Another twist in masking against covid-19: Single or double masking for all?

By Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL) 

Specialist Consultant Paediatrician

If one looks at the history of advice regarding the wearing of masks as an effective COVID-19 control measure, it has gone through a full 180-degree swing. In the initial phases of the pandemic, even the World Health Organisation (WHO) was not convinced that wearing masks was of any benefit. Our health authorities followed suit, as they always do in any situation where the WHO pontificates. Then the research scientists showed very clearly the benefits of wearing masks and after virtually a Herculean effort on the part of the scientific community, it was agreed that all should wear masks. Now, at least in our emerald isle, it has become law and at present the police even go after people who are not wearing masks and take steps to prosecute them. It has become like a kind of a mandatory second nature for all of us to wear masks.

Masks, of course, have to be worn properly for optimal benefits. This has been said over and over, again and again. With more contagious variants of the coronavirus spreading and optimal vaccination still months away for many people, all over the world, experts agree that it is time to think even harder about how well the face masks are protecting people.

Now enter DOUBLE MASKING …In a recent statement, the Director of the National Institute of Allergy and Infectious Diseases (NIAID) of the USA, Dr. Anthony Fauci, a foremost authority on COVID-19, stated that he favours double-masking as a further measure to protect against even the new and more infectious Covid-19 variants, like the UK and South African strains, as well as other similar mutant variants that may arise with time. These new recommendations are in line with the regulations being currently imposed across Europe, where medical-grade face masks like the N95 and the FFP2/3, rather than cloth masks, are becoming mandatory in public spaces.

Why the sudden change? More importantly yet, how does one double-mask correctly? Here’s what you need to know. Why Is Double-Masking Necessary? Doubling-Up on Masks is perhaps the need of the hour. When it comes to double-masking, it all boils down to extra protection. As Dr. Fauci further stated in an interview with the Today Show, “If you have a physical covering with one layer, and then you put another layer on, it just makes common sense that it is more likely to be more effective”.

The main reason why the extra protection is necessary, now more than ever, is that the new Covid-19 variants are more contagious than the original strain of the SARS-CoV-2 virus. As has been pointed out repeatedly, it is easier for these new Covid-19 mutations to bind to human cells. Therefore, minimizing the number of novel coronavirus particles in the air that enters the human respiratory system is the key, and the easiest way to do so is to make sure that everyone is wearing masks that offer the best possible protection. One way to do this is by wearing two masks. It is of course quite important to cover our noses and mouths completely and for both masks to fit snugly. Not only will double-masking help to protect others if someone in a crowd has Covid-19, but it will also decrease every individual mask wearer’s risk of contracting the disease.

All in all, wearing two masks is a better shield between you and the novel coronavirus. But why are doctors not advising us to wear three, four, or even five masks at the same time? More layers must surely be better. However, the main reason why that is not a good idea for most people is that wearing multiple masks will make it difficult for you to breathe, depending on the material. “You can pack on 10 layers, but what you do is to lose breathability, become quite uncomfortable and you have overdone the filtering capacity that you want” states Onyema Ogbuagu, an infectious diseases specialist and the primary investigator of Yale’s Pfizer COVID-19 Clinical Trial.

How to Double-Mask correctly? There are a few things to keep in mind if you decide to start double-masking. Here are some key points: –

Which masks are the best to combine?

Research shows that N95 masks offer the best filtration against the novel coronavirus. That being said, these masks may not be the best choice for most people because putting on and breathing in an N95 may be quite tough, especially if you have to wear it for hours. Still, if you can handle it, wearing an N95 mask is the gold standard. It is, however, not your only option. Ideally, you just want to use masks that offer both sufficient air filtration and breathability. A worthy alternative to N95 masks is a combination of a cloth mask or a surgical mask on top of a KN95 mask, which is a modification of the N95 mask. Keep in mind that by “cloth mask”, experts mean a face mask that consists of at least two layers of tightly-knit material, and certainly not a bandana handkerchief or a neck gaiter or a scarf.

How should we layer the face masks?

According to infectious disease experts, the best way to wear two masks is to start with the mask that offers the best air filtration and then wear the other mask, usually a cloth mask, over it. Therefore, put on the KN95 or a surgical mask first, and then wear the cloth mask over it. Make sure there are no gaps on the sides of the masks and they provide a tight fit. That manoeuvre will ensure that no contaminated air will be able to sneak in from the sides.

All in all, the idea of double-masking is pretty straightforward, and it is definitely worth a shot, especially when you have to commute by public transportation or have to spend time in populated areas. However, experts are of the opinion that it is generally better for someone to even wear a single mask properly than to wear two masks improperly. Of course, if one could wear two masks properly, then that would probably be best. The philosophy that “one mask is good, two masks are better, is probably true”, said Dr Georges Benjamin, Executive Director of the American Public Health Association. He further stated “I would prefer that somebody wore one mask properly than two masks improperly, but if you can wear two masks properly, that’s great”.

Whether you’re doubling up, wearing an N95, or just donning your favourite fabric mask, the most important thing to do is to make sure that you are wearing it properly. Masks should cover your nose and mouth and be as tight to your face as possible, according to the Centres for Disease Control in USA.

Experts say that the coronavirus variants do not have superpowers to penetrate masks better than the older versions of the virus. But when they do get through, it is more likely that a person will get sick. There is still a lot we do not know about the variants or what makes them more contagious. It could be that they are better at entering cells, or that they produce higher viral loads, meaning that when an infected person talks or coughs, they’re spewing out more viral particles.

Yet for all this, what they do have is the ability to exploit any kind of lapses in the way you wear those masks. Therefore, if you have got a flimsy mask on or if you have got a mask that you do not wear that well … it is going to be less forgiving when you are dealing with a new variant,

Until more people are vaccinated, just keep physical distancing and wearing masks, and avoid mixing in crowds indoors. Of course, masks are just one way to reduce your risk of transmitting and spreading COVID-19, and everyone should continue distancing, avoiding crowds, limiting time indoors with people outside your household, and staying home as much as possible. There is no way in which these can be relaxed, at least not as yet.

Whatever it is, try to do a little bit better job at both the masking and all the different prevention steps that all of us have been following to try to get everybody past that finish line where we have enough people vaccinated to be able to spend less attention on these very same things. Public cooperation in that scenario is the holy grail on which we have to depend on, relentlessly.