New information is emerging every day on how the new coronavirus spreads and the best ways to protect against COVID-19. The most effective protections include washing your hands frequently with soap and water and practicing social and physical distancing. However, wearing cloth face masks or coverings in public when social distancing can’t be observed does offer protection against spread of COVID-19.

Lisa Maragakis, M.D., M.P.H., an expert in infection prevention, provides guidance based on Johns Hopkins Medicine policy.

Should I wear a face mask or covering for coronavirus protection?

The answer depends on who and where you are. At Johns Hopkins, a team of experts in infection prevention, emergency medicine and emergency management is always reviewing the best ways to protect our patients, our staff and the general public. These are our current recommendations.

Masks for the Public

The general public: The virus can spread between people interacting in close proximity — for example via speaking, coughing, or sneezing — even if those people are not exhibiting symptoms. In light of this evidence, wearing a cloth face mask or covering in public places where social distancing can’t be observed will help reduce spread of the disease. For example, in a grocery store or on a bus, if you wear a face mask, you help protect those around you in case you cough or sneeze.

Federal and state agencies also provide specific recommendations:

• The Centers for Disease Control and Protection (CDC) recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (for example grocery stores and pharmacies), especially in areas of significant community-based transmission. Social distancing and taking precautions such as washing hands, using hand sanitizer and disinfecting surfaces frequently are also appropriate measures to avoid the spread of illness.
• Some states are now requiring face masks in retail stores and on public transportation. In Maryland, starting on Apr. 18, face masks or coverings will be required in retail stores and on public transportation.  

People with higher risk factors for COVID-19: This would include people over age 65, and those living with heart disease, diabetes, chronic lung disease, immunity problems or cancer.

According to the CDC, since recent studies indicate a significant portion of people who have COVID-19 don’t show symptoms, the virus can spread before they realize they are sick. This new research — combined with the fact that the coronavirus can spread through close proximity to others, often via speaking, coughing or sneezing — led to their recommendation for the general public to wear cloth masks in public, especially where social distancing may be difficult and in areas of significant community transmission.

While social and physical distancing and frequent handwashing are the best ways to protect against COVID-19, you should check with your doctor about the best option for you. Johns Hopkins Medicine offers these directions for a homemade mask and child size masks, intended for use in non-patient care settings.

Masks for COVID-19 Patients and Their Caregivers

In order to protect from the spread of droplets, a surgical or cloth mask should be worn in a home setting by those with COVID-19 when they are around others. If the person who is ill is unable to wear a mask, their caregiver should wear one. Patients being treated in hospital settings will follow hospital guidelines.

Many websites offer guidelines on how to make a cloth mask. Johns Hopkins Medicine offers these directions for a homemade mask and child size masks for non-patient care settings.

Masks and Other Protective Equipment for Health Care Workers

Health care workers testing and treating patients for COVID-19: Anyone interacting directly with people ill or suspected to be ill with COVID-19 need professional respirators, such as N95 respirators, which are designed for medical use. N95 respirators fit the face snugly and filter the air to stop respiratory droplets from getting through or around the device. In addition, our care teams treating patients with COVID-19 wear added protective gear, including face shields that protect the eyes, nose and mouth from contamination from respiratory droplets, along with masks or respirators.

An important note about N95 respirators is that they are in high demand during this pandemic. It is crucial that they are only used by medical workers and first responders who have been fit tested to wear them so they can continue treating patients. Hoarding or diverting the use of these respirators could lead to serious harm to patients and medical staff.

Health care workers in patient areas, but not working directly with COVID-19 patients: Procedural, surgical and cloth face masks are being used to help guard against the possible spread of COVID-19. These masks don’t have a tight seal and are made of different types of materials.

Similar to influenza and other respiratory viruses, the virus that causes COVID-19 appears to be transmitted primarily through large respiratory droplets. Surgical or procedural masks provide protection against respiratory droplet spread.

While cloth masks are not medical-grade, they may be helpful in non-patient settings to contain coughs and to remind people to not touch their face, but they are not suitable for providing medical care to patients.

Read more about Johns Hopkins Medicine’s use of face masks in our care facilities.