N95 Masks Will Save Your Life. Wear Them.

End of story.

Joe Biden, late 2021/early 2022

A long time ago in a galaxy far, far away…

Democrats did the right thing.

So did a few Republicans.

I chose this image of Biden from the early days because it represents a particular time in many lives, a time when we still had some hope.

That hope has withered substantially over the last three years. These days, even those who describe themselves as pro-science and pro-health can’t resist the temptation to spread misinformation about masks and respirators, saying they don’t work—or they’re not worth the effort. For example, one popular account announced he was filing a complaint against a nurse who antagonized his spouse over a flu shot. Down in the comments, while ranting about misinformation on vaccines, he declares that masks “work for the patient, not the person wearing the mask.” Honestly, it’s getting hard to stomach. Because they’re wrong.

Very wrong.

Earlier this month, ironically on April Fool’s Day, The Atlantic ran a gently condescending piece on the “evermaskers,” those of us who face social stigma for continuing to take precautions against airborne disease. Despite the sympathy it shows at times, this piece got several things painfully wrong about the reasons why many of us continue to strap on quality masks when we interact with anyone. The biggest thing it misses: It’s not just Covid anymore, not by a long shot. With measles, tuberculosis, and flu now in the mix, we have no end to good reasons for protecting our health. And guess what? Measles mutates faster than Covid. It’s unlikely it’ll evade vaccines, but the chances aren’t zero—and they get higher every day we have grifters like RFK Jr. and Dr. Oz in charge.

This newsletter focuses on practical things we can do to protect ourselves from threats, and it appeals to the inner prepper in everyone. So I’ve gotta ask, what kind of prepper doesn’t try to stop the transmission of airborne diseases given the abundant evidence that they shred your health? What kind of prepper doesn’t wear a mask when they know, for a fact, that governments—especially the current administration—are seeking to suppress information about public health, while recommending snake oil over actual medical care?

Not a very good one.

Unfortunately, Starbucks has reportedly joined the list of major chains that are trying to prevent their employees from wearing masks. It’s a big deal with big implications. If they get away with it, this will send a message to hundreds of other employers that it’s okay to stop your workers from protecting their health. If there’s even a hint of this happening, they need to be reminded what a bad idea it is. These companies never stop trying to sneak things by.

As I documented last year, many of us who mask face a crushing amount of discrimination. It happens in our homes. It happens with our friends and families. It happens at work. It happens when we’re trying to run errands. Strangers make snide comments. They start arguments with us. They cough on us. They wish us dead to our face. Sometimes, vendors deny us service. Sometimes our own family members assault us, trying to pull our masks off. In one especially bad case, a nurse called security on a vulnerable patient for declining to remove her mask. If this hasn’t happened to you, I’m glad, but you’re also quite lucky.

Here’s the bottom line: Masks work. We’re going to examine all the evidence that they work, why you need them, and where you can get the best. I’m putting this one in front of the paywall, and you can use whatever parts of it you like when you contact Starbucks and tell them how wrong they are and what it’s going to cost them in every logical, ethical, and financial sense.

Let’s go:

A major investigation on masks in Clinical Microbiology Reviews examined 100 published articles on masks and found that when they’re “correctly and consistently worn,” masks and especially N95 respirators are “effective in reducing transmission of respiratory diseases.” The authors explain why N95 masks work. As they point out, “respirators are not simple sieves,” meaning they can easily trap viral particles 65-125 nanometers in diameter. Here’s how they do it:

• “Viruses travel through the air as passengers in or on respiratory aerosols [much larger], rather than alone.

• Filters work via “inertial impaction” and “interception” of larger particles that get stuck in the filter fibers.

• The electrostatic charge of an N95 mask creates a field that attracts and captures smaller particles (.1-.5 microns).

• Filters also work via “diffusion, in which smaller lighter particles (.01-.4 microns) impact fibers with Brownian (zigzag) motion.

