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Why do Americans still wear – still! – cloth masks?

Every time I leave my apartment, I grab a mask from the pile by the door. After all these months of pandemic, I’ve amassed quite a large collection: some are embroidered, while others bear the faded logos of the New York Public Library or the TV show. Success. What they all have in common is that they are made of fabric.

At present, cloth masks are so ubiquitous in the United States that it can be easy to forget that they were originally intended as an emergency measure. In April 2020, when surgical masks and coveted N95s first to be scarce, the CDC released its first mask guidelines, saying: cloth masks were the best choice for most people-noting that they could be sewn at home from old T-shirts. Even at that time, when the pandemic was full of unknowns, we knew that cloth masks, while much better than going maskless, were not as protective as other types. A growing body of research supports the idea that our masking standards don’t make much sense: a recent study in Bangladesh, which has yet to be peer-reviewed but is considered to be one of the most rigorous methods of tackling masks to date, wearing surgical masks was associated with an 11.2 percent decrease in COVID-19. 19 symptoms and antibodies, while cloth masks were only associated with a 5 percent drop. It is no wonder that many other countries, including France, Austria and Germany, shifted their mask guidance away from cloth masks toward those who long ago offered higher protection.

We may have once hoped that vaccines would completely prevent masking, but unfortunately masks seem to be around for quite some time. And yet, while much of our approach to the pandemic has changed in the past 18 months, our approach to masking has largely not. So why do we still tie bits of cloth to our faces?

Unless you work in healthcare, the CDC still recommends masks made with at least two layers of washable, breathable fabric. An important reason for this is that, yes, surgical masks are still limited available, according to the FDA, which is why they should be a priority for health professionals. Although the shortage appeared to increase this summer, widespread vaccination led to a dip in demand for both surgical and cloth masks, the rise of the Delta variant caused another big mask crunch.

But that’s not the only reason masking habits haven’t changed. Part of the problem is that the ongoing mask wars have helped to frame mask wearing as a simple binary number. “Unfortunately, so much misinformation has come out about masking that it has become so polarized,” Michael Osterholm, an epidemiologist at the University of Minnesota, told me. “People are just divided into whether you’re masked or you’re not. And that would be like saying that everything that has wheels” – including a tricycle and a jet plane – “is the same.”

Faced with this binary number, Americans generally don’t pay enough attention to the quality of a mask and how it is worn. As Harvard epidemiologist Bill Hanage told me in an email, we still wear cloth masks because they are “still expected to be better than nothing.” And they really are much better than nothing: He compared surgical masks to a sturdy, well-made umbrella and cloth masks to the cheap kind that reverse. “Both are better than a plastic bag held over your head, which in itself is better than nothing,” he said.

But America’s complacency about masks isn’t just the result of individual decisions. Public health authorities could have prioritized the use of government funds to remedy the mask shortage and sent all Americans better protective masks. “I can’t speak for the CDC,” Hanage said, “but I hope they can get the message across that not all masks are the same, just like all umbrellas are not the same.” A CDC spokesperson told me that while the agency believes N95 masks are “better at protecting the wearer, and should be worn when available,” cloth masks have been shown to be an “effective method of source control,” according to CDC research, and are still recommended when N95s are not available. (The spokesperson did not mention surgical masks and did not respond to a follow-up question.)

Far less scientific reasons also play a role in our ongoing obsession with cloth masks. Even if you don’t make cloth masks at home, they are generally cheaper than surgical masks because they are intended to be reused. (That said, the Bangladesh study found that even a surgical mask that was washed 10 times was more effective at filtering out particles than a cloth mask.) A 24 pack of cloth masks costs $9 on Amazon — about 37 cents per piece – while disposable surgical masks are about 30 cents each and N95’s are over 63 cents. For the same reason, cloth masks are considered more environmentally friendly – a non-trivial consideration, given the increasing concern about the waste generated during the pandemic.

And for all the companies that now offer cloth masks, selling them is a solid undertaking that, through 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 pastime: swearing allegiance to sports teams, colleges, and political causes. For the more luxurious enthusiasts, Fendi offers a logo embroidered silk version for $590.

While masking is important, ultimately it is not the most important thing we should be doing to protect ourselves from the coronavirus. While Osterholm makes it clear that he is very pro-masking, “it’s really all about the whole hierarchy of environmental control,” he said, referring to the different methods of mitigating risk within a space, a key concept in occupational safety. Vaccination is by far the most protective measure a person can take. Second, it provides good ventilation — changing the air in a room at least five to six times an hour, he explained. Next up is social distancing. And then there’s the masking: “You keep going down in that order, and ultimately individual respiratory protection is the lowest in terms of overall prevention potential,” he said.

And there is still a lot to learn about the effectiveness of masking. Even the most rigorous studies on masking have limitations, Osterholm said, largely because of flaws in their methodology. Cloth masks are less protective than surgical masks, but precisely 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 hasn’t found a lot of evidence” about the effectiveness of cloth versus surgical masks in stopping the spread of COVID-19 in communities, though he said plenty of other data could test their effectiveness. to support . The most important thing, Chou said, “is to wear a mask, whether it’s a surgical mask or a cloth mask.”

Even if a pivot toward surgical masks weren’t a pandemic panacea, America’s mask inertia is in many ways a symptom of the country’s one-sided pandemic response. The country has collectively committed to vaccination to end the pandemic, and as a result, attention to other protective measures has lagged. Our vaccines are great, but it’s now clear that our best way out of the pandemic doesn’t depend on injections 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 [one slice] alone on the table, I promise you, you will see the table.’

If masks are slivers of Swiss, cloth masks 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 slab.