Do You Want a Clear Face Mask?
They’re a better, more accessible alternative — if people will wear them
A new study in the journal JAMA Surgery published last week examined a new tool that could potentially improve medical care during the Covid-19 pandemic: transparent face masks. The study — which involved 200 patients — compared traditional surgical face masks with newly-available, FDA-cleared masks which are fully transparent. In a surgery setting, the study found that transparent face masks improved doctor-patient communication, lead to better trust, and were preferred by patients nearly 100% of the time. Transparent masks have the potential to improve medical care, teaching, artistic performances, and everyday work. They also have the potential to finally let us see each other smile again.
Although they’re essential to preventing the spread of Covid-19, traditional masks kind of suck. They fog up, they’re unwieldy, and they cut off the lower part of our faces, which has major implications for how people perceive our facial expressions. According to a study in Nature, most people can recognize basic expressions like anger or happiness even behind a mask, but people are more likely to rate a masked person’s neutral facial expressions as “negative” if they can’t see the person’s mouth. The inability to flash a quick smile or otherwise show a full range of facial expressions makes it harder to communicate effectively.
For most people, that’s a small annoyance. But for deaf and hearing-impaired people, it can be a major obstacle to communicating with caregivers and getting effective medical treatments. Many deaf people rely at least partially on lip-reading to communicate with hearing, non-signing people. When masks cover a friend's (or a doctor’s) face, that communication becomes nearly impossible, and crucial information can be lost.
It’s that challenge that inspired the founders of ClearMask, a startup based in Baltimore, Maryland, to develop what the company says is the first fully transparent, FDA-cleared Covid-19 face mask. ClearMask launched in late 2017 after one of the company’s co-founders, who is deaf, had “a negative surgery experience.”
According to an article in the journal JAMA Otolaryngology-Head & Neck Surgery, deaf and hard of hearing (DHH) patients had negative medical experiences with masked caregivers pre-covid, and the pandemic has only intensified those communication issues. Even obtaining basic consent for procedures can prove impossible when a deaf person is unable to read a medical provider’s lips behind a mask.
To address these challenges, ClearMask developed a new face mask that consists of a clear piece of plastic that covers the user’s nose and mouth, along with foam inserts that keep the mask in position. Elastic bands loop around the head and neck to hold the mask in place. The mask itself is covered in a special film that prevents it from fogging up, even as the wearer breathes directly into it. Because the mask is clear, the wearer’s mouth and facial expressions are visible through it. The company’s masks were used in the JAMA Surgery study, and the company received a substantial equivalence determination from the FDA on April 6, 2020, allowing ClearMask to market their product as FDA cleared.
The company’s masks are now reportedly in use in doctors’ offices and other medical settings around the world. The CDC specifically references ClearMask on its webpage about face masks, writing that “The FDA recently approved a transparent medical mask. These transparent medical masks should be reserved for use by healthcare workers and patients who require them.”
In addition to medical-grade masks, ClearMask sells a consumer version of their product. The company’s consumer-grade masks are reportedly being used for a variety of non-medical purposes during the pandemic. Schools in New Jersey are using them for American Sign Language instruction, and theatre groups are using them to protect performers from the coronavirus while still allowing them to emote to audiences. Business Insider reports that as of November 2020, ClearMask had sold 12.5 million of its masks.
When I first read about ClearMask, I wondered how a transparent mask would be perceived in daily life. If I wore a ClearMask around during a typical day, would people believe it was really effective? Would strangers’ ability to see my face make it easier for me to communicate?
ClearMask launched out of the Emerging Technology Centers (ETC) in Baltimore, an incubator where I briefly worked on a company about a decade ago. In late 2020, I reached out to the incubator’s executive director, who sent me samples of ClearMasks’ FDA cleared mask to try out. For several days, I wore a ClearMask around the San Francisco Bay Area, to see how people would react.
