Surgical Masks

Are Surgical Masks Safer than Cloth Masks on Planes?

Several international carriers have recently banned cloth masks. Are they less protective than surgical masks? Experts on infectious diseases weigh in.

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Ever since face masks became mandatory on most forms of public transportation, many air travelers have been flummoxed by the question of what type of protective gear to don. Will that floral-printed cloth mask you wear around town actually protect you on a crowded airplane? Should you double up on your masks or even add a face shield or goggles for good measure?

But now that some international airlines are banning cloth masks altogether, some travelers might be questioning their in-flight mask choices anew. In August, Finnair became the latest carrier to require all passengers and crew to wear medical grade masks—such as N95, KN95 or surgical masks (like those ubiquitous blue and white or all-black ones you can buy in bulk)—joining Air France, Croatia Airlines, Lufthansa, Swiss, and LATAM.

Why the change? “Fabric masks are slightly less efficient at protecting people from infection than surgical masks,” Finnair released a statement explaining their decision. It was a practical move by other carriers to comply with local regulations. Lufthansa, for example, made the change earlier this year after Germany adopted a policy requiring medical masks to enter many public places.

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U.S. airlines and most other foreign carriers have thus far chosen not to further adjust their mask protocols and continue to allow the cloth variety as long as it covers your nose and mouth and doesn’t have slits or valves. However, bandannas, balaclavas and loose-fitting scarves are prohibited. Domestic carriers are having enough trouble enforcing the existing rules as evidenced by the recent move to double fines for mask refuseniks in the U.S. But, still, this raises the question—if some airlines are concerned that cloth masks don’t adequately protect fliers against COVID-19, especially given the rise of the Delta variant, shouldn’t all passengers be concerned?

Experts in infectious diseases say that this is not the case. While you may want to opt for the medical variety for peace of mind, travelers who are fully vaccinated and have no health risks can still be protected by a good cloth mask, especially one with two layers and a pocket for an insertable filter.

“What is most important is the fit of the mask,” says Dr. Ravina Kullar, a Los Angeles–based spokesperson for the Infectious Diseases Society of America. While cloth masks don’t have the same filtration effectiveness as medical grade face masks, “the best face mask is one that fits correctly on a person, fully covering the nose, mouth, and fits below the chin.” One tip, she adds: If your glasses are fogging, “your face mask is leaking and you are not getting the ideal fit.”

But the recent surge in COVID cases in the United States and abroad is bolstering the case for masking to the max. True, airplanes have high-capacity, hospital-grade ventilation systems, Dr. Kullar notes, but with the airlines’ empty middle seat policies a thing of the past, people are sitting closer together, and that adds to the risk.

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The science behind the design of medical masks is clear, according to Dr. David Aronoff, director of the division of infectious diseases at Vanderbilt University Medical Center. “Masks are more protective against transmission events as their filtration efficiency improves; in other words, those that filter smaller particles from the air are more protective than those that do not,” He says. Cloth masks are at the lower end of that scale, and at the high end are the N95 or KN95 masks, which are capable of screening out some 95 percent of particles. Surgical masks are somewhere in between the two, he says.

But the choice of which mask to wear gets a lot harder when you’re facing a long flight trapped in the back of a crowded coach cabin, Dr. Aronoff admits. “The trade-off for moving from less to more filtering power is a loss of breathability, which can affect comfort, particularly for long durations of use.” And, he adds “evidence suggests that even cloth masks, when properly fit and sufficiently thick, help reduce the risk of virus transmission.”

Part of the problem with cloth masks is that they are not regulated, unlike the medical variety. But it’s worth noting, too, that the mask guidance from both the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) does not call for banning cloth masks.

In the end, a lot comes down to the individual’s own personal risk. “I recommend a face shield in addition to a medical grade face mask for high-risk individuals, such as those that are immunosuppressed and elderly, to offer an added layer of protection to these populations,” says Dr. Kullar. “With the Delta variant and the surge in cases, it is critical to use the infection prevention measures we know that have worked to protect us as we fly.”

Those prevention measures have been and remain wearing masks, sanitizing, and distancing—to the best extent possible.

 >> Next: How the Delta Variant Might Change Your Travel Plans

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