The authors go on to describe their work in The Conversation and why it corrects a popular misconception after a widely misinterpreted Cochrane Review went viral on social media in 2023. As they state:

Like the Cochrane team, we pooled data from randomised controlled trials (RCTs) and analysed the combined data – a so-called meta-analysis. Unlike them, we also examined non-RCT evidence, including dozens of laboratory studies which showed that respiratory infections, including the common cold, COVID, flu, measles and TB, spread mainly through the air… When we looked at RCTs, we found that masks do protect in the community, and N95 respirators (masks made using higher-grade filtration material and designed to fit closely around the face to protect against airborne contaminants) are superior to masks in healthcare workers, especially when respirators were worn continuously at work. Non-RCT evidence also shows that masks work and respirators work better.

If you want more evidence:

A major 2023 study by the Royal Society examined the available research on masks and found that “wearing masks, wearing higher quality masks (respirators) and mask mandates generally reduced… transmission.”

The case for N95 masks also includes an official statement by OSHA that “surgical masks are not designed or certified to prevent the inhalation of small airborne contaminants” and “are not designed to seal tightly against the user’s face.” They just don’t work as well. As they further state:

During inhalation, much of the potentially contaminated air can pass through gaps between the face and the surgical mask and not be pulled through the filter material of the mask… so they cannot be relied upon to protect workers against airborne infectious agents.

More evidence:

Another major study in eBioMedicine (a Lancet Journal) reached similar conclusions, stating that “an N95 is significantly better than the other options.” The authors of the study have stated very clearly that “N95 masks should be the standard of care in high-risk situations, such as nursing homes and healthcare settings.” They work even without training or fit-testing. How do surgical masks stack up? Not well. In this study, even cloth masks with a good fit outperformed them.

A review of studies by Michael Klompas and Chanu Rhee in the Journal of Infectious Diseases also shows that “surgical masks provide substantially less protection against viral inoculation of the respiratory tract compared to fitted N95 respirators” and refers to “a wealth of real-world studies that document failures of surgical masks worn by healthcare workers… to prevent transmission, as well as case-control studies that found respirators to be more protective than surgical masks.” In fact, the authors end by declaring it’s time for the CDC to update its infection control guidelines in the face of such overwhelming evidence. Frankly, they should’ve been recommending N95 masks to the public this entire time.

Over the last few years, corporate media have fed the public a steady diet of misinformation that every mitigation behavior, like wearing a mask in public, constituted a form of “lockdown” that destroyed our mental health and put kids behind in school, leading to “learning loss.” On the contrary, studies have found these protection measures saved hundreds of thousands of lives. A 2021 study in PLoS One found a “statistically significant decrease” in cases, hospitalizations, and deaths after mask mandates at the state and county level. The same study found similar results in 69 different countries worldwide. A 2022 study in HealthAffairs compared 412 different counties in the U.S., finding that infection rates “in masked counties compared with unmasked counties declined by 25-35 percent up to six weeks after they were implemented.” It made a big difference.

Also:

A 2022 study in PNAS examined mask wearing across 92 different regions on six continents. They found a 19 percent decrease in transmission in areas where populations embraced masks.

A 2024 study in BMC Public Health examined a mask mandate in Illinois from October through December of 2021. Even in their most conservative model, masks “likely prevented approximately 58,000 cases and 1,175 hospitalizations.” This model only assumed 20 percent mask efficacy and 71 percent compliance. That’s one state, for three months, with mediocre masking. Yet another 2024 study in JAMA found that stronger mask-wearing could’ve saved hundreds of thousands of additional lives, lowering deaths by as much as 21 percent—if all states had adopted the same policies as the most protective ones. Another study in the Journal of Health Economics found that state mask mandates saved 87,000 lives in 2020 alone and that a national mask mandate would’ve saved an additional 57,000 lives.

These studies only look at cases, hospitalizations, and deaths. They don’t mention Long Covid, which we’ll discuss in a minute. They also examine populations where people wore a wide range of masks. More people wearing higher quality masks would’ve seen even better results.

