It’s just a very fancy and expensive surgical mask

Thursday, March 26th, 2020

Is it true that the public won’t be able to use N95 respirators correctly? Yes, Scott Alexander says:

I remember my respirator training, the last time I worked in a hospital. They gave the standard two minute explanation, made you put the respirator on, and then made you go underneath a hood where they squirted some aerosolized sugar solution. If you could smell the sugar, your respirator was leaky and you failed. I tried so hard and I failed so many times. It was embarrassing and I hated it.

I’m naturally clumsy and always bad at that kind of thing. Some people were able to listen to the two minute explanation and then pass right away. Those kinds of people could probably also listen to a two minute YouTube explanation and be fine. So I don’t want to claim it’s impossible or requires lots of specialized background knowledge. It’s just a slightly difficult physical skill you have to get right.

Bunyan et al, 2013, Respiratory And Facial Protection: A Critical Review Of Recent Literature, discusses this in more depth. They review some of the same studies we reviewed earlier, showing no benefit of N95 respirators over surgical masks for health care workers in most situations. This doesn’t make much theoretical sense – the respirators should win hands down.

The most likely explanation is: doctors aren’t much better at using respirators than anyone else. In a California study of tuberculosis precautions, 65% of health care workers used their respirators incorrectly. That’s little better than the general public, who have a 76% failure rate.


Is a poorly-fitting N95 respirator better than nothing? The reviewed studies suggest that at that point it’s just a very fancy and expensive surgical mask.


  1. Kirk says:

    The chief benefit, in my observation, is that the masks keep people from using their booger-hooks to touch their faces with. Short of an actual overpressure mask set-up, keeping any sort of seal is virtually impossible. My guess is that even trained soldiers operating in a chemical/biological environment would have been a lot less likely to survive than the projections guessed at. It’s easy to get into the gear, less easy to keep it sealed over time, and the more you’re doing while in the gear, the less and less likely it is to maintain seal.

    One of my more motivated NBC NCOs (Nuclear-Biological-Chemical, the guys who specialize in maintaining the equipment and running all the surveys/tests…) talked our commander into doing a full-on bridge construction project while in the highest level of chemical protection, which the military calls “MOPP 4″. That’s mask, chemical suit, gloves, booties, and supposed total isolation from the environment. At the beginning of it, he went around and checked everyone’s mask seal with the banana oil test to see if we all had good seals. He spot-checked over the course of us trying to build that frigging bridge, and I don’t think we had anyone whose seals maintained over the time we were doing it. Sweat, motion, whatever–The seals were lost, and odds were that if we’d been doing that crap in a contaminated environment, we’d have all been dead in relatively short order. I don’t think the N95 situation is much better, TBH. Unless you’re in a spacesuit-like set of equipment, it ain’t happening.

  2. Graham says:

    For private citizens not in health care environment, and practicing the usual social distancing guidelines, would it not be of modest, nonzero help? Especially if you wash right after removal.

    I’m not suggesting one can maintain hot zone decontamination practices in civilian life- every day I reenter my home I reflect on the sequence of coat and boot removal and how many things I have or have not touched and in what order- already impossible to quite maintain an “outside” and an “inside” list exclusive of one another.

    It’s just that compared with an environment contaminated with radiation, some chemicals, or more specialized bio agents deliberately deployed, I would have thought the amount of virus out there to be both less and mostly airborne only at close range. I appreciate that NBC environments military would have had to operate in would have had very varied possible contaminants, but this thing still seems to be water droplets and relatively rapidly landing aerosols, and at close ranges.

    Not so?

  3. Lucklucky says:

    Even an incorrect put mask might protect.

  4. John in Philly says:

    During a recent visit to a membership store I saw a fair amount of glove wearers, and a lesser number of mask wearers.
    One bearded gent didn’t bother putting the top strap over his head and left it dangling down in front, and another gent had cut the bottom strap off of his respirator. Much truth about training and technique to use a respirator effectively.

  5. Lucklucky says:

    Here are some studies about homemade masks.

    For me it has been clear from beginning that masks are very important. Essential.

    One of most important things is that the initial strength of contact with virus is most important, even if anyone is contaminated through a make shift mask but it is with just half of infectious material it might mean the difference between a mild infection versus a dangerous one.

