We Need Better Face Masks, Now

They are the most effective barrier to combat the spread of the SAR-CoV-2 virus. To say they are a hot commodity is an understatement. We’re talking about N95 respirator face masks. A paper that appeared in The Lancet has found them to be the best resource to reduce the risk of spreading the virus based on scientific data.

The authors of the study used a meta-analysis to assess the effectiveness of face masks (N95 respirator, disposable surgical, and cloth), eye protection, and social distancing in reducing the risk of spreading the virus. Their findings were not surprising. Two meters of separation is less risky than one meter, using eye protection is less risky than using no eye protection — and using N95 respirator face masks is less risky than using disposable surgical masks or cloth face masks with 12-16 layers of cotton.

With all that said, the researchers acknowledged the limitations of their findings. Meta-analysis is an analysis of existing studies. It combines the data embedded in published studies to perform a grand study, taking into account the assumptions of each one. One limitation of their analysis is the fact that the underlying studies were all observational, not randomized, which means that unknown and unobserved factors may have biased the findings.

As states, cities and communities reopen and social distancing becomes more challenging, N95 respirator face masks may be the game-changer for permitting large gatherings of people without an associated surge in virus transmission. This translates into the possibility of holding sporting events with fans present, as well as reopening movie theaters, performing arts theaters and museums. Churches could reopen with large congregations. Universities can welcome back students in the fall with less risk. The list of activities that get reclassified from “very risky” to “less risky” grows.

But be warned, before jumping on a plane and heading on a weekend excursion, there are a few catches. First, N95 respirator face masks do not eliminate the risk of transmission, they reduce the risk of transmission — there is a difference. It is important they are used in conjunction with social distancing for them to still remain the best defense.

Second, densely populated environments only remain less risky if there is 100 percent compliance with N95 respirator face masks being used and they must be fitted properly to be effective. All it takes is one infected person not wearing a N95 respirator face mask or wearing it incorrectly among a group of moderately packed sports fans at a college football stadium and we could see dozens of new infections.

Third, and most critically, the stark reality is there are not enough N95 respirator face masks available for everyone. If each adult used one N95 respirator face mask per week, we would need 12 billion N95 respirator face masks over the next year. At this time, several companies are ramping up their production capacity to meet demand. The largest manufacturer of these masks, 3M, hopes to reach a capacity of 50 million masks per month, and 2 billion masks per year worldwide. That is a lot of masks, but woefully short of what is required just for the United States.

Reopening is an exercise in risk mitigation. N95 respirator face masks can be a game-changer for safer reopening. Though they do not replace social distancing, they do make it possible for people to gather when social distancing is limited. The need and necessary demand for N95 respirator face masks is an opportunity to be filled, now and could be the difference it how fast “normal” returns.


Sheldon H. Jacobson, PhD, is a founder professor of computer science at the University of Illinois at Urbana-Champaign, applies his expertise in data driven risk assessment to evaluate and inform public policy and public health, and is an active member of the Institute for Operations Research and the Management Sciences (INFORMS).  

Janet A. Jokela, MD, MPH, is the acting regional dean of the University of Illinois College of Medicine at Urbana-Champaign and has served as an infectious disease and public health consultant throughout her career.

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