Life is Now a Masquerade: Everything You Wanted to Know About Face Masks in the Time of COVID

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by Stuart M. Caplen, MD

Medical mask use dates back to the 1600s when doctors wore bird-like head and face coverings during plague epidemics. The beak of the mask was filled with straw and aromatic herbs, in an attempt to prevent “bad air” miasma from infecting the wearer. [1]

An Italian Plague doctor and one from France
An Italian Plague doctor (left) and one from France (right).[2]

Masks played a prominent role in trying to decrease the infection rate in the 1918 influenza pandemic. Then, just as now, mask wearing was politicalized. In San Francisco, in just one day, 1,000 people were arrested for not wearing masks. A health inspector shot a “mask slacker” after a fight ensued about mask wearing. An organization called the Anti-Mask League was formed and their objections to mask wearing included a lack of scientific evidence that masks worked, and the belief that forcing people to wear them was unconstitutional.[3]

Why Did the CDC and the WHO Flip-Flop on Mask Use?

At the beginning of the COVID-19 outbreak, the Centers for Disease Control and Prevention(CDC) and prominent health officials were saying that masks should be reserved for health care workers. In February, U.S. Surgeon General Jerome M. Adams tweeted "Seriously people - STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can't get them to care for sick patients, it puts them and our communities at risk!"[4] After evidence came out that asymptomatic people could spread the disease, the CDC in April recommended that all Americans over the age of two wear masks when out in public. The recommended masks are cloth facial coverings, or homemade masks, and the CDC still recommends that medical-grade masks be reserved for health care professionals. The World Health Organization similarly flip-flopped on mask usage.[5] Dr. Anthony Fauci has said that his initial reservations were in part a fear that if everyone wore masks, it would exacerbate the mask shortage occurring in hospitals at the beginning of the pandemic.[6]

Medical Masks and Nanofiber Masks

Medical masks such as N95 respirator masks (also called N95 masks), when fit tested, do provide the wearer significant protection against COVID-19 infection. Surgical masks provide droplet protection, but not as much as an N95 mask. Surgical masks are also not...

Read the conclusion on medical masks and nanofiber masks, N95, N99, and N100 masks, reactions to masks, do they work, and protection rates. Plus details on removing, reusing, and cleaning masks.

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Stuart M. Caplen, MD, FACEP, MSM

Dr. Caplen is a former emergency physician and emergency department medical director, now retired from clinical practice. His current interests include how quality is produced and maintained in health care, and he recently achieved greenbelt certification in lean/six sigma.


[1] Durn S, A Brief History of Medical Face Masks, Gizmodo, May 29, 2020. Retrieved from:

[2] Schultz I, European Plague Doctor Garb Was Black, Beaked, and Very Bleak , Atlas Obscura, April 2, 2020. Retrieved from:

[3] Hauser C, The Mask Slackers of 1918, The New York Times, Aug. 3, 2020. Retrieved from:

[4] Keegan M, Do Masks Work to Fight Coronavirus? East Asia Says ‘Yes’; East Asian countries have embraced wearing masks to fight COVID-19. Why has the U.S. dragged its feet?, US News & World Report, April 7, 2020.

[5] The Associated Press, WHO changes COVID-19 mask guidance: Wear one if you can't keep your distance, June 5, 2020. Retrieved from:

[6] O’Donnell N, Dr. Fauci Says, “With All Due Modesty, I Think I’m Pretty Effective.”, InStyle, Jul 15, 2020. Retrieved from:

[7] Litke E, Fact check: No, N95 filters are not too large to stop COVID-19 particles, USA Today, June 11, 2020 updated June 12, 2020. Retrieved from:

[8] Size of the Nanoscale, United States National Nanotechnology Initiative. Retrieved from:

[9] Respirators Versus Nanofiber Face Masks: How do They Protect You?, Respilon, 2020.

[10] Ullah S et al., Reusability Comparison of Melt-Blown vs Nanofiber Face Mask Filters for Use in the Coronavirus Pandemic, ACS Appl. Nano Mater, June 12, 2020, 3, 7231–7241. Retrieved from:

[11] Medicircle, Organic-Inorganic Hybrid Nanocoatings for Disposable Masks, April 27, 2020. Retrieved from:

[12] Chiome TJ, Srinivasan A, Use of antiviral nanocoating in personal protective wear, International Journal of Health & Allied Sciences, April 6, 2020. Retrieved from:

[13] Roberge R et al., Physiological impact of the N95 filtering facepiece respirator on healthcare workers, Respir Care, May 2010, 55(5):569-77. Retrieved from:

[14] Talhelm T, Do N95 Mask Deprive Us of Oxygen, Smart Air, July 16, 2020. Retrieved from:

[15] Li Y et al. Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. International Archives of Occupational and Environmental Health. 2005 Jul;78(6):501-509. Retrieved from:

[16] Roberge, R, et al., N95 respirator use during advanced pregnancy, American journal of infection control vol. 42,10 (2014): 1097-100. Retrieved from:

[17] Tong, P.S.Y., Kale, A.S., Ng, K. et al. Respiratory consequences of N95-type Mask usage in pregnant healthcare workers—a controlled clinical study. Antimicrob Resist Infect Control 4, 48 (2015).

[18] Li Y et al., In Vivo Protective Performance of N95 Respirator and Surgical Facemask, American Journal of Industrial Medicine 49:1056–1065 (2006).

