N95 Masks vs. Surgical Masks: Which Is Better at Preventing The Coronavirus?

Scientists have actually randomized people to wear N95 or regular surgical masks, then tracked how many people got infected with colds and flus similar to the coronavirus. This data can tell us whether N95 or surgical masks are more effective at preventing transmission of viruses. The results surprised me.

N95 masks prevents coronaviruses

Coronavirus & Mask Livestream

Wondering whether masks work to protect you against the coronavirus? Check out our livestream recap covering all the info here!

 

People’s Intuitions About N95 Masks and The Coronavirus

The results are surprising because I’ve seen several people claim that we need N95 masks to stop the coronavirus. They say surgical masks just won’t cut it when it comes to the coronavirus.

 

Coronavirus mask claim N95 surgical mask

 

Similarly, a doctor interviewed on CNN said that masks don’t work.

Coronavirus masks don't work

 

And to be honest, that’s my intuition too. N95 masks fit a lot tighter than surgical masks, and they capture a higher percentage of particles. They’re what I wear in Delhi and Beijing.

 

N95 masks prevent infection with viruses and PM2.5

The Surgical Mask vs. N95 Mask Test

Scientists tested this question by randomly assigning over 2,000 nurses to wear N95 or surgical masks. Then they tracked how many of them caught the flu.

 

Surgical masks prevent infection with viruses and PM2.5

 

polled people on Twitter to see what people guessed. A majority (68%) guessed N95, so I’m not alone in my intuition.

 

N95 and surgical masks prevent infection with viruses and PM2.5

 

But when the data came back, it turned out that rates of infection were the same!

 

N95 and surgical masks prevent infection with viruses and PM2.5

 

Differences weren’t significant, although surgical mask users actually had slightly lower infection rates.

 

 

 

OK, Maybe That Study Was a Fluke

Data can be fluke-y. That’s just one study. But it’s not the only one.

 

N95 masks and surgical masks prevent infection with the virus

 

Researchers in Canada randomly assigned 446 nurses to wear N95 or surgical masks during a few months of cold and flu seasons (September to December). Then they tracked how many got the flu or a cold.

 

N95 masks and surgical masks prevent infection with the virus

 

Again, no significant difference! Both masks performed just as well at preventing the transmission of the viruses. About 9% percent of nurses wearing surgical masks got sick versus 10% wearing N95 masks.

 

N95 Surgical Mask Prevent Infection

 

Entirely Reasonable Skepticism

At this point, there must be at least a few savvy readers thinking, “aha!”

 

I know what’s going on! These studies didn’t have a control group, so we don’t know whether the masks actually worked. If they both don’t work, then of course there’s no significant difference!

That’s a great question. It’s just hard to test because, what are we going to do? Assign nurses to NOT wear masks? That seems irresponsible.

What we need is some situation where people face infection but don’t normally wear masks. It turns out, scientists found just such a place:

 

 

Home!

 

The No-Mask Test on Viruses

Researchers in Australia studied parents taking care of their children, who were sick with the flu.

 

N95 masks and surgical masks prevent infection with the virus

 

Because people often don’t wear masks at home (even around sick people), researchers could defensibly randomly assign people to wear masks or not. They randomly assigned parents to wear no mask, a surgical mask, or an N95 mask like the one I’m wearing here.

 

N95 mask prevents virus and PM2.5

 

Then they tracked how many parents got the flu.

About 16% of parents not wearing a mask got sick, compared to 8% in the surgical and N95 mask groups (called “P2” masks in Australia). Thus, masks seemed to work! But again, surgical masks were just as effective as N95 masks. And the effect size was fairly large—half the infection rate.

 

Surgical Mask N95 P2 Mask Prevent Flu Infection

 

Perhaps not surprisingly, the masks only worked for people who actually wore them. There was no benefit among people who often forgot or just gave up on wearing the mask.