  6. Graham says:

    That sounds eminently sensible. If it’s true, I rather wish our various public health authorities had been saying that a month ago instead of some version of “OMFG don’t wear a mask it’s like SOOO useless and dangerous for you rubes”.

    I can’t tell if that message was just to hoard what was available for health workers, which I could at least respect, or just the usual patronizing of the citizens.

  7. Kirk says:

    If there is one lesson that needs to be taken, coming away from all this? We need to slap the metaphoric sh*t out of the bureaucracy and the complacent idiots we have for political “leaders”.

    Cuomo was told he needed to rebuild his ventilator stockpile, and that it would cost a bunch of money. Instead of doing that, he blew even more money on that solar boondoggle in upstate New York that only enriched his cronies. Obama was told to restock the N95 mask stockpile that was depleted after they used it up for the H1N1 pandemic that he didn’t even bother to declare (note the difference in coverage on that deal, which killed a bunch more people than this one has, so far…), and that didn’t happen. I haven’t heard what happened with Trump and that issue, but I wager it was like 9/11 and Bush–So much BS left undone and imprudently allowed to slide that it would have been a full time job just to try to figure out what hadn’t been done. And, with an uncooperative Federal bureaucracy? LOL…

    A huge component of why we’re so screwed up has to do with that bureaucracy: Dr. Fauci, for example? A Hillary supporter. No telling what else is hiding in the politicized permanent fourth branch of government we’ve allowed to grow up, but it needs to be dealt with. Some of these people are actively sabotaging the country, out of pure political spite.

    I almost think we need to sh*tcan the supposed “civil service reforms” from the 19th Century and go back to good old patronage. At least, that way, you knew you had biased crooks in position throughout the Federal government. And, given that we can’t imbue the bastards we put into those jobs with saint-like qualities, maybe the answer is to politicize the whole thing and downsize it to where we can manage to deal with changing them out every election cycle.

    The bureaucrats have literally become a fourth, damn near dominant, branch of government. That has to change, or we’re all going to turned into their serfs.

  8. Bruce says:

    Here’s a guy making and selling masks:

    Rob Zuazua
    How can we get Americans to start wearing masks in public? I feel like most Americans have heard so much mixed messaging on masks and there is stigma attached.

    I made to connect volunteer mask makers with those who need masks, but no one orders.

    Kirk is right; it’s really easy to screw up protective gear. I’d like to see a mask integrated with a hooded sweatshirt, something something tubes bronchioling for small filtered air intakes behind your back, in your armpits, around your wrists, using teeny check valves so your normal motions power air toward your face. Loose enough that you can pick your nose through the mask (telling people ‘don’t touch your face’ my ass). Washable. disposable

  9. Harry Jones says:

    I was raised by an emotionally defective parent to fear everything except the actual worst dangers. I had to unlearn all that and I will never, ever go back.

    I have a healthy respect for black swans, which by definition can’t be planned for. I have little faith in plans, especially those driven by fear.

    So I’m not going to wear a surgical mask the rest of my life. It’s not a good look. It’s a purely passive defense, and that’s never a good look. It signals weakness and fear.

    In parts of the Far East they do this because of some other plague some years back. They make a fashion accessory out of germ phobia. The girls even have a floral pattern on their masks. I haven’t the heart to tell them they look ludicrous.

    There are reasonable precautions, and there are hysterical overreactions. What they do over there is over the top. Let’s not emulate it.

    And maybe they could clean up those wet markets? Just saying.

  10. Graham says:

    Harry Jones,

    The subject of risk perception and risk management, on all kinds of issues, comes up a lot for me in conversation and with a couple of coworkers from time to time. This sort of thing- why are people so afraid of terrorism when they could die in a car crash so easily.

    I generally agree with this sort of thing, even when it is offered as one of those unreflective tropes one sees in newsmagazine columns. Sometimes they’re right, although the reasoning toward and from these conclusions is usually weaker.

    For example- yep, the odds of any North American dying from terrorism, even factoring in 9/11, has never been that high. One is right to fear violent crime a little more, but not too much depending on where one lives, and disease more still, and accidents on the road more yet, and accidents in the home even more. And, even with COVID in the background, chronic and lifestyle diseases even more than all of them.

