after studies uncovered that a significant percentage of people with COVID-19 have no symptoms at all. This indicates that the virus can spread between people interacting in close proximity, potentially while just talking to each other — even if they seem perfectly healthy. In light of this new evidence, the CDC has recommended wearing cloth face coverings in settings where physical distancing is difficult to maintain. The mask is meant to act as a barrier to virus particles coming out of your mouth and nose when you talk or exhale — in case you are infected without realizing it.

But it is important to remember that cloth face masks don’t necessarily protect the person wearing the mask; they keep the wearer from infecting others. In fact, there is a hierarchy when it comes to masks, in their ability to protect the wearer:

• Respirators (like N95 masks) offer the highest level of protection for the person who is actually wearing them; they are specifically fit to the wearer and filter out airborne particles.
• Surgical masks (disposable, not fitted to individuals) are less protective than respirators, but form a physical barrier between the mouth and nose of the wearer to keep out larger respiratory droplets. Both respirator and surgical masks have been shown to protect healthcare workers from respiratory viruses like the flu. That said, respirators and medical-grade surgical masks are currently being reserved for healthcare workers, due to shortages across the country.
• Cloth masks are the least protective of the wearer. The FDA has said they should only be used as “source control,” meaning as a method of preventing transmission to others. Fortunately, according to OSHA, cloth face masks are sufficient for most workers who can avoid working in close proximity to others.

Given the limited wearer protection, it’s extremely important to avoid a false sense of security among employees if providing them with cloth masks. Remind them that cloth masks are only part of a multi-pronged strategy to keep the workplace safe. Maintaining at least six feet of distance whenever possible, reducing the number of people in a space at any given time, increasing cleaning of high touch surfaces, improving HVAC systems and increasing hand-sanitizing/washing are all necessary, in addition to wearing masks when working near others. And it’s important to provide training to employees on these infection control measures, prior to their return to work.

All cloth masks are not created equal
As employers sift through the exploding number of masks available on the market, they may find it difficult to decide what’s best for their employees. Here are some questions to ask vendors, when making your selection:

• Material: What type of fabric is the mask made of? Thicker, higher thread count cotton masks are usually better at filtering small particles. An experiment at Wake Forest suggested a double layer of quilters cotton, with a thread count of 180 or more, was more effective at blocking particles. And another recent study showed that cotton hybrids (like cotton-silk, cotton-flannel, and cotton-chiffon) are actually even better than cotton alone.

• Layers: How many layers of fabric are in the mask? CDC’s cloth mask designs suggest at least two layers of fabric in a mask - three layers may be even better. The study with cotton hybrids found that one layer of a tightly woven cotton combined with two layers of polyester-spandex chiffon filtered out the most aerosol particles, with performance close to that of an N95 mask. Switching out the chiffon with either natural silk, flannel or a cotton quilt, led to similar results. A replaceable filter could also be used as a substitute for a third layer.

• Fit: How well does this mask fit most people? Can it be adjusted to reduce leaks or gaps? If not, does it come in different sizes for smaller and larger faces? Because no matter what fabric the mask is made of, an improper fit can reduce its effectiveness by 60% or more. And given the importance of fit, consider asking vendors if they offer easy-to-understand instructions (either written or by video) on how to properly wear the mask, for optimal fit. This would be important to distribute to employees, to promote proper use.

• Comfort: In order for a mask to work it has to be worn - and worn properly. The tolerability of a mask is often impacted by breathability, heat buildup inside the mask, skin irritation from rough materials and difficulties in talking. The less comfortable a mask is, the less likely it is that employees will actually wear it. Have a group of employees test out the masks you are vetting, and rate their comfort before purchasing, to avoid a wasted expense.

• Ease of cleaning: How easy is the mask to clean? Ideally, it would be easy to launder in hot, soapy water, without losing its shape, fit, comfort and efficacy. The WHO recommends washing fabrics that may be infected with coronavirus at water temperatures between 140–194°F. Ask the vendor at which temperatures the fabric can be safely washed, and consider testing out a sample, to see if it experiences shrinkage or other issues.

Thinking through these considerations can help employers purchase the right type of mask for their workers. Further, coupling the right type of mask with the other infection control measures mentioned above can lead to a safer workplace.