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Though the first Covid-19 vaccines are now being given to health care workers, other frontline workers, and the elderly in the United States, it will likely be months before enough Americans are vaccinated to stop the spread of SARS-CoV-2. And with a more-infectious variant, called B.1.1.7, spreading globally — for which vaccine effectiveness is still unknown — more must be done to prevent as many infections and save as many lives as possible. Wearing a mask can help do that.

Wearing a mask or face covering in two high-risk scenarios can help prevent the spread of SARS-CoV-2, the virus that causes Covid-19. These include being indoors with others outside of your immediate social bubble, in places like grocery stores, indoor malls, restaurants, churches, public transportation, and the like; and being outside in a crowd.

While most masks provide some level of protection for the wearers and those around them, many masks, including the widely used cloth and surgical masks, only partially filter the small Covid-19-spreading particles known as aerosols that people emit when coughing, sneezing, breathing, and talking. As demonstrated in a recent study, high-filtration (hi-fi) masks like N95 masks are the best protection against these small particles.

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As the country awaits the scale up of population immunity through vaccination, we need a National Hi-Fi Mask Initiative to churn out masks that provide more protection from droplets and aerosolized virus particles and also reduce the number of them emitted into the environment by people infected with SARS-CoV-2.

Wearing a hi-fi mask substantially reduces the chance of becoming infected with Covid-19 while in close contact with someone who has the disease. Two of us (A.K. and R.D.) have direct experience with that: We wore N95 masks for the past year as we cared for Covid-19 patients and neither caught Covid-19, shown by regular negative PCR testing.

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Such masks could have the same effect in indoor settings and could also help curtail superspreading events.

As transmission of SARS-CoV-2 once again surges across the country, so do the odds that infectious aerosols are being emitted and linger in the air in indoor venues that people frequent. This may, to an extent, explain infections in people who were otherwise “doing everything right” but still got infected.

We proposed the need for such masks early in the pandemic, and highlighted that masks would be one way to safely get people back to school or work. In July, we co-signed an open letter calling for a national mask initiative also that was also signed by more than 70 scientists and public health advocates, including two former Senate majority leaders, two former Cabinet officials, and several leading epidemiologists and infectious disease experts.

Later this month, a new administration keen to act on the pandemic plans to ask for 100 days of masking. That’s a good start. But the Biden administration also needs to do something in tandem: invoke the Defense Production Act to immediately scale up the production of already certified hi-fi masks as well as accelerate the development of new designs.

South Korea’s government, for example, began to purchase and ship large batches of KF-94 masks (its equivalent of N95s) early on in the pandemic to ensure that everyone had access to them.

Ideally, a set of masks would be mailed to each U.S. household every month — the costs of doing so pale in comparison to the pandemic’s toll on lives and the economy. The use of such masks would, in combination with other risk-reduction strategies, create safer workspaces for essential workers, many who are not currently prioritized to get early vaccinations.

Since the pandemic began, surgical and cloth masks have become widely available at pharmacies, grocery stores, hardware stories, online, and elsewhere. Hi-fi masks should also be made ubiquitously available through these same venues, some of which are already coordinating with the federal government to roll out Covid-19 vaccines.

Given the unprecedented scope of Covid-19 vaccination programs, their rollout may not go as smoothly as hoped. Production and supply chain issues, along with fragmented uptake, will likely mean delays until the country reaches the point of functional herd immunity.

More and better masks can help get us to that point with fewer infections and deaths. With validated designs already on the market, mass production of hi-fi masks could be done relatively quickly.

The value of a National Hi-Fi Mask Initiative would last long after this pandemic has been extinguished. It is only a matter of time until we face another respiratory pathogen like SARS-CoV-2, or even a potential bioweapon, that could be even worse. In such scenarios — as with Covid-19 — vaccines would take months to be ready.

Just as every home should have a fire extinguisher, every person should have ready access to a hi-fi mask that can be used for protection against such threats.