    And to evaluate risk and take measures accordingly.

    Of course, the recommended policy conclusions usually take this over the insanity line by concluding that we need not pursue terrorists, or secure pilot training, or secure borders, or kill enemies, until we have given over the roads to perfectly safe autocars or total public transit.

    For me, the distinction is between a risk that is required to function in everyday life given our level of tech, etc., and which offers corresponding benefits, and one that just smacks of inattention.

    Not that I think every measure to stop terrorism is valid at any price either, of course. It’s been overblown a lot with useless responses put in place.

    A crude summation of what I like to think is a reasonable perspective- evaluate risks realistically, define what you are willing to accept and why, and probably accept those that are most necessary to your way of life and be more aggressive with those that aren’t, which means some variation from the objective risks and the policy results.

    Of course, the actual odds of any one person dying in a traffic accident are pretty low in their own right, so we all kind of operate with that in mind too.

    All that rambling was kind of a prelude to a question- if you don’t mind- what sort of things were you raised to most fear and, if not likely to be obvious, what taught you to later evaluate them differently?

    For my part, I can’t recall much specific from when I was a kid in the 70s and 80s that I was taught to fear. I remember the generic scares- Halloween candy with razor blades or poison. IIRC, the facts still are that that never happened even once in the real world. I don’t remember my mother being at all freaked about that, but it was in the air and on the news. We still collected candy and took homemade candy apples and regular apples from neighbours. Probably more cautious about whose doors and how many we knocked on than the previous generation of kids.

    Toronto had a rash of teen and kid kidnappings in the 80s. I was mostly too old for any concern, especially being male. But my mother was probably a little unnecessarily skittish about me being out too late when I was 12-13 or so, especially when she knew I was just at a friend’s house a km or so away through a very safe residential neighbourhood.

    That sort of thing- Toronto wasn’t exactly 1980s Manhattan.

    More broadly, I somehow inherited a more pathological fear of debt, a little bit to a fault, but as long as our fiscal system lasts that has probably been beneficial.

  11. lucklucky says:

    the odds of any North American dying from terrorism, even factoring in 9/11, has never been that high.

    Well if US and other forces wouldn’t have killed thousands of Islamists and if Iraq intervention did not had showed Muslim world what Islamists do, what would be the chances?

  12. Lucklucky says:

    “So I’m not going to wear a surgical mask the rest of my life. It’s not a good look. It’s a purely passive defense, and that’s never a good look. It signals weakness and fear.”

    Like a helmet, a bulletproof vest, our shoes, clothes, a wall, a door in your home. etc.

    Is it the luxury of aesthetics that drive you? i hope you have made something aesthetically worthwhile in your life at least.

    You have to do what you have to do. A mask is a double barrier — from you to others, from others to you.

    I’m sure the vírus will avoid you because you signaled no fear…

  13. Graham says:

    I had hoped I conveyed that I largely favour the US killing enemies, partly for reasons of state and partly because they do represent some degree of threat to Americans. On the whole, the ranking of that threat on the overall scale of what could kill X Americans on any given day or in any given year is a stupid reason to make such policy decisions, and the lowness of that ranking should not be, but often is, raised as an argument against such actions.

    Whether or not these military operations should have been done, or not, or in different ways, should basically be unrelated to such calculations. unfortunately, the threat can be and has been overblown because those are the kinds of arguments that sway the public, and similarly opponents throw up stuff about how car crashes will kill more people in a red herring approach to arguing against military action.

    My only point is that in the context of personal risk assessment, the chance of getting killed by terrorism in North America as something to be afraid of, has never been all that likely compared with other risks everyday. Still true even when the dead of 9/11 are counted. Doesn’t make any point about what America’s responses should have been then or since. It does make a point about what one should really fear on an everyday basis and how much, and it isn’t terrorism.

    Even infectious disease normally not so much. But our culture has been underplaying that one for a long time rather than overplaying it.

  14. Harry Jones says:

    Luckylucky: you can afford to go about in combat armor if you have a reputation for killing enemies. That cancels out the defensive signal. A flak jacket plus a rifle is a very different look from a flak jacket and no rifle.

    Did I mention those Asians also wear helmets? Motorcycle helmets, but still… And they flash the V sign without having won a war first.

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