Can ‘Strategic Masking’ Protect Against COVID-19, Flu, and RSV?

It can feel lonely when you’re the only person wearing a mask in the grocery store, an office meeting, or wherever you gather with other people. You may wonder if wearing a mask to protect against COVID-19 is even worth doing, as many of those who have gotten the virus recently have been reporting mild symptoms.

But the coronavirus is still infecting people. This summer brought an uptick in COVID-19 cases, hospitalizations, and deaths, and a winter spike is also possible, based on the virus’s seasonal behavior in previous years. There are also two new Omicron subvariants, EG.5 (Eris) and BA.2.86 (Pirola), which may be more transmissible than their predecessors.

And SARS-CoV-2, the virus that causes COVID-19, isn’t the only highly contagious virus that makes people sick. Flu and respiratory syncytial virus (RSV) have also overwhelmed hospitals in previous years. Together, the three diseases—and the uptick in cases of each simultaneously during fall and winter—have become known as a ‘tripledemic.’

Across the U.S., there has been a smattering of new mask mandates in schools, businesses, and other places in response to recent COVID-19 surges; however, infections and hospitalizations are still lower than in previous years, and no one expects the country to go back to widespread masking, which means that people will have to decide how to best protect themselves.

“People can make their own choices about wearing masks to protect against COVID-19 and other respiratory diseases now,” says Karen Jubanyik, MD, a Yale Medicine emergency medicine specialist who has cared for patients with COVID-19.

As a result, some people are adopting what's called "strategic masking"—wearing a mask when and where it might matter the most. While most people don’t want—or need—to wear a mask all the time, “It makes good sense to be strategic about it,” Dr. Jubanyik says. Individual risk for infection, the need to protect loved ones who are at high risk, personal risk tolerance, and the degree to which viruses are circulating in a given area are all factors to be taken into account.

Yale Medicine experts offer some recommendations to help address any confusion about when you might want to consider wearing a mask.

If you are at high risk for severe disease from COVID-19 (see more on that below), it would be smart to wear a mask in public indoor spaces, especially if the coronavirus is circulating in your area, says Dr. Jubanyik.

To assess the situation in your county, you can check the Centers for Disease Control and Prevention (CDC)’s COVID-19 hospital admissions by county, which provides information on whether hospital admissions are low, medium, or high in your area.

Everyone’s situation is different. If you are at high risk for severe disease, the CDC recommends talking to your health care provider about whether you and the people around you should wear a mask or respirator (see more on that below) when hospital admissions for COVID-19 are at a medium or high level.

You are at higher risk than other people for a severe outcome from COVID-19 if:

• You are age 50 or older, with the risk increasing with age (more than 81% of COVID-19 deaths are in those ages 65 and older—that’s 97 times higher than deaths among people ages 18 to 29 years).
• You are any age with certain medical conditions, such as heart disease, diabetes, or obesity.
• You are pregnant.
• You live in a long-term care facility.
• You face barriers to accessing health care, including lack of health insurance, transportation, childcare, or the ability to take time off from work. (These factors have contributed to racial, ethnic, and socioeconomic disparities in some cases of severe COVID-19.)

Everyone, including young, healthy people, might consider wearing a mask in some situations if they live in a geographical area where the virus is spreading.

Even if your personal risk is not high, you might want to wear a mask in more situations than usual to avoid infection and protect loved ones—you won’t always know if you have been exposed, and you have the potential to spread the virus even if you don’t have symptoms.

Wearing a mask may be a personal choice when visiting a doctor or a hospital. Not all medical centers require masks now, although some that abandoned mask mandates are discussing bringing them back in response to the recent uptick in COVID-19 cases.

Authors of an article published in July in the New England Journal of Medicine said that while COVID-19 vaccines and treatments have helped to reduce hospitalizations and deaths from the disease, extra care may be needed in hospitals, where acute illness makes patients especially vulnerable to COVID-19.

Wearing masks in this setting could help protect you and others from viruses that can also exacerbate any underlying conditions, causing such problems as lung disease flares, arrhythmias, and even death, according to the article.

The length of time that you expect to be in a “high-risk” situation, such as a crowded room, matters. Contact for longer than 15 minutes with a person who has COVID-19 is more likely to result in transmission than two minutes of contact, according to the CDC. “Many people are infected in social settings and in households when people are indoors, in close contact, and without masks,” Dr. Jubanyik says.

A study led by Yale School of Public Health scientists published in August in Nature Communications documented a long-held belief that high levels of exposure to the coronavirus may reduce or overcome the protection provided by vaccination and/or prior infection. Akiko Iwasaki, PhD, a Yale immunobiologist (who did not participate in the study), commented in Nature that the findings suggest that masking and improved ventilation, among other mitigation measures, could help reduce chances of infection, even among people who are vaccinated.

The CDC provides specifics on the types of masks and respirators that can prevent the transmission of SARS-CoV-2. They describe mask options that offer varying levels of protection, from well-fitting disposable surgical masks to KN95s to National Institute for Occupational Safety & Health (NIOSH)-approved respirators (including N95s), with the latter providing the highest level of protection. They advise wearing the most protective mask you can that fits well and that you will wear consistently.

Whether you wear them strategically or all the time, masks can reduce your risk of getting infected, but they aren’t perfect. “If you are the only person in a crowded room wearing one, you’ll get less protection than you would if everyone wore one,” says Dr. Roberts.

That’s why masking should be one strategy among many to protect against respiratory infections, especially this winter when SARS-CoV-2, flu, and RSV are expected to be circulating simultaneously.

The first line of defense is vaccination, Dr. Roberts says. This fall, in addition to the annual flu vaccine, there is an updated COVID-19 booster shot, approved by the FDA and CDC in early September for everyone ages 6 months and older. There also are new preventive options for RSV, such as vaccines for older people, and RSV treatments for young children, such as a monoclonal antibody for infants and toddlers and a vaccine given to pregnant women to provide antibodies that will protect their newborn infants from birth to 6 months.

Staying away from sick people, maintaining a six-foot distance from other people, avoiding crowded indoor places, washing your hands properly, and seeking out good air filtration are also things that make a difference, Dr. Roberts says.

And while the protection provided by wearing a mask isn’t 100%, it’s certainly better than zero, he adds. “I plan to mask strategically, and if the COVID-19 numbers rise, I'll probably mask everywhere,” he says.