By Victoria Knight, Kaiser Health News
January 12, 2022

The highly transmissible omicron variant is sweeping the U.S., causing a huge spike in covid-19 cases and overwhelming many hospital systems. Besides urging Americans to get vaccinated and boosted, public health officials are recommending that people upgrade from their cloth masks to higher-quality medical-grade masks.

(Eric Harkleroad/KHN Illustration; Getty Images; Unsplash)

But what does this even mean?

At a recent Senate Health, Education, Labor and Pensions Committee hearing, top public health officials displayed different types of masking. Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, wore what appeared to be a surgical mask layered under a cloth mask, while Dr. Anthony Fauci, chief medical adviser to the president, wore what looked like a KN95 respirator.

Some local governments and other organizations are offering their own policies. Los Angeles County, for instance, will require as of Jan. 17 that employers provide N95 or KN95 masks to employees. In late December, the Mayo Clinic began requiring all visitors and patients to wear surgical masks instead of cloth versions. The University of Arizona has banned cloth masks and asked everyone on campus to wear higher-quality masks.

Questions about the level of protection against covid that masks provide — whether cloth, surgical or higher-end medical grade — have been a subject of debate and discussion since the earliest days of the pandemic. We looked into the question last summer. And as science changes and variants emerge with higher transmissibility, so do opinions.

The Centers for Disease Control and Prevention has not updated its mask guidance since October, before the omicron variant emerged. That guidance doesn’t recommend the use of an N95 respirator but states only that masks should be at least two layers, well-fitting and contain a nose wire.

Multiple experts we consulted said that the current CDC guidance does not go far enough. They also agreed on another point: Wearing a cloth mask is better than not wearing a mask at all, but if you can upgrade — or layer cloth with surgical — now is the time.

Although cloth masks may appear to be more substantial than the paper surgical mask option, surgical masks as well as KN95 and N95 masks are infused with an electrostatic charge that helps filter out particles.

“From the perspective of knowing how covid is transmitted, and what we know about omicron, wearing a higher-quality mask is really critical to stopping the spread of omicron,” said Dr. Megan Ranney, academic dean for the School of Public Health at Brown University.

A large-scale real-world study conducted in Bangladesh and published in December showed that surgical masks are more effective at preventing covid transmission than cloth masks.

So, one easy strategy to improve protection is to layer a surgical mask underneath cloth. Surgical masks can be bought relatively cheaply online and reused for about a week.

Ranney said she advises people who opt for layering to put the better-quality mask, such as the surgical mask, closest to your face, and put the lesser-quality mask on the outside.

If you’re really pressed for resources, Dr. Stephen Luby, a professor specializing in infectious diseases at Stanford University and one of the authors of the Bangladesh mask study, said surgical masks can be washed and reused, if finances are an issue. Nearly two years into the pandemic, such masks are cheap and plentiful in the U.S. and many retailers make them available free of charge to customers as they enter businesses.

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