Understanding the Distinctions Between Respirators, Surgical Masks, and Cloth Face Coverings: FACS Update #6

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Public Health organizations, such as the Centers for Disease Control and Prevention (CDC), United States Department of Defense (DoD), and many local or state public health departments, have recently made recommendations or released guidance on the use of cloth face coverings by individuals when in public settings to slow the spread of COVID-19 illness where other social distancing and hygiene measures are difficult to maintain, particularly in areas where significant community-transmission has been documented. These recommendations may have been perceived by many as contradicting the statements previously made by CDC that face masks/coverings were only necessary for people who were ill or those who were treating them.

With available information and recommendations changing rapidly, it is critical that members of the public who are subject to following public health orders and recommendations understand the technical differences between various terms, including “cloth face covering”, “surgical mask” or “medical mask”, and “respirator” as well as the type and level of protection each provides. These terms are often incorrectly used interchangeably. As such, FACS has compiled some definitions below:

  • Cloth Face Covering: Cloth face coverings are any loose-fitting piece of cloth material that covers the mouth and nose. They can be made at home from common materials, such as t-shirts, bandanas, or cotton fabric at low cost. Face coverings should fit snugly but comfortably against the side of the face, be secured with ties or ear loops, include multiple layers of fabric if possible, and allow for breathing without restriction. The CDC recommends that members of the public use simple cloth face coverings when in a public setting to slow the spread of the virus, since this will help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings are not assigned certifications or safety ratings.
  • Surgical or Medical Masks: A surgical or medical mask is a loose-fitting, disposable mask that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. Most surgical masks do not effectively filter small particles from air and do not prevent leakage around the edge of the mask when the user inhales. Surgical masks are regulated by the Food and Drug Administration (FDA) under 21 CFR 878.4040.
  • Respirators: Respirators are tight fitting masks, which create a facial seal when used. Respirators are designed to protect the wearer (when worn properly) from exposure to airborne contaminants within the limitations of the safety rating of the mask and filtration type used (particulate, organic vapor, etc.). There are many types of respirators including disposable, half-face, or powered air-purifying respirators and supplied air respirators. Respirators are assigned an “Assigned Protection Factor” and in the United States must be approved by the National Institute of Occupational Safety & Health (NIOSH) for specific ratings. Persons wearing respirators as part of employment must be cleared by a medical professional to do so and a fit-test must be performed to ensure proper fit to the wearer. Seal checks also need to be performed each time these respirators are put on. “N95” respirators, defined below, have become one common subject of discussion as part of the COVID-19 outbreak.
  • N95 Respirator: An N95 respirator is a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. An N95 respirator is one of nine types of disposable particulate respirators. Respirators in this group are rated as “N”, “R”, or “P” based on whether they provide protection against oils. Respirators are rated “N,” if they are not resistant to oil, rate “R” if somewhat resistant to oil, and “P” if strongly resistant (e.g., oil proof). An N95 respirator is rated to remove 95% non-oil particulates that are at least 0.3 µm in diameter. While N95 respirators are expected to provide some filtration of viral particles, even a properly fitted N95 respirator does not eliminate the risk of illness or exposure. These types of respirators also require fit-testing as well as user seal checks each time they are donned.

In a nutshell, the major distinction is that cloth face coverings are not intended to protect the wearer, but CDC states that they may prevent the spread of virus from the wearer to others. Surgical or medical masks may provide some protection for the wearer, the extent of which is dependent on the FDA approval for use but are not tight-fitting and use can result in some escape of unfiltered air into the breathing zone. Surgical or medical masks are also not designed to filter very small particles that may be inhaled. Respirators are designed to form a tight-fitting seal around the face and to protect the wearer from exposure to airborne contaminants within the limitations of the rating.

Perspectives on use of cloth face coverings or surgical masks by the mass public are divergent and dynamic with changing conditions. Some studies suggest that the use of cloth face coverings can result in an increase in the rate of infectivity. Other sources, such as the Center for Infectious Disease Research and Policy (CIDRAP), suggest that the use of cloth face coverings is not well-studied, available information is conflicting, and the data is lacking to support a widespread recommendation. Still further, a recent study published in Nature suggests that surgical masks may reduce exposure to respiratory droplets contaminated with viral particles. One of the article authors, Dr. Benjamin Cowling, stated in an interview that he found it to be a “big jump to say [surgical masks] are essential when worn by healthcare workers but useless when worn by others”. Finally, an article in the Lancet suggests that the use of face coverings by the public during a pandemic might be “rational”.

Regardless of differing perspectives on the use of cloth face coverings by the public, most experts agree that if people ease up on other critical public health recommendations such as social distancing and hand hygiene, or touch their faces more when using a face covering and cross-contaminate the face covering or parts of the body, the consequences may be detrimental.

At this point, the public use of cloth face coverings is recommended and voluntary in many areas. However, some local ordinances have required employees in certain industries (e.g., grocery stores) and even members of the public doing their essential business, e.g. grocery shopping, to wear cloth face coverings or have allowed businesses to refuse service or building entry to patrons who are not wearing one. If a person opts to wear a cloth face covering, FACS recommends that the wearer properly affix the face covering over the nose and mouth, remain conscientious of the potential to contaminate the outside of the face covering, and limit touching the face, nose, mouth and eyes while wearing the face covering. Hand hygiene should be practiced before the face covering is removed to prevent contact of potentially contaminated hands with the face during removal and again after removal. Face coverings should be washed frequently in accordance with the CDC recommendations; ideally after each use or at least daily.

Finally, it is important to remember that wearing a cloth face covering does not eliminate the need to use a combination of protective measures, including proper hand hygiene, cough and sneeze hygiene, minimizing touching one’s face and mucous membranes, frequent cleaning and disinfection of commonly touched surfaces and maintaining at least 6 feet of physical distancing, to help prevent the spread of all droplet-borne illnesses, including COVID-19.

Please contact us if you have any questions or if our experts can be of assistance in managing your response.