Learn about the latest guidance for the use of face masks during the COVID-19 pandemic. This post is updated regularly. Last updated: March 1, 2022
Face masks are obviously one of the big topics of conversation during the COVID-19 pandemic. Understanding COVID-19 and the way it spreads has evolved over the past two years. So has scientific guidance about how to protect yourself and those around you. Research has shown that masks and face coverings, if widely worn, can substantially reduce the spread of COVID-19.
Who should wear a face mask and where?
The U.S. Centers for Disease Control and Prevention (CDC) face mask guidelines are based on levels of COVID-19 in each community. The levels are determined by:
- hospital beds in use;
- hospital admissions;
- the total number of new COVID-19 cases in an area.
CDC lists three levels to determine whether face masks are appropriate in a community. This applies to adults and children ages 2 and older. It also applies regardless of vaccination status.
HIGH – Wear a mask indoors in public places (including K-12 schools and other community settings). This may be especially important for people who are immunocompromised or at high risk for severe illness. People who are immunocompromised or at high risk for severe illness may include people with moderate to severe asthma, COPD or other chronic lung diseases.
MEDIUM – Choose to wear a face mask based on your personal preference or personal risk assessment. However, if you are immunocompromised or at high risk for severe illness, talk with your doctor about whether to wear a mask indoors. If you live with someone at high risk for severe illness, consider wearing a mask when indoors with that person.
LOW – Choose to wear a face mask based on your personal preference or personal risk assessment.
You can check your community’s level and locate areas of the country with high levels on CDC’s website.
Masks do not need to be worn outside. In areas with high COVID-19 numbers, masks should be considered in crowded settings or when in close contact of those who may be unvaccinated.
What type of face mask should I wear?
Early in the pandemic, there was a shortage of masks, so CDC was recommending that medical grade masks be saved for medical personnel. As supplies have become more readily available and with new variants, guidance has changed.
CDC still continues to emphasize that the best mask is the one you will wear consistently and comfortably all day long. Any mask is better than no mask!
That being said, masks vary on their level of protection. Loose-fitting cloth masks provide the least amount of protection, while the respirators, such as the N95 or KN95, provide the most protection. The reason for this is that different materials have different abilities to filter out virus particles. No matter the mask you use, it should always be clean and dry.
CDC has not specifically stated that everyone should wear surgical masks or respirators. But with increasingly contagious variants such as Omicron, you may want to take into consideration your mask choice, especially if you are living with asthma or another respiratory disease.
Cloth masks provide the least amount of protection from COVID-19. If you are wearing a cloth mask, it should fit snugly over your nose, mouth and chin, without gaps. It should have multiple layers of breathable fabric, as well as a nose wire. It should also block out light.
Cloth masks should be washed after use or at least once a day.
Surgical (or procedure) masks are disposable masks that are readily available. They provide more protection than cloth masks. They should fit snugly over the nose, mouth, and chin without gaps to prevent leaks. They should have multiple layers and a nose wire.
For extra protection, you can wear two masks, such as a surgical mask underneath and the cloth on top.
Surgical masks are disposable and should be thrown away after every use.
Respirators provide the most protection. These include masks such as the N95 or KN95. These masks are very similar and provide similar protection. The main difference is that the N95 is certified in the United States, while the KN95 is certified in China. N95s also have loops that go over the back of the head, while the KN95s have ear loops. To be certified, these masks must filter out 95 percent of 0.3-micron particles. These masks have several layers of materials, providing additional protection from virus particles.
Respirators fit differently on different people. It is important to make sure the one you are using is the right fit. It should fit snugly and seal to your face. Do not use a respirator with a valve or other opening.
While the public may use N95s and KN95s, CDC continues to recommend that surgical N95s (a N95 subtype) be reserved for healthcare personnel.
Of note, counterfeit masks are a real concern. The National Institute for Occupational Safety and Health (NIOSH) certifies only N95 masks. If you see a NIOSH-certified KN95, that may be counterfeit. CDC has a website showing known counterfeit masks and tips on how to spot one.
Unlike surgical masks, you can reuse respirators as long as you take appropriate precautions. Do not wash your respirator. Wash your hands before you put it on and after you take it off. Storing in a paper bag is a good idea as it keeps it from touching other things and lets it dry out. Do not store a respirator in a location where it is exposed to direct sun or may touch other things (such as in a purse). Throw away your respirator if it becomes dirty, does not seal to your face, or is misshapen.
How should a mask be worn?
When wearing a mask, it should fit snugly against the face and include layers that can keep your respiratory droplets in and others’ out. It’s best to use a mask with a nose wire to prevent openings at the top of the mask. A mask fitter or brace can improve fit.
Always use a clean mask for each outing. If possible, don’t take your mask off and put it back on during a single outing, as touching the mask increases the possibility of exposure. Try to avoid removing your mask indoors where you might be exposed to virus particles. Wash your hands before putting a mask on and after taking it off.
Where are masks required?
Face mask requirements are easing in most areas of the United States. Some private businesses or workplaces may still require them, however. Masks are no longer required on U.S. commercial flights. Some international flights may still require them, however. Masks are optional on most public transportation such as buses and trains, including Amtrak. Masks may still be required in hospitals, clinics or medical offices; CDC recommends they be worn in all healthcare facilities.
