Every time I leave my apartment, I grab a mask from the stack by the door. After all these months of pandemic life, I’ve amassed a pretty big collection: Some are embroidered, while others bear the faded logos of the New York Public Library or the TV show Nailed It. What all of them have in common is that they’re made of cloth.
At this point, cloth masks are so ubiquitous in the United States that it can be easy to forget that they were originally supposed to be a stopgap measure. In April 2020, when surgical masks and highly coveted N95s were first in short supply, the CDC released its initial mask guidance and said cloth masks were the way to go for most people—noting that they could be sewn at home from old T-shirts. Even at that point, when the pandemic was full of unknowns, we knew that cloth masks, although far better than going maskless, weren’t as protective as other types. A growing amount of research supports the idea that our masking norms don’t make much sense: A recent study in Bangladesh, which has yet to be peer-reviewed but is considered one of the most rigorous to date to tackle masking, linked wearing surgical masks with a 11.2 percent decrease in COVID-19 symptoms and antibodies, while cloth masks were associated with only a 5 percent decrease. It’s no wonder that many other countries, including France, Austria, and Germany, shifted their mask guidance away from cloth masks toward those offering higher protection a long time ago.
We might have once hoped that vaccines would entirely obviate masking, but unfortunately, masks seem poised to stick around for quite some time. And yet, even as much of our approach to the pandemic has changed in the past 18 months, our approach to masking largely has not. So why are we still strapping pieces of fabric to our face?
Unless you work in health care, the CDC still recommends masks made with at least two layers of washable, breathable fabric. A big reason for this is that, yes, surgical masks are still in limited supply, according to the FDA, and so they must be prioritized for health-care workers. Though the shortage appeared to relent this summer, when widespread vaccination led to a dip in demand for both surgical and cloth masks, the rise of the Delta variant precipitated another major mask crunch.
But that’s not the only reason masking habits haven’t shifted. Part of the problem is that the enduring mask wars have helped frame mask wearing as a simple binary. “Unfortunately there’s been so much misinformation that’s come out about masking that it’s become so polarized,” Michael Osterholm, an epidemiologist at the University of Minnesota, told me. “People are just divided into either you’re masked or you’re not. And that would be like saying everything that has wheels”—including a tricycle and a jetliner—“is the same.”
Faced with this binary, Americans generally don’t pay enough attention to the quality of a mask and how it’s worn. As the Harvard epidemiologist Bill Hanage told me in an email, we’re still wearing cloth masks because they’re “expected to still be better than nothing.” And they really are far better than nothing: He likened surgical masks to a sturdy, well-made umbrella and cloth masks to the cheap kind that inverts. “Both are better than a plastic bag held over your head, which is itself better than nothing,” he said.
But America’s complacency about masks is not simply the result of individual decisions. Public-health agencies could have prioritized using government resources to remedy the mask shortage, as well as simply mailing all Americans more-protective masks. “I can’t speak for the CDC,” Hanage said, “but I would hope that they would be able to convey the message that all masks are not alike, just like all umbrellas are not alike.” A spokesperson for the CDC told me that although the agency believes that N95 masks are “better at protecting the wearer, and if available should be worn,” cloth masks have been shown to be an “effective method of source control,” according to CDC research, and are still recommended when N95s aren’t available. (The spokesperson did not mention surgical masks, and did not respond to a follow-up question.)
Many less scientific reasons also play a role in our continued obsession with cloth masks. Even if you’re not making cloth masks at home, they’re generally more affordable than surgical masks because they are meant to be reused. (That being said, the Bangladesh study found that even a surgical mask that had been washed 10 times was more effective at filtering particles than a cloth one.) A 24-pack of cloth masks costs $9 on Amazon—about 37 cents apiece—while single-use surgical masks are about 30 cents each and N95s are upwards of 63 cents. For the same reason, cloth masks are considered more eco-friendly—a nontrivial consideration, given mounting concerns about the waste generated during the pandemic.
And for all the companies now offering fabric masks, selling them is a brisk business that, by one estimate, was worth $19.2 billion in 2020. Like T-shirts and baseball caps, cloth masks have become a way to encourage that most American of pastimes: pledging one’s allegiance to sports teams, colleges, and political causes. For the more luxury-inclined, Fendi offers a logo-embroidered silk version for $590.
Ultimately, while masking is important, it’s not the most important thing we should be doing to protect ourselves from the coronavirus. Although Osterholm makes it clear that he’s very pro-masking, “it’s really all about the whole hierarchy of environmental control,” he said, referring to the various methods for reducing risk within a space, a key concept in occupational safety. Vaccination is by far the most protective measure a person can take. Second is ensuring proper ventilation—replacing the air in a room at least five to six times an hour, he explained. Next is social distancing. And then there’s masking: “You keep going down in that order, and finally the lowest thing in terms of overall prevention potential is individual respiratory protection,” he said.
And there is still much to learn about the effectiveness of masking. Even the most rigorous studies on masking have limitations, said Osterholm, largely because of shortcomings in their methodology. Cloth masks are less protective than surgical masks, but exactly how much less remains uncertain. Roger Chou, an epidemiologist at Oregon Health & Science University who tracks mask studies, told me in an email that he “really has not found much evidence” on the effectiveness of cloth versus surgical masks in stopping the spread of COVID-19 in communities, even though he said that plenty of other data back up their effectiveness. The most important thing, Chou said, “is to wear a mask, whether it is a surgical mask or cloth mask.”
Even if a pivot toward surgical masks wouldn’t be some pandemic panacea, America’s mask inertia is in many ways a symptom of the nation’s single-pronged pandemic response. The country has collectively banked on vaccination to end the pandemic, and one consequence is that attention to other protective measures has lagged. Our vaccines are terrific, but it’s now clear that our best way out of the pandemic does not rely on shots alone. “If you have enough pieces of Swiss cheese, you can cover every hole, and you can’t see the table,” Osterholm said. “If you put [one slice] by itself on the table, I promise you, you’re going to see the table.”
If masks are slivers of Swiss, cloth ones have more holes than the surgical kind. As long as America is stuck with masks, we might as well make the switch to a less permeable slice.
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Why Are Americans Still—Still!—Wearing Cloth Masks? - The Atlantic
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