I Am Wearing My Mask Properly. Are You?

The COVID-19 pandemic is continuing to wreak havoc throughout the world. More than 230 million people in the world and more than 33 million people in India have been infected since the onset of the pandemic. Modes of transmission of the virus include droplet transmission, aerosol transmission and direct or indirect contact with an infected individual. In order to protect ourselves from COVID-19 and to mitigate the spread of the deadly virus in the society, WHO has advised various measures like social distancing, usage of masks, hand hygiene and vaccination.


Masks have become a part of one’s own attire since then. However, there is still no proper usage of masks, especially in developing countries, due to lack of awareness among the general public. Even among those who comply with COVID appropriate behaviour, there are various concerns regarding the ill-effects masks have/might have on their normal day-to-day functioning. Here, we have tried to address the most basic queries regarding masks.

What are the various masks available?

  • Cloth mask
  • Surgical mask
  • Respirator masks which include N95, N99, FFP1, FFP2 and FFP3

What are the differences between these masks?

  • Cloth masks and surgical masks allow air entry through the mask as well as around the edges while respirator masks make a tight seal around the mouth and nose thereby allowing air entry only through the mask and not around the edges. Filtration efficiency also varies among the three with respirator masks providing the highest filtration efficiency followed in order by surgical mask and cloth mask.

What dose N95 and FFP mean?

  • N95: Non-oil based and has 95% filtration efficacy
  • FFP2: Filtering face piece which has the same efficacy as N95

Whom and what to use?

  • Cloth mask: General public in outdoor settings.
  • Surgical mask:
    • Health care workers in hospitals
    • General public who are more than 60 years of age
    • Immunocompromised patients
    • People with chronic respiratory illness, cardiovascular disease, cancer, obesity and diabetes
    • People who tested positive for COVID
    • People awaiting COVID-19 test results
    • Caretakers of COVID-19 patients
  • Respirator masks (N95, N99, FFP1, FFP2 and FFP3): Health care workers in hospitals performing aerosol-generating procedures like intubation, nebulisation, cardiac resuscitation, bronchoscopy or sputum induction.

When to use?

  • Outdoor settings: Always
  • Inside the home: When a non-house hold member visits the house
  • Exercise: Not advised to use masks during vigorous exercise because of risk of reducing the breathing capacity

Should a vaccinated person wear mask?

  • Definitely yes. Completely vaccinated persons can still get infected with COVID-19 and transmit it to others especially with the emergence of COVID-19 variants. Hence, it is mandatory that vaccinated persons continue to follow COVID appropriate behaviour.

How to choose a cloth mask?

  • A proper cloth mask should be made of multiple layers of woven fabric, doesn’t allow light to pass through while being held against a light source, shouldn’t be hard to breathe through and should fit properly around the nose and mouth without leaks.
  • Masks with valves: Not to be used.

What not to use?

  • Masks that are wet, soiled or damaged are not to be donned.

Are two masks better than one?

  • Yes, wear a surgical mask underneath and a cloth mask on top for better fit and extra protection.

Can masks be reused?

  • Cloth mask: Yes, wash it with detergent and hot water (at least 60 degrees Celsius) daily and store it inside a separate bag.
  • Surgical mask: No,not to be reused.
  • Respirator mask (N95, N99, FFP1, FFP2 and FFP3): No,not to be reused.

What are the precautions while using a mask?

  • Check for damage or soiling before wearing the mask.
  • Clean your hands with alcohol-based hand rub or soap and water before wearing the mask.
  • Place a metal strip on top and pinch so that it moulds to the shape of the nose.
  • Avoid touching the front of the mask to avoid contamination.
  • Clean your hands before and after removing it.

Are there any side effects related to mask wearing?

  • Commonly encountered problems are impressions from masks over the face, itching, acne, contact eczema, temperature rise behind the masks, condensation of exhaled air behind the mask and fogging of glasses.
  • Less common adverse effects include fatigue, poor exercise tolerance, breathing difficulty, impaired concentration and headache.
  • MIES (Mask Induced Exhaustion Syndrome) is a recently introduced terminology associated with wearing masks.
  • These adverse effects have been noticed from as early as 1 hour after continuous donning of masks especially in those with underlying chronic illness, obesity, pregnancy and after physical exertion.

How to deal with mask related fatigue?

  • N95 is not for the general public and hence not recommended for them.
  • Avoid physically demanding activities while donning masks.
  • People engaged in physical work can work in shifts of 2 hours each with a break in between.
  • Change the masks once they get soiled/wet.

NOTE: Yes, there might be some side effects but benefits far outweigh the side effects. Life is more important than discomfort!!!!

Finally, regarding the third wave of the COVID-19 pandemic in India, there is a lot of uncertainty and fear among the masses. Guess work on the timing and severity of the third wave will only worsen the situation.

Now, trying to answer the question based on available evidence, the second wave hasn’t yet completely receded and India is still reporting more than 30000 cases a day. Also, a nationwide sero-surveillance of more than 36,000 people conducted by ICMR in July 2021 has shown seropositivity of 67% with wide variability among various states. Madhya Pradesh shows 79%, Tamil Nadu 69% and Kerala 44% positivity reveal the true story. This means a good 1/3rd of the population is still susceptible to COVID-19 and with the emergence of virus variants, possibility of a 3rd wave can’t be ruled out. Also, various states might experience the 3rd wave at different times given the different sero-positive rates. For example, Kerala is already reporting more than 50% of the case load which could very well be its 3rd wave. Tamil Nadu is still experiencing the tail of the 2nd wave and the timing of the 3rd wave is for anyone to guess. However, the severity of the 3rd wave can be mitigated by aggressive vaccination campaign and by continuing COVID appropriate behavior.


Dr. R. Nithiyanandan
Associate Consultant – Pulmonary and Critical Care Medicine
Kauvery Hospital, Chennai