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Finding, Vetting, and Buying the Best Respirator Masks

Recent reports predict the Centers for Disease Control and Prevention will recommend people wear more effective respirator masks, like N95s and KN95s, instead of cloth or surgical masks when possible.

According to several recent news reports, the Centers for Disease Control and Prevention is likely to recommend that people wear more effective respirator masks, such as N95s and KN95s, instead of cloth masks or surgical masks when possible. The news reports cite unnamed agency officials, but it wouldn’t be surprising if the CDC issued more specific guidance on masks now that Omicron is causing record numbers of infections. In addition, many public health experts have advocated for months that the CDC acknowledge the better protection that respirator-type masks can provide. In short, the higher-quality mask you wear, the less likely you’ll contract an infection.

Why Respirator Masks Are Superior

Respirator masks refer to those that are explicitly designed to protect the wearer from contaminated particles in the air as opposed to just source control, which prevents the wearer from spreading infectious particles to others. The primary purpose of standard medical/surgical masks is to provide a mechanical barrier that protects patients from the germs of healthcare providers. However, medical masks also provide moderately good protection to the wearer. But respirator masks, such as N95s, provide more than a mechanical barrier. The filter is made of several layers, including electrostatic material that repels aerosols and is, therefore, more effective at protecting the wearer from breathing in aerosols from the environment.

In addition to N95, other commonly available respirator mask types include KN95, KF94, and FFP2. KN95 masks are primarily manufactured in China, and KF94s are manufactured in Korea. FFP2, which stands for “filtering face piece,” is a European standard for mask efficiency, where the “2” means the mask filters out 94% of all aerosols. Although all these masks should, in theory, filter out 94-95% of aerosols, their quality can vary widely depending on where they’re purchased.

You may have seen a chart floating around that lists how long it takes for an infectious dose of SARS-CoV-2 to reach an uninfected person depending on what kind of face covering the infected person and the uninfected person are each wearing. For example, the chart shows that it takes 40 minutes to infect someone wearing a typical cloth mask if the infected person is wearing a surgical mask or 2.5 hours if the infected person is wearing a respirator that hasn’t been fit-tested. The susceptible person is wearing a surgical mask.

The chart is derived from an actual study published in June 2021, but the way it’s been shared online is misleading. The chart implies that people can rely on those time frames as accurate measures of the time it takes to get infected, but that’s not how the chart was intended. The chart’s purpose was to show the increasing protection offered in going from no face covering to a cloth mask to a surgical mask to a respirator to a fit-tested respirator.

Nursing During the Covid-19 Pandemic

Here are the reasons you cannot rely on the time durations listed:

  • The study was published before the Delta and Omicron variants began circulating, so even if it was previously accurate, it isn’t now.
  • The infectious dose of SARS-CoV-2 isn’t known and never has been, so the chart would have been based on assumptions that may or may not be accurate.
  • The chart suggests that each type of mask protects the wearer as much as those around them. Still, nearly all masks are more effective at source control—preventing the wearer from spreading infectious droplets or aerosols—than protecting the person wearing the mask.
  • The risk of infection depends not only on the length of exposure but also on environmental factors, such as temperature, humidity, and airflow. Infection is far less likely outside or in a well-ventilated location than in a small room with poor ventilation.

Healthcare providers who have been fighting for high-quality PPE since the start of the pandemic know it can be challenging to find masks that aren’t counterfeit, a problem that has only grown as the pandemic has dragged on. The New York Times recently reported that companies selling poor-quality masks raked in nearly $34 million in sales in November 2021. The article also reported that most of the 50 best-selling KN95 masks on Amazon had some sort of quality control problem, such as manufacturers falsely claiming that their masks have passed federal testing standards.

The proliferation of low-quality or counterfeit masks, mainly those imported from China, led the FDA to revoke its earlier Emergency Use Authorization this past July for masks not approved by the National Institute for Occupational Safety & Health (NIOSH). The CDC has a list of NIOSH-approved N95 masks that help cross-check masks you have or are thinking of purchasing. The agency also has a page describing what to look for when examining whether a mask might be counterfeit.

How to Confirm a NIOSH-Certified Respirator

Look on or in the respirator mask’s packaging for the NIOSH approval label, which also appears in abbreviated form on all NIOSH-approved respirators. The approval number can be verified at either the NIOSH Certified Equipment List (CEL) or the NIOSH Trusted-Source page. NIOSH-approved respirators besides N95 include N99, N100, R95, R99, R100, P95, P99, and P100.

In addition to a list of photo examples of counterfeits, the CDC provides the following list of red flags that mask may be counterfeit:

  • No markings at all on the filtering facepiece respirator
  • No approval (TC) number on filtering facepiece respirator or headband
  • No NIOSH markings
  • NIOSH spelled incorrectly
  • Presence of decorative fabric or other decorative add-ons (e.g., sequins)
  • Claims of approval for children (NIOSH does not approve any respiratory protection for children)
  • Filtering facepiece respirator has ear loops instead of headbands

Where to Buy Masks

One of the best places to get NIOSH-certified N95 masks that you can be sure aren’t counterfeit is ProjectN95, a nonprofit whose mission is to make reliable, high-quality PPE and COVID tests available. The website contains a wealth of information about masks and other PPE, and the group offers to help communities and healthcare providers experiencing shortages of PPE. In addition, you can purchase NIOSH-certified N95s and high-quality KN95 masks at their shop.

The following sites are reliable, vetted places to purchase disposable N95 and other respirator-type masks:

  • Bona Fide Masks sells N95, KN95, and children’s KN95 masks.
  • Well Before sells N95, KN95, KF94, and children’s respirator masks.
  • Be Healthy sells KF94 masks for children and adults.
  • Mask Lab sells KF94 and FFP2-certified masks for children and adults.
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