THIS UPCOMING winter season, the stage is set for seasonal sickness and COVID-19 infection rates to surge aggressively, in what's being called a "tripledemic" — and healthcare experts are urging Americans once again to consider wearing face masks while in public.
The latest call for masks doesn't concern COVID-19 alone, in spite of national infection rates noticeably spiking over the holiday season, per Centers for Disease Control and Prevention (CDC) figures. Healthcare providers are also concerned about a higher level of influenza transmission as well as respiratory syncytial virus, referred to as RSV in recent national media coverage concerning its rapid spread last fall. Healthcare data did reflect a dip in the total case count of both flu and RSV cases in late December — but experts are concerned that a strong early season debut of these respiratory illnesses may signal a particularly viral cold season this winter. The threat has prompted officials in New York City as well as Los Angeles County to urge residents to wear a mask in public spaces, particularly indoors.
Why is there a public call for masking if infection rates are on a slow decline currently, and much lower than in years past, you might ask? Greg Schrank, M.D., MPH, an epidemiologist at the University of Maryland Medical Center and assistant professor of medicine at the UM School of Medicine, says that federal officials aren't getting as comprehensive COVID-19 testing data from Americans as they did in years past.
"We observed, however, that surveillance of virus measured in wastewater from locations across the country were increasing during December — as were the number of recorded positive tests and associated hospitalizations," says Schrank. "Current CDC estimates suggest almost 50% of counties are experiencing an increase in COVID-19 hospitalizations."
And just as they did earlier this year, new Omicron subvariants are expected to arise, proving especially impactful for those who have not been recently infected by SARS-CoV-2 or have not received a bivalent COVID-19 booster vaccine. Wearing a well-made respirator or face mask in public settings, particularly crowded interior spaces, can work to offset the risk that new subvariants will inevitably bring to Americans this winter.
"A well-made and well-fitting mask can both protect the person wearing it and protect others, helping to stop transmission," Dr. Schrank adds. "That same principle holds true for these other viruses — the mask does not care which virus someone is infected with, as it works in the same way to prevent transmission of all respiratory viruses."
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Can face masks prevent flu and RSV transmission, too?
The simplest answer is possibly. A mask could bolster your defenses against getting sick with the flu or developing RSV at some point this winter — but healthcare officials note that masks are more effective at stemming COVID-19 spread directly. This is because there hasn't been established research into how influenza spread, specifically, may be curbed by widespread face mask usage. This is why masks weren't recommended by federal healthcare officials in years prior to the global pandemic when it comes to flu season safety.
But both the flu and RSV spread in a similar way that SARS-CoV-2, the virus that drives COVID-19, infects individuals — via droplets of infectious respiratory secretions, explains Charles Bailey, M.D., the medical director of infection prevention at Providence St. Joseph Hospital in Orange County. "Masks can provide some degree of protection against illnesses such as flu… by providing a physical barrier to limit the quantity of infectious particles and the distance they might travel to potentially infect others."
Respiratory illnesses can easily spread between people through shared airspace, especially during the winter, as colder, dry air enables an easier spread of infectious airborne particles. And because many people are inside during the winter, a mask may be one of the few factors that you can individually control; it can work to combat any poorly ventilated air, especially in crowded spaces.
"Well-fitting, multi-layered masks work to protect the wearer by filtering out the small particles containing the viruses; whereas if someone is sick, the masks work by containing these particles and preventing them from spreading out into the surrounding environment," Dr. Schrank says.
Which masks provide the best protection against the tripledemic?
The best protection against crowded, poorly ventilated public spaces is provided by N95 respirators, namely those that meet manufacturing guidelines for efficacy set by industry regulators — and those officially regulated by the CDC's National Institute of Occupational Safety and Health (NIOSH).
These respirators provide a protective edge over other kinds of face masks because they filter out 95% of large and small airborne particles around you. Many healthcare experts recommend that Americans seek out N95s before considering KN95 respirators (or the similar KF94 manufactured in South Korea) because they're actually regulated by a U.S.-based healthcare body and are approved for domestic medical settings specifically.
For a multitude of reasons — including price points and overall comfort for extended periods of time — some individuals opt for a disposable medical-grade face mask. But disposable face masks aren't all made equal, as they're not regulated as N95 respirators are, explains Lexie Sachs, executive director of the Good Housekeeping Institute's Textiles, Paper and Apparel Lab.
The most protective disposable face masks are made with multiple layers of non-woven textiles that fit snugly on your face. Sachs says that industry organization ASTM International has instituted standards for manufacturers to follow in the production of disposable face masks — leading to language that indicates if a mask "Meets ASTM F2100" directly on its packaging or marketing materials. Shoppers should also note which level of certification the face mask has, with Level 3 being the most protective (and the best option to buy currently).
While the ASTM standard isn't required for a disposable medical-grade face mask to be sold, checking if a manufacturer adhered to their recommendations is an easy way for shoppers to see which masks are made well.
If you're holding on to any cloth masks or DIY options from earlier in the pandemic, now would be the time to replace them with a respirator or a medical-grade disposable mask. "Cloth masks were an attempt to make the most of the resources available at the time," explains Shira Doron, M.D., an infectious disease physician and epidemiologist at Tufts Medical Center. "With medical grade masks now available, and the very low effectiveness of cloth masks, I would not recommend anyone wear one."
How to choose the most protective face masks this winter:
Regardless of where you choose to shop for a mask, keep these tips in mind for finding the most protective option:
For respirators, verify that your chosen N95 is NIOSH-approved by verifying it on the CDC's registry. A real N95 will bear specific markings on its packaging, including NIOSH-approval and TC-approval numbers, as well as model numbers that are unique to the brand.
For disposable masks, search for products that are made to satisfy industry standards set forth by ASTM International — namely, medical-grade face masks that "meets ASTM F2100" level guidelines. These standards ensure disposable masks are made with the most protective materials and are designed to fit snugly across your face. Those designated as Level 3 are the most protective and are readily available online currently.
If costs are prohibiting you from purchasing new respirators, consider turning to the interactive CDC database that shows Americans where they can locate free masks at nearby pharmacies and health agencies. Federal officials have released N95s made by 3M and Honeywell, among other manufacturers, from the federal stockpile for your use.
Consult the CDC's interactive community risk map to determine your risk threshold in public spaces for COVID-19 spread. A medium-level designation (or those areas shaded in yellow) should prompt you to wear a mask, especially if you are considered at high-risk for complications stemming from COVID-19.
Masks aren't the only line of defense against these particular tripledemic respiratory illnesses. It's never too late to get up to date on your vaccinations against COVID-19 and influenza, as both are available free of charge in many locations. "People should consider wearing a mask in public if they are high risk or live with someone who is," Dr. Doron advises. "It's still important to be vaccinated and boosted, test for even mild symptoms, and have a plan to obtain treatment if positive."
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