The first person I showed the mask to was my four-year-old son. He liked that he could see my face, and especially the fact that I could wear a mask and still stick my tongue out at him. This meshes with guidance from the CDC, which recommends “clear masks or cloth masks with a clear plastic panel” for people who interact with “young children or students learning to read.”
In other settings, I got mixed reactions to the mask. When I wore it into a pharmacy, no one gave it a second glance. Pharmacists and other medical professionals are likely well-versed in the current guidelines around mask use, so a clear mask didn’t seem to phase them. When I wore the mask into stores and restaurants, though, it was clear that it made people a little uncomfortable. I could see strangers do a double-take when they first looked at me and realized they could see my mouth. It seemed to distract them as they spoke to me, rather than improving communications.
No one confronted me about my mask or asked me to leave their store, but others haven’t been so lucky. In Canada, a woman wearing an approved transparent mask to improve communications with her disabled daughter was reportedly forced to leave a Chapters store, an experience she found “traumatizing.”
For me, one of the best things about wearing the ClearMask wasn’t the clarity of the mask itself, but the fact that the antifog coating on the mask’s clear interior absorbed the water vapor from my breath, preventing my sunglasses from fogging up while I wore it. Fogged glasses resulting from mask wearing are annoying and create a range of safety issues, especially for people wearing protective eyewear on a job site or in a medical setting. A mask that prevents glasses from fogging is a big deal and could encourage mask-wearing by increasing comfort and safety for users.
When I asked ClearMask’s founders how their antifog coating works, they declined to answer since they’re using proprietary tech. It’s likely, though, that ClearMask is using a product like 3M’s Anti-Fog Face Shield Film, a thin, transparent polyester film that uses a hydrophilic coating to absorb water vapor from a wearer’s breath. 3M says that the film “is designed for use in health care medical devices such as face shields and other personal protective equipment that needs a transparent, anti-fogging material.”
While ClearMask claims to be the first company to receive FDA clearance for a transparent mask, more have followed. Competitor Safe N Clear markets a similar mask that uses a clear window instead of a fully clear front, and says that their product is approved by the FDA. Safe N Clear President Dr. Anne McIntosh told me via email that on their mask, “the film itself does not fog” and that “there is enough material around the clear window to absorb moisture that is present from the breathing (inhalation and exhalation).” McIntosh also told me that the company’s mask is made in the United States, and meets the requirements of the Americans With Disabilities Act (ADA).
Just as face masks of any kind were a rarity in the United States at the start of the pandemic, transparent masks are a rarity today. But that’s likely to change rapidly, as more states reopen and more people return to work. Major companies including SalesForce have spoken out in favor of transparent masks, saying that “Clear masks, or cloth masks with a clear panel that exposes the mouth, give a clearer path to communication for people who benefit from reading lips.” The company says that it has purchased thousands of masks from The Hearing Spot, another maker of transparent masks.
Apple reportedly distributed ClearMasks to many of its staff members in late 2020. The National Association for the Deaf has come out in support of transparent masks as well, and the CDC recommends the masks for a variety of users beyond the hearing-impaired, including those who work with “students learning a new language” or “people who need to see the proper shape of the mouth for making appropriate vowel sounds (for example, when singing).” Some individuals have even begun making DIY masks with clear inserts.
If you want your own transparent face mask, several options are available. ClearMask prefers to sell its FDA cleared masks primarily for medical professionals (they are currently back ordered), but does offer a consumer version of the mask. The Hearing Spot offers a variety of masks with transparent inserts, and Safe N Clear sells masks online as well. Plans are available online for making DIY masks with clear inserts, although they’re likely to offer less protection than FDA cleared or medical-grade masks.
As vaccination rates increase and the world continues to reopen, new mask technologies will proliferate, and transparent masks, in particular, are likely to gain wider acceptance in the months ahead. This is especially true since the masks appear to have the support of major companies, governments, and advocacy organizations. If the public accepts them, transparent masks promise to improve communication for deaf individuals and the hard of hearing, but also for anyone who benefits from seeing another person’s facial expressions — or seeing them smile.