 

How on Earth Could Surgical Masks Work as Well as N95 Masks at Capturing Viruses

OK, at this point, there must still be some skeptical readers out there. There’s no way that surgical masks can capture particles that small! I saw a doctor on Quora say that “most masks” can’t capture particles the size of viruses.

 

It is suspected that surgical masks do not prevent infection

 

But when we ignore our intuition and look at actual test data, reality is far more interesting. Test data shows surgical masks are surprisingly effective, even for tiny particles. For example, in one study, researchers tested particles down to .007 microns (even smaller than viruses) and found that a simple surgical mask blocked 80%.

 

surgical masks prevent viruses and PM2.5

 

Yet still, N95 and N99 masks outscore them. For example, in that study, N95 masks captured 96% (see also 1).

 

N95 masks prevent viruses and PM2.5

 

So it’s downright surprising that surgical masks are just as effective! Maybe virus particles are actually easy to capture because they fly on water droplets. Or maybe mask usage prevents people from touching their mouth and nose. For now, I can only speculate.

Bottom Line: N95 Masks and Surgical Masks Are Equally Effective

 There’s scientific evidence finding that (1) masks prevent flu infection and (2) surgical masks prevent infection of viruses like the coronavirus (Covid-19), as well as more sophisticated N95 masks.

Breathe safe!

P.S. Do we even know whether masks capture tiny virus particles? Aren’t they too small for masks?

This is a solid intuition I’ve seen several times, including here on Quora, repeated by a doctor.

 

Can N95 masks prevent coronavirus transmission

 

The only problem it doesn’t fit the data. I summarize that data here: Can wearing masks stop the spread of the coronavirus?

 


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Albert

Are N99’s effective against Covid?

Liz - Smart Air

Hi Albert, N99 is one step up compared to the N95 on the filtration efficiency. It requires the mask filter out more than 99% particles with a diameter of 0.3 microns. So in terms of filtering out covid virus, N99 should do a better job than N95.

Michael Gray

Great discussion. Surely we breathe mostly around a surgical mask, not through it. So the filtration capabilities are mostly irrelevant. Maybe breathing around the (Surgical) mask eliminates droplet access to out nose/mouth as well as breathing through the N-95 mask and sucking the droplets onto the mask when inhaling. This makes efficacy entirely dependent on mask filtering capability.

Serena

Tom is it possible that n95 is more effective if worn properly but since it’s much less comfortable than a regular surgical.mask that people do things like not wear it tightly or adjust the mask more decreasing the effectiveness down to the level of the surgical mask? Personally I find the n95 much harder to tolerate while I can wear a surgical mask comfortably much longer.
Thanks so much for your insights and articles here!
Serena
@DrSerenaHChen

les katsura

Does a cloth mask with a PM2.5 insert work as well as an N95 mask?

Liz - Smart Air

Hi Les, N95 is a standard that guarantee your mask reaches a filtration rate to filter out at least 95% 0.3um particles. While a cloth mask doesn’t need to pass a lab test. A PM2.5 filter can filter out PM2.5 particles, but how well? We do not know. I’d say a cloth mask with a filter would be better than mere cotton mask, but we do not have data on how close the protection efficiency could be compared to an N95 mask.

jeff

Hi, At what point should I discard surgical/n95mask? I have short supply so ideally i don’t discard until I see material degradation. Or another way: how many hours of mask usage until I throw away? Second, there are so many defective masks sold on amazon, suggestions where to find reputable kn95/surgical?

Liz - Smart Air

Hi Jeff, you can check out our knowledge base these two QAs, hope they help to answer your first question:
https://smartairfilters.com/learn/smart-air-knowledge-base/whats-a-reliable-way-to-disinfect-masks-from-viruses-without-harming-effectiveness/ https://smartairfilters.com/learn/smart-air-knowledge-base/how-long-do-air-pollution-masks-last/
We do not sell masks and there is no way we can test all masks available out there. But we do offer mask tests if you want to know how well exactly your mask works. You can go to our webstore to learn more details.