Abraar Karan and Ranu Dhillon are physicians at Brigham and Women’s Hospital and Harvard Medical School. Devabhaktuni Srikrishna is founder of Patient Knowhow, which curates patient educational content on YouTube, including a list of N95 masks and hi-fi alternatives. The views expressed here are the authors’ and do not necessarily reflect the views and opinions of their institutions.

  • brilliant…i wondered early on why the us govt did not invoke defense production act and mail by usps these masks so people could go to work and school and help each other…seems so obvious

  • I am 96 years old and I am allergic to iodine IV, is it safe for me to get the vaccine , I also have affid.

  • N95 masks are tricky to wear correctly & do not work well if not used correctly. There’s no way that most people will be able to use them correctly.

  • I am unable to obtain a medical N95 mask. I use a 3M Niosh 8511 TC 84A 1299 N95 mask made forcarpenters and plasterers. It has a valve for exhaling so I use a triple layer cloth mask over it.
    It has a soft edge , 2 elastic straps that go around my neck and the back of my head. It is a very good seal. The metal bendable strip helps it conform to the bridge of my nose. It doesn’t leak at the edges.
    This is very important because the people I see when I go food shopping weekly wear their cloth masks in various disarray. Many of them wear the mask below their nose. Many of them have a clear space around their nose. On TV I see poeple who clearly leaking air around their mask edges.
    In addition to the nominal filtering properties, a mask must be molded so as not to get inhaled and wet.
    The mask I have, if it did not have an exhale relief valve would be perfect.
    The National Hi-Fi mask must also have the good sealing and comfort features that the 3M 8511 mask that I have has.
    If the National Hi-Fi mask was effective, comfortable and with good sealing people would be more likely to wear it.
    If the National mask were to be provided for the price comparable to the mask I had. Real medical masks with these good properties should be less expensive to make because there would be no exhale release valve. Actually they would be cheap enough to give away.

  • The Defense Production Act should have been invoked right in the beginning to produce hundreds of millions of N95 masks, which were known from the outset to be the only reasonably reliable protection against Covid. It was only denial politics, abysmally poor government administration, and the initial lack of product that caused the CDC to falsely claim that N95 masks weren’t essential. I hate to imagine how many poor souls have and will needlessly sicken and die because of this?

  • Finally, I’ve been saying this since the start of the pandemic. Unfortunately the government lied and said a cloth mask is effective. I understand their motivation, to avoid a run on N95’s, but a lie is a lie and it would behoove those vulnerable in the US if Fauci and others now advocated for hi-fi masks as this article suggests.
    The article does miss something though: there is an ample supply now of KN95 masks manufactured in China. Just make sure to pick one from the FDAs emergency use list as that identifies the ones that actually filter >95% as they’re supposed to.

  • Good call by the writers, very valid points. There is a rather simple solution to accomplish broader use: daily broadcast on national TV what masks to wear and how to wear masks properly. And have loads of them available everywhere (pharmacies, drug stores, food stores, etc). Those who are smart enough to see the merits of masks will then be better served. The others? nature eliminates. Darwin.

    • Your statement is false. And the article doesn’t say masks don’t work. It says all masks work. N95s work better than others. So we should be making N95’s available to all.

  • People do not even wear a basic cloth mast correctly, yet they have all of the confidence in the world that they are safe. Providing N-95 respirators is a nice idea, but most people are not going to have the knowledge or take the time to fit them properly and others will not want to cut off facial hair. Nor do they know how to care for them etc….Keep in mind that you have a LARGE portion of the population that still thinks this is a hoax or just like the flu.

    I agree that we need a robust supply for our front line medical and safety professionals and that they need to be available at a reasonable cost for the general population who know their value and know how to use and care for them.

    Promote their value and teach volunteer emergency Teams like the CERTs and those who take first aid / CPR courses. That will be your best bang for the buck and will get you to people who WANT to know how to use them and would do so properly. Trying to push them onto the public like a smoke detector or fire extinguisher will be a wasted of time, money, product, and effort.

    • Having n95s available for all would have some benefit over cloth masks. It would be nice to quantify how much more benefit for the general population. But I’m not sure why you would argue against it without at least further study. People don’t use masks perfectly. That doesn’t argue against providing better masks if supply is ramped up to cover the population.

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