Practical pandemic guidance is still a huge problem.
Charlie: Zeynep, we are almost a year into this pandemic, and I still have a very basic question that I can’t seem to find the answer to: How long can you use an N95 mask before you have to replace it?
I try to follow the best advice from smart people … and yet! Hat in hand, I went to Twitter last week with my straightforward question. I was looking for guidance. What I ended up with was chaos. Dozens of replies, many either vague or contradictory. My DMs were worse. Multiple medical professionals offered drastically different advice ranging from one use and one use only, to “Eh, you’ll be fine for a while, don’t sweat it.” It was alarming. It seems like yet another failure of our institutions to provide functional guidance — not just for medical professionals but for regular people like myself.
You recently wrote about how we really need to be wearing better masks. But it seems even those of us who are onboard face obstacles on issues like basic hygiene. What are we to do?
Zeynep: Trying to follow the best advice from smart people has been a problem from the beginning. We haven’t been able to turn to authorities like the Centers for Disease Control and Prevention or the World Health Organization for practical, timely, trustworthy and appropriately detailed advice without doing more research. First there was the brouhaha over masks. Both organizations recommended against them before doing a turnaround — the C.D.C. much earlier than the W.H.O. But such changes require better explanations and outreach to make sure the confusion doesn’t get worse. I also think we didn’t get clear guidance quickly enough from them on topics like the role of ventilation and the differences between indoor and outdoor exposure.
In the United States, with its misinformer in chief, all this occurred last year in the context of political interference with the C.D.C. and the Food and Drug Administration. For example, the C.D.C. finally updated its website to have more information about airborne transmission in the fall, then deleted it saying it was a mistake, and then put it back up again a few weeks later. What happened? Mistake? Donald Trump? Hiccup? But even global organizations haven’t been stellar. The W.H.O.’s website had many messaging and guidance hiccups. To be clear, even when things aren’t perfect, like last year, these are organizations full of excellent people and do great work. The W.H.O. was also working under difficult conditions, being pressured or stonewalled by China but also the Trump administration threatening it and then pulling out. All this mis-messaging makes it very hard for an ordinary person to get practical advice.
Charlie: Recently, somebody directed me to the C.D.C.’s website. “Here’s the gold standard of information,” they said. I clicked. But what I read only confused me more. Here’s a line from the F.A.Q. on how long you can wear the same N95 respirator: “extended use will not degrade the filter efficiency below the efficiency level specified in 42 CFR 84.” Not exactly easy-to-use language. This feels like a problem that we see quite a bit. Not only is a lot of medical guidance not applicable to normies like myself, but it also seems like some of it is coming from professionals who might not even know how to communicate it in a way that we can understand.
Zeynep: That’s right. That’s advice that’s geared toward health professionals. They are exposed to sick patients, and they keep their masks on all day. What we need is answers for the general public.
Charlie: Then you have the way this information is distributed, especially on social media. In one respect, a platform like Twitter has felt indispensable during the pandemic — it’s connected us with so many experts in real time. Too bad even medical professionals can be seduced by dangerous algorithmic incentives of engagement!
Zeynep: Many people have had to turn to social media to wade through all this, and that is quite unfortunate. There is a lot of excellent expertise out there, and one can find someone with the right credential on almost any claim. But experts with seemingly excellent credentials are contradicting one another all the time, as you saw. Plus, not everyone is equally good at communicating. Further, some discussions among experts — the nitty-gritty about some remote possibility that’s potentially concerning but not a big threat now — can frighten people without the background to appreciate the contexts.
To make all this worse there are a lot of people who seem to be addicted to getting retweeted — scary warnings and sensationalism can be more engaging. And it’s not just a problem for social media. Traditional media can highlight the worst possible interpretation of news and use scary headlines.
I read many papers and have a really good sense of many of these experts. It’s just not reasonable to expect ordinary people to replicate this. The scientists who are domain experts may have ongoing debates about the exact micron size cutoff for respiratory emissions that can float, but the question for the general public is simpler: Should I wear a mask indoors even if I can distance? (The answer is yes). And so on.
Charlie: It’s a bit depressing when people like yourself have to step up when the stakes are so high.
