Study: Mask type really matters, ventilation may matter more

University of Waterloo researchers used a sealed room, a masked mannequin and atomized olive oil to simulate breathing in their study. They used lasers to measure the aerosols, tiny particles that can float in the air, getting past masks and circulating in the room.

Then they added ventilation, courtesy of an air purifier equipped with the sort of high-powered HEPA filters used in labs and on airplanes.

The University of Waterloo study reached several conclusions:

"Indeed, our research shows that fresh air exchange or air purification can be very effective in controlling aerosol buildup indoors," Professor Serhiy Yarusevych, one of the researchers, told WRAL News via email. "The most beneficial strategy would be to employ both masks and ventilation to minimize the risk of virus transmission. However, given the relatively low efficiency of cloth and surgical masks in aerosol control, it is essential to complement their use by adequate ventilation for prolonged indoor occupancy."

"This paper confirms with a more controlled set-up (and more math) what other studies have shown before," said Dirk Dittmer, director of virology and global oncology programs at the UNC Lineberger Comprehensive Cancer Center. "N95 is much better than anything else."

Dittmer said that, in Germany, the government routinely sends his parents and others N95 masks. He also said ventilation is important, along with mask fit. Because he works in a lab with coronaviruses, Dittmer said he gets annual fitting lessons.

Pia MacDonald, a UNC professor of epidemiology and senior director of applied health research for RTI International, said ventilation should be considered crucial.

"While masking is one strategy for reducing risk of transmission indoors, the combination with ventilation (air exchange) is a critical strategy to reducing risk of SARS-CoV-2 transmission," she said.

Tarek Echekki, a professor of mechanical and aerospace engineering at N.C. State, noted that the Waterloo study had an average droplet size of one micron.

"A human exhalation may involve larger droplets as well," he said. "It is not clear if the use of smaller droplets is placing the more common face masks (surgical and cloth) at a disadvantage and thus reducing their efficacy."

Echekki noted that the study doesn't account for any protection you get for your self in wearing a mask, it only measures aerosols exhaled. He said the experiment deviates from normal life in a number of ways, but he called it "a nice addition to the available literature."

Martin Fischer, a Duke University chemistry professor who compared masks in his own experiment last year, said the Waterloo study shows yet again the complexity of evaluating masks.

"I would take this study with a grain of salt," Fischer said. "How many of the super-spreader events involved a bunch of folks sitting still doing nothing but steady breathing in a room with absolutely no air movement? Nevertheless, the message as far as masks and ventilation should be: Wear a mask, try to make it fit to avoid gaps, and exchange your air (filter or exchange the air in a room, or go outside). And go get vaccinated!"

Asked about the Waterloo study, North Carolina's Department of Health and Human Services called ventilation "part of a layered strategy to reduce exposure to the virus that causes COVID-19."

"Increasing the amount of outdoor air into a building, increasing filtration, and enhanced air cleaning, such as using HEPA filtration systems, are important factors to improving indoor air quality and reducing exposure to viruses," DHHS spokeswoman Catie Armstrong said in a statement. "Improving indoor air quality and using a properly fitted mask are additive – they work better together to help control the spread of COVID-19."

Wake County schools spokeswoman Lisa Luten said the system upgraded its HVAC filters to MERV-13's and plans to spend about $940,000 this year on filters alone. That sort of filter captures at least 75 percent of particles below 1 micron in size and at least 90 percent of particles above that, according to Yarusevych, one of the researchers in the Waterloo University study.

HEPA filters used in the study catch at least 99 percent of particles across this entire range, he said in an email.

Luten said the system couldn't point to any spending to move students outside, or to improve ventilation, beyond the filter improvements. But she also said school HVAC systems are tested every year and meet higher standards than, say, a home. She said system leadership has reviewed a number of studies on ventilation and COVID.

"It’s hard to read those studies and compare them to our schools," she said.