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Dr. Mark E. Esterle, MD

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Addendum: CDC Recommendation for Cloth Masks alone was Misguided and Poorly Educated to Public!

First things first. Social distancing is the one thing that the general public can do and will make the greatest impact on reduction of spread of the COVID-19 Coronavirus. Second, I am not saying that mask use is not beneficial but proper use and knowledge of appropriate mask type is needed along with the recommendation. For several weeks, people have been asking if they should or could wear a mask in public. Initially, the CDC recommended not wearing masks to the general public. Then suddenly, they did a 180 on their recommendation. First, let's talk about masks in general. There are several types of masks. The mask that the public is hearing so much about through the media, the N-95 mask, is the medical grade mask that blocks 95% of particulate matter. This is the same type of mask that hospital workers wear when working with tuberculosis patients and currently using with the Coronavirus as well. It is a very tight fitting mask. You need to be “fit tested” for appropriate size to make sure you’re wearing the right mask, otherwise, it too will not work. There is an even higher filtering mask the N-99, which blocks out 99% particles. This mask is a little harder to come by and a bit uncomfortable, as it is quite difficult to breathe through for very long. Next up is the standard surgical mask that we use in the operating room. A surgical mask is a general all-purpose mask for the hospital employee but does not have nearly the level of filtration as an N-95 and is not truly for protecting the individual wearing it. A surgical mask is protecting people around the individual that is wearing it. This mask does not provide the wearer much protection at all from the Coronavirus. Despite this, the CDC is recommending that the hospital employees wear this mask predominantly for their protection. There are several different opinions as to why this is, but clearly supply is a component to the decision.


The masks that the CDC is recommending now for the general public to wear, is just simple cloth masks. The 180 degree shift to this recommendation from the CDC came after public scrutiny that the agency and government were not collectively doing enough to protect the general public. I believe that this posturing from the "powers-that-be" is more about their protection than yours. So what's wrong with the recommendation of the general public wearing cloth masks? Isn't something better than nothing? Maybe, but maybe not. First, to be clear, if you are having symptoms with cough and have to go out into the public then clearly, to protect other people, it would be a good idea for you to wear a mask. The mask that that person should wear, however, should probably be a surgical mask to try to help protect other people. A cloth mask really does not help prevent the spray when people cough and is not very good protection for others around the individual coughing, despite their cloth mask. It will help with very large particles so I guess it does a little bit, but that's about it. Smaller spray particles can certainly clearly go through cloth mask without much difficulty. The problem I have with masks for the general public is in relation to the wearing of the mask potentially increasing their risk of infecting themselves. If the person is asymptomatic and practicing social distancing appropriately then using a mask may increase their risk of infecting themselves. How is this possible you ask? Clearly, the greatest risk in getting the Coronavirus is through your own hands. This is why the recommendation for washing your hands frequently with soap and water for 20 seconds at least is so important. The problem with wearing a mask is when you touch the mask with your hands you contaminate the mask. I see people in public walking around with masks and they're constantly touching their faces now. The mask moves slightly and they instinctively reached up and adjust the mask. I see this everywhere. I see this in the hospital and I see this in the community. It is a distraction and increases your risk of infecting yourself through contaminated hands. It also gives people a false sense of protection and I fear that they will then reduce their vigilance in regard to social distancing practices. The best thing you can do is simply keep your distance. Practicing social distancing is recommended with 6-10 feet distance when you have to go out in public. This alone is the one thing that will make a meaningful difference.


For better clarification, wearing a mask if you have symptoms is certainly something that should be done to reduce spread. As the knowledge of the virus, and how it is affecting the public in the pandemic evolves, we will have to reconsider our stance on the subject. In the end, wearing a mask is a small thing to ask to protect your fellow man, so, when I am going out and in public with others I will do so, even though I have no symptoms. If the number of cases continues to rise this will have to affect how aggressive we are at making recommendations and enforcement of those recommendations. This is far from over.


Addendum to this article July 1, 2020 for clarification of confusion noted by readers of earlier post.

Desk with Stethoscope

"Well done is better than well said"

Benjamin Franklin

Dr. Mark Esterle, MD

Louisville Pulmonary Care, PLLC

(502) 899-7377

4003 Kresge Way #312, Louisville, KY 40207, USA

©2018 by Dr. Mark E. Esterle, MD.