For some people, mask mandates may involve a trade-off with personal freedom, but it’s clear the benefits outweigh any potential harms, doctors say in a December 2020 article in the Annals of Internal Medicine.
They are recommended to help slow the spread of the virus and keep people who may have the virus but not know it from transmitting it to others. Think of it this way – my mask protects you and your mask protects me!
Should people with asthma wear masks?
Many people with asthma have questioned if it is safe for them to wear a mask. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), there is no evidence that wearing a face mask can worsen your asthma.
Data from a recent study presented at the 2021 AAAAI annual meeting found that wearing a face mask does not affect oxygen saturation levels, whether the wearer has asthma or not. Oxygen saturation levels among study participants were between 93-100%, with an average of 98% for people with asthma. Normal oxygen saturation is between 96-98%.
“This data reinforces that wearing a mask, whether it is a surgical mask, cloth mask or N95, is completely safe,” says study author and board-certified allergist Alan Baptist, MD. “This is true for all individuals whether they have a diagnosis of asthma or not. Wearing a mask is an essential step we can all take to reduce the spread of COVID-19.”
Some people with severe asthma still may feel it is difficult to breathe while wearing a face mask. If you don’t feel you can wear a mask due to severe asthma, it may be best for you to stay home or avoid public places as much as possible. Ask family and friends to run errands for you. If you must go out, avoid large crowds, and practice social distancing. Being in public without a face mask may increase your chances of getting COVID-19 or passing it on to others.
If you are experiencing difficulty breathing when wearing a mask, schedule an appointment with your healthcare provider to review your asthma control.
Is there a type of asthma face mask or allergy face mask recommended?
There is no endorsement of a “best mask” for people with asthma or chronic lung diseases. However, respirators offer the best protection, followed by double masking (cloth + surgical).
If you are using a cloth mask, fabric selection must balance sufficient capacity to trap viral particles with comfort. Recommended fabrics include cotton blends, 100% cotton T-shirt fabric and sheets/pillowcases with high thread counts. Two layers of fabric or one layer of fabric plus a filter layer are most commonly recommended. Too many layers will result in a mask that makes breathing difficult. All cloth masks must fit snugly and have no gaps.
We recognize that for many people, masks are inconvenient and not always comfortable. Try on a variety of masks, materials and styles to see what is comfortable for you and your family. For children to be compliant, it may be helpful to involve them in choosing their masks and by letting them practice wearing them at home. Adults should set a good example by wearing a mask in public and modeling other good hygiene practices.
Remember it is the responsibility of all of us to help stop the spread of COVID-19.
What face masks should be avoided?
CDC recommends against using masks with valves or vents. These masks contain openings through which air is exhaled and are designed to filter out particles.
Valved or vented masks may actually be counterproductive, causing the user to release respiratory droplets into the air. This type of mask does not prevent the person wearing the mask from transmitting COVID-19 to others.
What COVID-19 face mask policies should be in place in schools?
School policies for wearing face masks will depend on your community’s level of COVID-19 risk. Some individual schools or school districts may elect to continue mask mandates even if there’s low or medium risk. Check with your local school for information.
Should I wear two face masks instead of one?
For extra protection from the COVID-19 virus, CDC suggests people wear a cloth mask with multiple layers or wear a cloth mask over a disposable surgical mask. The second mask should push the edges of the inner mask tightly against your face.
The recommendation comes after CDC conducted lab experiments involving face masks. The experiments found that wearing a cloth mask over a surgical mask can reduce exposure by about 95%. It can also decrease spread of the virus to others.
When wearing two masks, make sure you can see and breathe easily, CDC says. Do not wear a second mask with a KN95 mask, the alternative to the professional-grade N95 masks. A surgical or cloth mask may be worn over an N95, but that is normally for high risk settings (such as in the hospital). Do not wear two disposable face masks at one time.
Double masking “offers more protection against COVID-19 as less particles are breathed in and fewer are released,” says Purvi Parikh, MD, board-certified allergist, and national spokesperson for Allergy & Asthma Network. “Many healthcare workers, including myself, already double up on masks at work.”
Wearing two face masks can also help fight against COVID-19 variants. Several different variants have emerged that are more easily spread among people.
Can I wear a face shield instead of a mask if I have asthma?
A face shield is primarily used for eye protection for the person wearing it. CDC says there is currently not enough evidence to support the effectiveness of face shields for protection from or transmission of COVID-19 respiratory droplets. Therefore, CDC does not currently recommend use of face shields as a substitute for masks.
There are masks with clear panels that can be used for certain people, such as those who are hearing impaired.
We encourage you to keep up with the latest information about COVID-19 by visiting our COVID-19 Information Center regularly. If you are preparing to send your child off to school this year, also check out our COVID-19 School Resources for Managing Asthma and Allergies.
Purvi Parikh, MD, FACAAI is an adult and pediatric allergist and immunologist at Allergy and Asthma Associates of Murray Hill in New York City. She is on faculty as Clinical Assistant Professor in both departments of Medicine and Pediatrics at New York University School of Medicine.