What’s the best COVID mask?

A doctor weighs in with the latest 

By Susan Tulino

The Expert: Dr. Eric Noh, DO
His Expertise: Family Medicine
Dr. Eric Noh, DO, is a family physician at Novant Health UVA Health System Bull Run Family Medicine. For more information about the doctors and services offered at Novant Health UVA Health System, visit novanthealthuva.org


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 Eric Noh, DO, a family physician at Novant Health UVA Health System Bull Run Family Medicine.

“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

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. Noh 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.

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, Noh said, are children under age 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 percent cotton mask outperforms most synthetic masks,” Noh said.
  • Multiple layers are better than a single layer. A mask with a cotton layer and a synthetic layer can be as effective as the gold standard N95 mask, Noh said. “The tightness of the weave is crucial. The higher the threads per inch (or TPI), the better.” 
  • Size and fit matter. “No fabric combination works if the mask doesn’t fit well,” Noh 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. Look for a mask with a nose wire to keep it in place.
  • Bandanas aren’t the best. “They allow for a lot of leakage of aerosolized droplets,” Noh said. “But I’d rather see someone wearing a bandana than wearing no mask at all.”
  • Masks with exhalation valves are not recommended. These masks have filters that are functional only in one direction. As you inhale, the 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 doesn’t protect others.
  • Wash your hands before putting your mask on. Once it’s on, don’t touch it. If you do, wash or sanitize your hands immediately. Handle your mask 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 one use.
  • Keep it clean. Think of your mask like underwear. “How frequently do you wash your undergarments?” Noh asked. “It’s best to wash after each use,” Noh said. “You should have enough masks on hand so that when one is being laundered, you have another.”

“We are unlikely to have a vaccine that’s widely distributed until well into 2021,” Noh said. “Until then, wearing a well-fitting mask is important.”

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

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