This article, in a slightly edited form, first appeared on Pain News Network on August 15, 2020.

As we learn more about COVID-19, top health officials update their advice about how we can protect ourselves from the virus. On February 29, U.S. Surgeon General Jerome M. Adams, MD, tweeted: “Seriously people- [sic] STOP BUYING MASKS!” By July 20, he was begging the public to “Wear a face covering,” although he still believes that wearing a mask should not be nationally mandated.

Benefits and Drawbacks of Face Masks

The Centers for Disease Control (CDC) also recommends wearing face masks to protect ourselves when we are in public and social distance is difficult to maintain, or when we are around people who do not live in our household. So does the Food and Drug Administration (FDA). There are different types of face masks, though, and some work better than others.

N95 respirators provide the best possible protection, followed by surgical masks, but they should be reserved for healthcare workers. Personal protective equipment (PPE) is still in short supply globally because of hoarding, misuse, and increased pandemic-related demand—which puts healthcare workers and their patients at risk.

Members of the public should buy or make their own cloth masks to wear. Laboratory tests have shown that, when worn properly, masks reduce the spray of viral droplets. Some individuals, however, find it uncomfortable to wear a mask, or they may have a medical condition or disability that makes it difficult for them to breathe while using a face covering. Face masks may also fog up eyeglasses, irritate skin, and inhibit communication by muffling the voice. People also frequently touch their faces to adjust or temporarily remove their masks, and that may increase the risk of infection.

However, not all face masks provide equal protection. At best, cloth masks can be as effective as surgical masks. But using some variants, such as neck gaiters made of a polyester spandex, may even be worse than not wearing a mask at all. Neck gaiters are less restrictive than masks, so they may be more comfortable. But their porous fabric breaks large viral particles into smaller ones, and that may allow them to linger in the air for a longer period of time. That makes them dangerous to the wearer and other people who are in the area.

Face Shields May Provide a Better Alternative—Sometimes

Jennifer Veltman, MD, chief of infectious diseases at Loma Linda University Health, recommends face shields made of clear plastic or plexiglass to people who are unable or unwilling to wear a mask. According to Veltman, “If someone coughs 18 inches from you while you are wearing a face shield, the immediate viral exposure is reduced by 96%. If the person remains coughing and talking with you for 30 minutes, then the face shield blocks 68% of the small air particles.”

Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security, believes that face shields may eventually replace cloth masks because they are more comfortable to wear. People in gyms can breathe better with a face mask than a cloth mask. They are lightweight, and as they extend down from the forehead, they protect the eyes as well as the nose and mouth. That can be important since viruses can enter the body via the eyes. It is also easy to wipe face shields clean and reuse them.

Perhaps face shields are a better alternative than face masks for people who are not in high-risk healthcare settings. It is relatively easy and inexpensive to make face shields, even for people who are not crafty and lack sewing skills.

Dr. Frank Esper, a pediatric infectious disease specialist at Cleveland Clinic Children’s Center, agrees that face shields have many benefits over cloth masks. However, they also have drawbacks. For example, he points out that viruses find it easier to survive on face shields than on cloth masks. Also, if a person wearing a face shield coughs, viral droplets can escape because of the gap between the shield and the mouth.

Face Shields Plus Face Masks Provide the Best Protection

Dr. Anthony Fauci of the White House coronavirus task force says, “If you have goggles or an eye shield, you should use it. It’s not universally recommended, but if you really want to be complete, you should probably use it if you can,” since it provides added protection for the eyes.

White House coronavirus response coordinator Deborah Birx may have the best recommendation of all: wear a cloth mask and a face shield simultaneously. The mask, she says, protects others, while the face shields protect wearers. She calls masks and face shields “two different technologies for two different reasons.”

How to best mask will evolve as we learn more. We’ll be needing face masks for an indefinite time period, so it is wise to become familiar with the different options for protecting yourself and your family.

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.