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Along with vaccines, the US needs a National Hi-Fi Mask Initiative – STAT

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.

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