To Mask or Not To Mask

This seems like a no-brainer, doesn't it? When air pollution is bad outside, it makes sense to wear a pollution mask to protect yourself. Right? Well, it turns out the answer is more complicated than that and health professionals are divided on whether its wise to recommend masks or not…an inconvenient reality I learned as I headed down my own journey of learning how to protect myself and my family against Delhi’s toxic air, starting in 2012. As a health professional myself I had to learn where I fell on the issue.
Here’s my story in a nutshell: My husband, two kids and I arrived in Delhi from Addis Ababa, Ethiopia in 2012, excited for the coming 3 years of adventure living in Delhi. We weren’t prepared for what was to become our greatest challenge living in Delhi, but  it hit us hard in our first months—we felt the air pollution in our chests and heads and tasted it in our mouths. The kids felt lethargic and I often felt dizzy. As a public health professional, I knew we had at least some recourse and sent away for home air purifiers and pollution masks. At the time only a few quality brands of either were available anywhere in India. Online, I ordered a bunch of different high-quality, certified air pollution masks from abroad for my family to try (3M, Vogmask and Totobobo)  in hopes that we would find ones that fit and felt comfortable enough to incorporate into our lives whenever we left the house. 
It was naive to think it would be that easy. None of us liked the way they felt, taking them on and off was a drag, and worst of all, no one else was wearing masks at the time and we attracted a lot of negative attention.  It wasn’t working. Frustrated by this failure, I began research to support my argument that we really SHOULD be wearing these masks…and this is where things got complicated. I found that for every expert who swears by them, there is one who doesn’t recommend them. What’s going on here? Here is my simple summary of what I have learned.

First some relevant facts:

• Air pollution is hazardous to health and to children's development
• It makes a difference how much you exert when you are in polluted air. You pull more air in when your heart rate is up, and you pull it deeper into your lungs.
• Children breath in more air per pound of body weight so their exposure to air pollution is much greater than adults
• A well made mask, worn properly, can protect your body from up to 99% of dangerous particulate matter in the air (and for health we are most concerned with particulate matter)

The case for wearing a pollution mask:

The public health message on air pollution is to minimize your exposure to toxic air as much as possible. So, it makes sense that a well-made, properly fitting mask would be a good response for when you are outside. Here are a couple scholarly articles for the nerdier among you on how N95 certified masks can help decrease health risks:
http://www.ncbi.nlm.nih.gov/pubmed/22389220
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662779/

The case against wearing a mask:

Health experts who don’t recommend wearing masks argue that there are just too many variables at play to make a solid recommendation that people should wear them. The mask needs to be well made to give you the kinds of benefits we are talking about so any old cloth won’t do (though they may keep out the larger particles, so saying an old cloth does “nothing” is also not accurate!)and there are a lot of masks on the market that don't filter the small particles we are most worried about PM2.5 and smaller. It also needs to fit well so that you pull the air you breathe through the filters in the mask. If there are gaps in how the mask fits you, it may not be doing you any good at all and in fact give you a false sense of protection. Under this false sense of protection you may engage in rigorous activities, pull in more air more deeply than you would without a mask and actually harm yourself more than you would have not wearing one and modulating your activity to keep your heart rate down. Finally, if the air inside your home/school/office is just as bad, what’s the point in wearing a mask when you venture outside? Will you wear your mask all the time? That's just not practical. Just a little of the time? If just a little of the time, is the inconvenience worth it? 

​My conclusion:

This is the thumb-nail sketch, mind you, but with everything I’ve learned about the benefits and limitations of masks over the last few years, I find I am still a firm pro-masker.  I think people are smart enough to understand the complexities here… it has to be a good one, it has to fit and hardest of all, you do have to wear it  for it to work. But some protection some of the time is better than none at all (minimizing your exposure is the name of the game, remember.)  Last summer my family and I moved to cleaner climes and don’t have to manage the fumbling and fuddling of air pollution masks in our daily lives anymore but, to me, its really heartening to see that quality masks like 3M, Totobobo, Vogmask and Respro are popping up in the markets and on faces all over Delhi now. It is a small tool in the arsenal against the harmful health effects of air pollution but air pollution is a serious foe and we need all the tools we can get.

Genevieve Chase
​​Genevieve Chase is an American public health professional who has worked for organizations including the UN and the World Bank. In October 2014, Genevieve founded Delhiair.org, an informational web site about the health effects of air pollution.  Since then, she has been pulling people together around the issues of air pollution, to create partnerships for innovative solutions. She lives in Washington D.C. with her family.

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