[19] Kyung SY et al., Risks of N95 Face Mask Use in Subjects With COPD, Respiratory Care, May 2020, 65 (5) 658-664. Retrieved from

[20] Donovan J et al., Skin Reactions Following Use of N95 Facial Masks, Dermatitis: June 2007 - Volume 18 - Issue 2 - p 104. Retrieved from:

[21] Cassata C, Face Masks May Be Irritating Your Skin — How to Stop It, Healthline, May 30, 2020. Retrieved from:

[22] The National Pressure Injury Advisory Panel, NPIAP POSITION STATEMENTS ON PREVENTING INJURY WITH N95 MASKS, 2020. Retrieved from:

[23] Bamford M, Sexual assault survivors tackle trauma to stay COVID-safe, self-isolate and wear face masks, ABC Radio Sydney, July 30, 2020. Retrieved from:

[24] Anderson K, Wearing of face masks can trigger trauma for some, Altoona Mirror, Apr 30, 2020. Retrieved from:

[25] Gandhi M et al., Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer, J of General Internal Medicine, July 31, 2020,

[26] Zhang R et al., Identifying airborne transmission as the dominant route for the spread of COVID-19, Proceedings of the National Academy of Sciences Jun 2020, 117 (26) 14857-14863. Retrieved from:

[27] Stutt R et al., A modelling framework to assess the likely effectiveness of facemasks in combination with ‘lock-down’ in managing the COVID-19 pandemic, Proc. R. Soc. Retrieved from:

[28] Kai D et al., Universal Masking is Urgent in the COVID-19 Pandemic: SEIR and Agent Based Models, Empirical Validation, Policy Recommendations,

[29] Chu D et al., Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis, The Lancet, June 01, 2020. Retrieved from:

[30] Voytko L, Fewer NY Healthcare Workers Are Being Infected With COVID-19 Compared To Public, Cuomo Says, Forbes, May 7, 2020. Retrieved from:

[31] MacIntyre C et al., A cluster randomised trial of cloth masks compared with medical masks in healthcare workers, BMJ open vol. 5,4 e006577. April 22, 2015. Retrieved from: doi:10.1136/bmjopen-2014-006577

[32] Foy K, Testing whether uncertified N95 masks are effective, MIT News, May 13, 2020. Retrieved from:

[33] MIT Lincoln Laboratory, KN95 Respirator Test Results, July 13, 2020. Retrieved from:

[34] Fischer E et al., Low-cost measurement of face mask efficacy for filtering expelled droplets during speech, Science Advances, Sept. 2, 2020. Retrieved from:

[34A] Pan J, Marr L, Neck Gaiters, Virginia Tech, August 15, 2020. Retrieved from

[34B] Parker-Pope T, Save the Gaiters!, The New  York Times, Updated August 18, 2020.  Retrieved from:

[34C] Hanlon S, How Those Bogus Reports on ‘Ineffective’ Neck Gaiters Got Started, Scientific American, September 1, 2020. Retrieved from:

[35] Implementing Filtering Facepiece Respirator (FFR) Reuse, Including Reuse after Decontamination, The Centers for Disease Control and Prevention When There Are Known Shortages of N95 Respirators, Updated Aug. 4, 2020. Retrieved from:

[36] How to Wear Masks, The Centers for Disease Control and Prevention, Updated Aug. 7, 2020. Retrieved from:

[37] How to Wash Masks, The Centers for Disease Control and Prevention, Updated May 22, 2020. Retrieved from:

[38] Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings, The National Institute for Occupational Safety and Health (NIOSH), last reviewed: March 27, 2020. Retrieved from:

[39] van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-1567. Retrieved from:

[40] Chin A, et al., Stability of SARS‐CoV‐2 in different environmental conditions. Lancet Microbe 2020. Retrieved from:

[41] Price a, Chu L, Addressing COVID-19 Face Mask Shortages, Stamford Medicine Anesthesia Informatics and Media Lab, Updated March 25, 2020. Retrieved from:

[42] Rubio-Romero, J C et al., Disposable masks: Disinfection and sterilization for reuse, and non-certified manufacturing, in the face of shortages during the COVID-19 pandemic, Safety science vol. 129 (2020): 104830. Retrieved from:

[43] Ozog D, The Effect of Ultraviolet C Radiation Against Different N95 Respirators Inoculated with SARS-CoV-2, International Journal of Diseases, September 03, 2020. Retrieved from:

[44] Communication to the American College of Emergency Physicians Engaged ED, Online Member Community, 2020.

[45] Battelle, 2016. Final Report for the Bioquell Hydrogen Peroxide Vapor (HPV) Decontamination for Reuse of N95 respirators. FDA, U.S. FOOD&DRUG, ADMINISTRATION. Available on 9th April 2020 at

[46] Schwartz A et al., Decontamination and Reuse of N95 Respirators with Hydrogen Peroxide Vapor to Address Worldwide Personal Protective Equipment Shortages During the SARS-CoV-2 (COVID-19) Pandemic, Sage Journals, April 8, 2020. Retrieved from:

[47] 3M, 2020b. Decontamination Methods for M N95 Respirators. M Science. Applied to life. Technical Bulletin. Revision 11, September 2020. Retrieved from:

[48] Price, A., Chu, L., 2020. Addressing COVID-19 Face Mask Shortages [v1.3]. COVID-19 Evidence Service. Stanford Medicine. April 20, 2020. Retrieved from:

[49] Aubrey A, A COVID-19 Vaccine May Be Only 50% Effective. Is That Good Enough? NPR, September12, 2020. Retrieved from:

[50] Collins M, Jackson D, Trump says CDC Director Robert Redfield 'confused' about coronavirus vaccine, mask efficacy. Redfield responded, USA Today, September 16, 2020. Retrieved from:


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