Zeynep: This isn’t what any of us should be doing. Not writers and journalists, not individual scientists — some of whom are doing their best on social media. Quickly synthesizing emerging evidence and providing practical guidance for the public and communicating it well is what the C.D.C. should be doing, and should have been doing. The new administration seems to have hit the ground running, and I hope that this is what it will be doing going forward.
Charlie: Which brings us back to my mask problem. For example, I am pretty sure I’d ruin any mask by trying to disinfect it as a hospital worker might. But it’s also clear that what I was doing (keeping a lightly used N95 in my car for months on end) is also not good. So how about reusing those N95s?
Zeynep: I will give a modified version of what health care workers were advised during the worst of the shortages. Rotating a few is enough for disinfection. Just let them rest for a few days in a non-airtight container (like a paper bag or a Tupperware container with holes) and replace one only when it no longer fits well or the elastics have gone soft, or if it is soiled. It’s also good to use hand-sanitizer before putting them on and taking them off. Handle them gently, because a good fit is essential to getting the most out of it. My sense from having heard a lot from people using all the other disinfection methods, like heat, is that they just increase the risk of damaging the mask.
Charlie: And how long can I use them? With the caveat, of course, that you’re not a medical professional but somebody who is trying to get through this safely and responsibly. Also, here’s the C.D.C.’s page on N95 masks.
Zeynep: If I were wearing an N95 just for the weekly grocery store run, I’d probably be fine with alternating two carefully handled masks for many months as long as the elastic works and there’s no soiling. That’s not a lot of use! But if I were wearing one all day, every workday, I’d consider having one for each day and replacing them maybe every month. So that’s about five per month. Could one be really careful and make that two months? Probably.
Also it’s important to emphasize that all this doesn’t mean cloth masks are worthless. Cloth masks do really help with stopping transmission onward, from the wearer to the other people. It would be good to be able to purchase certified cloth masks with the three layers the WHO recommends, with features like nose wires and ties that make them fit better. One can also wear surgical masks — those light, papery ones commonlyused in hospitals — with a brace to help hold them in place. Preliminary studies show those do a great job, too. It’s just that medical respirators like the N95s, KN95 (the Chinese standard), disposable K94 (the South Korean standard) and FFP2 (the European standard) do a much better job of protecting the wearer in addition to helping prevent onward transmission — because that’s what they are designed to do! Protecting the wearer is more important if, for example, someone works with other people who don’t mask up well, or if one is high-risk and can’t isolate. This is especially important with the new, more transmissible variants. But you don’t need an N95 for that outdoor walk.
But that brings me to the other problem: How are people supposed to find the right mask? I have purchased KN95s at local reputable stores and checked that they were included in the list of ones approved by the F.D.A. However, I would be careful about buying online, unfortunately. Too many fakes. I have seen reputable retailers like Costco beginning to sell N95s online again, and I would trust that. People can also purchase braces for surgical masks or make a brace themselves from a template, which really improves fit. Fit is very important for upping one’s mask game. We can start by noting that facial hair makes the fit worse, so shaving that beard for the pandemic is an option. (Sorry!) People can check the fit by adjusting the nose bridge to be tight and holding the mask and inhaling sharply, and seeing if they feel cool air coming in from the sides of the mask. The better the fit, the less the air from the sides. Preferably, there’s none. Also, my best-fitting mask does not fog my glasses at all because no air is escaping upward. When I get a new type of mask, I inhale and exhale while focusing to see if I feel if the air is escaping, or if there’s any gaping on the sides or around the nose area (my glasses fog to let me know of that).
Charlie: Hearing this advice and listening to you explain all the nuance, I can think only one thing: We desperately need the Biden administration and our government public health institutions to issue more plainspoken best-practice guidance. There’s still way too much confusion!
Zeynep: I hope the government will soon step up and provide a way for the public to buy certified products.
But for the future, I fervently look forward to the day when anyone can just click on the C.D.C. website for timely, well-researched guidance that’s communicated clearly, updated as necessary. I recently saw that the White House would be providing multiple health briefings each week. I hope that the kind of conversations we’re having here will be totally irrelevant.
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