We had a growing body of evidence in favor of N95 masks before the current pandemic began. One 2017 study in Influenza and Other Respiratory Viruses found that N95 masks “provide superior protection” for droplets.

Nonetheless, a handful of poorly designed studies and reviews reinforced the myth that surgical masks work just as well as respirators. In reality, these studies simply reveal that many healthcare workers aren’t trained or educated on how diseases spread. They don’t wear protection as often as they should, and they don’t understand asymptomatic transmission.

You still need a mask for a range of reasons, as explained here. Vaccines reduce your risk of Long Covid by roughly 62 percent, but even that mediocre protection wanes over time, requiring boosters once or even twice a year. As the studies show, it’s no trifling matter. It’s a condition characterized by lasting damage to multiple organ systems, and patients have put their pain and quality of life on par with advanced terminal cancer. The mountains of research have prompted many experts to describe the result as “the greatest mass disabling event in human history,” with an oncoming health crisis “so large as to be unfathomable.”

Do you want organ damage?

I don’t.

An internal slide presentation from the summer of 2021 reveals that the CDC was fully aware of waning vaccine effectiveness and the risk of variants like Delta. The presentation urged officials to “acknowledge the war has changed.” Slides said that “breakthrough cases may reduce public confidence in vaccines.” It even reported that vaccinated patients could still spread the virus almost as much as the unvaccinated, and that they were making up a larger portion of hospitalizations and deaths. Once it became impossible to deny the reality of serious breakthrough infections by late summer, the CDC made a muddled attempt to bring back masks in the fall of 2021, but they didn’t try very hard and eventually gave up.

The CDC would abandon any attempt to protect the public during the winter of 2021-2022, caving to corporate pressure to ease quarantine and testing guidelines. Anthony Fauci didn’t even try to hide the real reason for the decision. It had nothing to do with science or medicine. Instead, he said, “We want to get people back to the jobs,” even if they were unwell.

There was already substantial data on Long Covid and “mild” Covid infections, including the likelihood of asymptomatic spread—you were contagious regardless of how you felt. Here’s the conclusion of a report published in the CDC’s own journal, Emerging and Infectious Diseases:

In summary, it is likely that a substantial proportion of patients surviving COVID-19 will experience long-term symptoms requiring prolonged care, even after mild to moderate disease. These symptoms might negatively affect patients’ quality of life and represent an additional burden for healthcare services and social security.

That was published in March of 2022, meaning the CDC had the information by the end of 2021, if not sooner. It was already clear that anyone’s odds of developing Long Covid from an infection hovered around 1 in 20, a conservative estimate. The main risk from Covid wasn’t death or hospitalization anymore. It was lifelong chronic illness. It was a dramatic increase in anyone’s risk of heart attack and stroke, diabetes, brain damage, and blood clots.

You can read all about Covid here.

The CDC should’ve been encouraging everyone to keep wearing N95 masks as the supply grew, but they didn’t.

There’s no end to additional reasons to wear a mask now, as a range of diseases now strike back harder than ever. As a 2024 article in BMJ confirms this fact, and we’re now seeing outbreaks of measles and tuberculosis in the U.S. It’s not just low vaccine uptake. It’s damaged immune systems and dirty air. If that weren’t enough, we’re now standing on the cliff of another pandemic.

You need to wear a good mask.

Many people stopped wearing a mask simply because they never found a comfortable one with a good fit they could trust. For the last several years, Aaron Collins (the mask nerd) has been reviewing masks for effectiveness, comfort, and fit—even for different face sizes. Here are his top picks:

Go to his channel, and you’ll find videos on everything from elastomeric masks to identifying counterfeit masks.

He keeps a list of them here.

He also talks about masks for kids:

Aaron Collins also provides a great spreadsheet for ordering these kinds of masks. My family has been using Well Before.

