Masks vs. Respirators: Experts Explain COVID-19 Recommendations

Acceptable respiratory protection devices for protection against MERS-CoV and COVID-19 include a properly fit-tested, NIOSH-approved filtering face piece respirator (N95 or higher level). A N95 filtering face piece respirator is shown. Photo Credit: CDC/Debora Cartagena

In its newly published infection prevention and control recommendations for COVID-19, the US Centers for Disease Control and Prevention (CDC) recommends the use of N95 respirators in a healthcare setting with the suspected novel coronavirus, but the World Health Organization (WHO) has recommended surgical masks for general patient care and respirators for aerosol-generating procedures only.

Bruce Ribner, MD, medical director of the Serious Communicable Diseases Unit at Emory University Hospital, said the two masks serve very different functions. A surgical mask, or procedural mask, is meant to protect the environment from the wearer.

“It’s meant to keep the surgeon’s respiratory issues away from a patient,” Ribner explained. A surgical mask does a good job of trapping large droplets, and some aerosol transmission, he said. Many of the masks being worn in China, though, are not designed for medical use or to any standards and so their effectiveness in trapping droplets is unknown.

A respirator, such as an N95, fits tighter to the face and is meant to help protect the wearer from inhaling infectious droplets in the environment.

“We don’t really know how the coronavirus is being transmitted from person to person, because no one has done the NIOSH studies that simulate the cough big droplets that land 3 to 6 feet away from a person or the little droplets that can travel long distances and in air handling system,” Ribner said. “So we have to use what we know about other coronaviruses and influenza when it comes to this disease.”

What we know, Ribner said, is that multiple modes of transmission are likely at play, including large droplets, small droplets (or aerosols), and contaminated hands.

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