Medical Examiner

Bring Back the Valved N95

Once a symbol of selfishness, these (more) comfortable masks are more protective than we thought.

A bunch of white N95 masks with openings.
Xinzheng/Moment via Getty Images

You’d be forgiven at this point in the pandemic for being exhausted of wearing a mask. Even as omicron subvariants cause infections to soar once moreexactly zero states have reinstated mask mandates. The Centers for Disease Control and Prevention remains shy on bringing them back despite their efficacy, only “encouraging” their use in select states.

But masks remain a reality for many—the elderly, the immunocompromised, or others who simply choose to be extra careful or extra courteous. And after two long years, it’s time for an upgrade. Valved N95s offer just that.

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Valved N95 masks aren’t a secret; they’re not even new. My dad donned them decades ago while shoveling out dusty grain bins back in North Dakota. The innovation that makes them the preferred protection for carpenters, construction workers, and farmers is a simple one-way valve. This contraption lets air out with exhalation, enhancing comfort, but slams shut with every breath in, preserving filtration.

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Earlier in the pandemic, this feature was treated as a bug. Experts worried that the unabated outward airflow risked spreading the virus to others. Surgeon and writer Atul Gawande distilled this widely held concern about valved masks with predictable precision in the New Yorker: “I protect me; I expose you,

Guided by this logic and encouraged by experts, cities, countiesairlines, and others banned valved masks early on in the pandemic. Last year, when my dad showed up the day of his surgery wearing his, the hospital offered him a simple surgical mask to substitute. Many hospitals, including my own, continue to not allow them. While the CDC stopped short of outlawing them, they initially issued guidance discouraging their use. Still today, the World Health Organization advises against using valved N95s.

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But such fears, while initially understandable, are no longer justified.

Without mask mandates, the primary purpose of masks, for better or worse, has shifted from community prevention to personal protection. When “one-way masking,” using an N95 (or similar respirator) rather than a surgical mask is especially important.

For doctors like me, the strongest evidence that one-way masking works comes from personal experience. When COVID-19 patients came in struggling to catch their breath, it often wasn’t feasible for them to mask. In that first year, health care workers didn’t have vaccines to keep us safe. Instead, our safety depended solely on personal protective equipment—especially our N95 respirators. And thanks to those precious masks, many, myself included, have cared for countless COVID-19 patients over the past two years without succumbing to infection. Two-way use is optimal, but one-way N95 use works.

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Many wearers know that higher quality masks could offer them better protection. But N95s and similar respirators can be hot, humid, and tough to breathe through. Even during long shifts caring for COVID-19 patients, these respirators bother us enough that we frequently seek breaks in safe areas to steal breaths of fresh air. Despite knowing their protection powers best, most doctors and nurses don’t bother with N95s when not directly caring for infectious patients, opting for less efficacious surgical masks.

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Those wanting the enhanced protection without the same discomfort could turn to valved N95s instead. And updated data show such a switch isn’t selfish, as previously thought. The National Institute for Occupational Safety and Health, the nation’s main regulator of masks, was commissioned by the CDC to test valved N95s and found that the masks both protect you as well as a traditional N95 and protect others with similar or better efficacy than a surgical mask. This data drove the CDC to update its stance, but the silent shift hasn’t spurred policy change or public awareness.

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The public should know that updated logic, sound data, and our country’s top public health experts agree: Valved N95s are safe, comfortable, and still neighborly.

Masks—especially high-quality respirators like N95s—remain one of our most powerful tools for protecting the vulnerable against a deadly ICU stay or debilitating bout of long COVID. But they only work when worn. Public health policymakers from local to global should recognize and advertise that comfort is critical for maximizing compliance. Valved N95s offer this needed comfort while preserving protection for wearer and public alike. If you’re still masking but haven’t tried one, it’s time to treat yourself. You’ve earned it.

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