Now, for a little venting:

It’s 2025, and it’s still hard to find good masks in the U.S., especially for children. As Aaron Collins points out in the last video I posted, other countries like South Korea are light years ahead of us on this front:

You just go to a Korean grocery store, or you could go to your pharmacy, and they would have a row of all these KF94s. You know they’re safe. You just try them on and figure out which one fits you best and which one you like the best, and then you just buy them for 80 cents.

We had four years to make this happen in the U.S.

We didn’t.

The public didn’t put pressure on their politicians to develop the infrastructure we would need to make masks available for the general population. Our institutions didn’t take up the charge. If anything, they suppressed information and minimized the threat of airborne diseases. The media helped, so it’s a little irritating that they’re now sounding the alarm about bird flu when that and several other diseases have presented an imminent threat for years now.

Most people don’t even know that, last December, a crucial CDC committee voted against recommending N95 respirators over surgical masks in healthcare settings. In their own words, “N95 respirators should not be recommended for all pathogens that spread by air.” Dubbed the Healthcare Infection Control Practices Advisory Committee (HICPAC), its members have spent the last two years working largely without participation from experts on aerosols, ignoring evidence and outcry at every turn. Honestly, you can’t get more anti-science. They even declined to strengthen guidance protecting voluntary use of N95 respirators, saying their existing language was sufficient. During the meeting, only one HICPAC member, Lisa Baum of the New York State Nurses Association, consistently spoke out in favor of N95 masks. (She was also the only person wearing one.)

More than 900 experts and healthcare workers sent a letter to the CDC in 2023, urging them to reconsider their stance in light of current research on masks, which we just talked about. During their meeting to finalize the guidance, public commenters declared, “CDC guidance must recognize the science.”

They were overruled.

Even before Trump shut things down completely, the CDC hasn’t been so great at communication with the public. Last summer, they tweeted this. Yes, that’s a doctor declining to wear a mask for a vulnerable patient, who wears a photoshopped earloop mask, upside down, incorrectly labeled as an N95:

Dozens of activists pointed out the mistakes. Instead of correcting this misinformation, the CDC decided to hide replies to their embarrassing failure, and it’s currently still up on their feed.

As for removing N95 masks from healthcare:

Hospital-acquired infections already happen on a regular basis. One study estimates these hospital-acquired infections run as high as 19 percent in the ICU, with a rate of 4 percent for general patients. If you get sick while recovering from a severe illness, your mortality rate shoots up to 50 percent. If you're in the ICU, it runs above 70 percent. Infection during surgery isn't even the most common risk. You can catch an airborne disease like tuberculosis, measles, or Covid in your room during recovery. In fact, based on the evidence reviewed here, it’s more likely than ever because diseases are striking back hard, and our public health agencies were doing a poor job, even before they were silenced by Trump.

The point here isn’t to shift blame. It’s to acknowledge something simple and universal, something true for us all. Many of us already recognize this, but we need more people to get on board:

Here it is:

Liberals often say it’s a sign of maturity to admit when you were wrong, to listen to inconvenient facts, and to do the right thing.

Well, this would be a good time.

The MAGA crowd has become a lost cause, though with enough effort we can still force them to do the right thing on occasion. For example, one account helped push this current administration to start testing for H5N1 bird flu again. How long will it last? I don’t know, but I’m glad for now. But the people who chant the loudest about science and research need to admit that masks work, and they need to start wearing them again.

Lives depend on it.

Nobody in a position of authority will tell you to put on a mask to protect yourself and the ones you care about, not once they’re in office. Nobody is going to spell it out as a vital means of fighting fascism and eugenics, the bad science behind it. After reading this, you have a wealth of truth and evidence.

Also:

If there’s one thing that should separate us from Donald Trump and the MAGA movement, it’s the ability to admit when we’re wrong and to change our behavior based on evidence. More than ever, nobody should be using the worst of humanity as a standard to evaluate their own behavior.

You have to make the decision to do the right thing.

It’s up to you.