Surgical mask or fabric mask: which to choose?
Text updated on 2020-12-08
Wondering which mask is best for you? Here are factors to consider in making the right choice.
Is it better to wear a cloth mask or a surgical mask? The choice depends on what you want first (protection, comfort, ecology, or economy).
- Filtration efficiency
Filtration efficiency is the ability of the mask to block particles. Filtration efficiency of surgical masks is generally higher (by about 10 points) than that of cotton masks. In general, there is less variability in filtration, breathability, and adhesion of surgical masks, as their performance is standardized. If you want to be sure of your mask's standards, choose a surgical mask. See also the question Counterfeit surgical masks: how to recognize a real mask from a fake one?
- Adjustment to the face
This is just as important as the filtering power of the mask material: if air (and virus) can pass over or around the sides of the mask, the filtering efficiency is greatly reduced. In general, surgical masks fit twice as well as fabric masks, but much less well than FFP2 or equivalent masks. Make sure you use a mask that fits snugly, without any gaps between the mask and your nose or cheeks, whether surgical or fabric!
- Correct and prolonged use
It is also very important to wear the mask correctly and to remove it only in low-risk situations. See the question Where and when should I put a mask? If you wear the mask under your nose, it doesn't matter if it fits snugly and filters well! If your mask always falls under your nose when you speak, you should choose one with tighter elastics or a metal bar that is securely fastened over the nose.
For the mask to be effective, it must be worn correctly and for a long period of time. It is therefore essential to choose a comfortable mask. In general, a fabric mask is more comfortable than a surgical mask, but it depends on the mask.
It's true that the mask must filter out particles, but you must be able to breathe! A plastic bag on your head blocks 100% of the virus but 100% of the air too! The breathability of a mask can be measured: it is generally better for surgical masks, with equal filtration, but some fabric masks are an exception.
To each their style: some will prefer the sobriety of the surgical mask, others will prefer the creativity and originality from a fabric mask. It is important that you wear your mask correctly and continuously in all environments where it is necessary!
You can wash your cloth mask and reuse it, just like other clothes. Single-use surgical masks are to be thrown away with the non-recyclable ones, therfore, not so good for the environment! We propose a simple method to reuse them several times: see the question COVID : Can a surgical mask be used more than once?
- Macro-economics: Surgical masks are mostly produced in Asia, so if you are in France or Europe, you probably aren't supporting the local economy by buying them or reduce the carbon footprint related to transportation. But pay attention to the place of production: there may also be a production site closer to your home! Cloth masks, if they are home-made, are very local. If you buy local masks in shops, it will help the economy a little bit, however, if you buy them online, understand who sells them and where they are made!
- Micro-economics: If you want to reduce your expenses, especially in this period of crisis, think about making your own mask in fabric (see the question How do you make your mask?) or to re-use surgical masks with the envelope method (see question COVID : Can a surgical mask be used several times?).
This study compares filtrations at 0.02 μm and 1 μm (no leakage) and shows that surgical masks have more efficient filtrations than a fine weft fabric such as a monolayer fabric (90% vs 72%) for small particles and for larger particles (96% vs 83%). Breathability and facial fit were also better for surgical masks than for fabric masks.Davies, A., Thompson, K.-A., Giri, K., Kafatos, G., Walker, J., & Bennett, A. (2013). Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic? Disaster Medicine and Public Health Preparedness, 7, 413-418.
The filtration efficiency of viral particles (0.1 μm) of a layer of very fine weft cotton (600 TPI) is around 70%, while that of surgical masks is 76%. For larger particles (3 μm), the filtration efficiency is comparable and around 98%. It should be noted that filtration decreases greatly (for all types of masks) in the presence of a small hole, which simulates the air passing around the masks. For example, a space of 1 cm2 between the face and the mask reduces the efficiency of the mask by 60%. These results suggest that the fit to the face is more important than the composition of the mask's filtering layer to effectively stop particles. Surgical masks then have 10 more filtration points than 600 TPI cotton pads for both small (0.1 μm) and large (3 μm) particles. Breathability and facial fit of surgical masks are better than those of fabric masks.Konda, A., Prakash, A., Moss, G. A., Schmoldt, M., Grant, G. D., & Guha, S. (2020). Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano.
A study that analyzes the facial adjustment factor. Fabric masks fit less tightly than surgical masks (for adults 50% less tightly and for children 33% less tightly). Facial fit factors change with prolonged use (but not significantly) and according to the type of activity. Masks work better as protection for the wearer than for the people around them (filtration is greater from the outside in than the other way around): FFP2 and surgical masks are similar, but fabric masks offer less protection than the other two.van der Sande, M., Teunis, P., & Sabel, R. (2008). Professional and home-made face masks reduce exposure to respiratory infections among the general population. PloS one, 3(7), e2618.
Large variations in filtration (particles <0.3 μm) are observed (28% to 91%) when a variety of different common fabric masks are tested. Surgical masks are less variable (53% to 75%).Mueller, A. V., Eden, M. J., Oakes, J. M., Bellini, C., & Fernandez, L. A. (2020). Quantitative method for comparative assessment of particle removal efficiency of fabric masks as alternatives to standard surgical masks for ppe. Matter, 3(3), 950-962.
Summary of 25 studies on the filtration power of different types of masks. The review shows that surgical masks almost always have better filtration than fabric masks that have similar breathability (2 layers of cotton T-shirt, very fine weft cotton fabric, 600 TPI).Clase, C. M., Fu, E. L., Ashur, A., Beale, R. C., Clase, I. A., Dolovich, M. B., ... & Pecoits-Filho, R. (2020, July). Forgotten Technology in the COVID-19 Pandemic. Filtration Properties of Cloth and Cloth Masks: A Narrative Review. In Mayo Clinic Proceedings. Elsevier.
A University College London working group has estimated that the current demand for masks in the UK is 24.7 billion masks per year. If every person in the UK uses a single-use mask every day for one year, this will create 123,000 tonnes of non-recyclable plastic waste.Report of UCL Plastic Waste Innovation Hub. The environmental dangers of employing single-use face masks as part of a COVID-19 exit strategy.
The release of a huge number of plastic surgical masks into the environment is leading to an unprecedented phenomenon of visual, biological, and chemical pollution on a global scale, in all ecosystems. It is in marine environments that the impact of microplastics is likely to be most harmful.Aragaw, T. A. (2020). Surgical face masks as a potential source for microplastic pollution in the COVID-19 scenario. Marine Pollution Bulletin, 159, 111517.
A well illustrated article showing the challenge posed by the release of billions of disposable masks into the environment. The consequences of these discharges are evoked, in particular the increase in microplastics content in the oceans. These microplastics are a threat to marine fauna, and a possible source of poisoning and infection for people.Fadare, O. O., & Okoffo, E. D. (2020). Covid-19 face masks: A potential source of microplastic fibers in the environment. The Science of the total environment, 737, 140279.
An adjustment factor greater than 100 indicates a filtration loss of less than 1%. Only FFP2 masks have such adjustment factors.Occupational Safety and Health Administration (1998). Respiratory Protection Standard 1910.134.
Summary of the physiological or psychological effects (tested or potential) of wearing a mask, comparing different types of masks where possible. Masks do not affect breathing and oxygen levels, but may be uncomfortable. These discomfort effects should be taken into account as they play an important role in whether or not a mask is worn.Scheid, J., Lupien, S., Ford, G. S., & West, S. (2020). Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. Volume 78, Issue 18, 6655.