Double-Masking? Here’s How It Can Keep You Safe

 

“With more contagious variants of the coronavirus spreading and vaccination still months away for many Americans, experts agree it’s time to think harder about how well your face masks are protecting you. That could mean double-masking or upgrading to an N95 respirator, the gold standard used by healthcare workers, in particularly risky situations, experts told BuzzFeed News. And while the best way to mask will depend on individual circumstances, it’s clear an ill-fitting, flimsy layer of cloth just doesn’t cut it…

“How should you double-mask? When? Is a cloth mask still effective? ‘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. ‘I would prefer that somebody wore one mask properly than two masks improperly, but if you can wear two masks properly, that's great.’

“…Whatever you wear, make sure it fits snugly to your face. Whether you’re doubling up, wearing an N95, or just donning your favorite fabric mask, the most important thing to do is make sure you’re wearing it properly. Masks should cover your nose and mouth and be as tight to your face as possible, according to the CDC. ‘It should fit tightly all the way around the mask, so that there aren’t any gaps where air — and viruses — can easily leak through,’ wrote Linsey Marr, professor of civil and environmental engineering at Virginia Tech, in a statement provided to BuzzFeed News. ‘Having a gap is like having a hole in the mask.’

“In an article published earlier this month, Marr, an expert in airborne transmission of viruses, recommended wearing a cloth mask on top of a surgical mask as one way to reduce leaks. Some engineers have also developed braces that help seal masks to the wearer's face. ‘It forces the air to go through the material’ rather than leaking out the sides or around your nose, Huffman said. Before heading out, check to see if you can feel air coming out the sides of the mask or out around your nose, and if so, try to adjust the nose wire and straps to make it as tight as possible.

“Who should double up? Dr. Monica Gandhi, who coauthored the article with Marr, recommends that people who are more at risk of severe illness, work indoors around other people, or live-in areas where COVID-19 transmission is high wear a cloth mask on top of a surgical one or insert a filter in between two cloth layers. The idea has been hailed as common sense by Dr. Anthony Fauci, the nation’s top infectious disease expert. The CDC, meanwhile, has not made a recommendation on double-masking and did not respond to questions from BuzzFeed News.

“Gandhi, an infectious diseases doctor and professor of medicine at the University of California, San Francisco, said people shouldn’t double-mask if they’re just going out for a walk in an area where they can still keep their distance from others. Double-masking is more important when indoors and in places where distancing is difficult, she added. Dr. George Rutherford, a professor of epidemiology at UCSF, said he prefers to wear the cloth mask or whichever layer is flatter underneath, saying he’s found it’s easier to create a seal on his face that way. (This reporter personally tried it both ways and found not too much of a difference.) ‘It’s what works for the wearer,’ Rutherford said.

“While some experts said it was probably fine to wear two cloth masks — as long as you can breathe easily and fit them close to your face — they said it probably isn’t worth it to wear three or more masks at once. ‘It just muffles your voice and it doesn’t add any extra efficacy,’ Gandhi said…

“I have N95s. Where should I wear them? While there is still an inadequate supply of N95s, the gold standard for protection, substitutes like KN95s are more available to the general public than they were months ago. If you have access to them, experts recommended wearing them in indoor spaces where you’re mixing with strangers, like at the grocery store and on public transit. ‘The extent of the surge has been greater and that means that the possibility that the person standing in line next to you has an infection is greater,’ said Bob Wachter, chair of the Department of Medicine at UCSF.

“Some experts are now arguing for universal N95 use, and certain European countries have begun requiring medical-grade face coverings in grocery stores and on public transit, though the CDC still says N95s and surgical masks should be reserved for healthcare workers. Even as daily case counts decline from the spikes seen over the holiday season, the spread of more contagious variants makes all activities outside one’s home riskier than ever before. ‘The hierarchy here is surgical is better than cloth, and N95 is better than surgical,’ Wachter said.

“That isn’t to say you should worry about going to the store or other indoor spaces with strangers if you and others are still just wearing cloth masks, according to Benjamin. ‘Even if you properly wear even a sufficiently thick cloth mask, your risk should be reduced and at the end of the day, this whole drill and exercise is about reducing risk,’ Benjamin said. ‘For the average person doing most of the average things that we do, I still believe that properly wearing a good cloth mask that's more than two layers thick should be sufficient.’

“Will my cloth mask protect me from the new coronavirus variants? Experts said the variants don’t have superpowers to penetrate masks better than the older versions of the virus. But when they do get through, it’s more likely a person will get sick. ‘It’s not so much that the mask is less effective against stopping particles, it's that these variants of the virus can transmit a little bit more efficiently,’ Huffman said. ‘The mask is doing its job and is still doing it in exactly the same way it was.’

“There’s still a lot we don’t know about the variants or what makes them more contagious. It could be that they’re 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. ‘What they do have is the ability to exploit any kind of lapses in the way you wear those masks, so if you’ve got a flimsy mask or if you’ve got a mask that you don’t wear that well ... it’s going to be less forgiving when you’re dealing with a new variant,’ said Amesh Adalja, an infectious diseases physician and senior scholar at the Johns Hopkins Center for Health Security.

“If you’re still wearing a bandana or a single-layer cloth mask, it’s time to upgrade. Because more contagious versions of the virus are spreading, experts agree that it’s worth it for people to upgrade their masks. ‘People should not be wearing bandana masks at all,’ Benjamin said. ‘Certainly, that covering will reduce your risk to some degree, but it's really insufficient.’

“Rosie Redfield, a microbiologist and professor in the University of British Columbia's Department of Zoology, recommends people check their current masks for leaks and determine how well they filter the air that passes through them. ‘When you breathe out, do you feel warm air flowing past your cheeks and eyes? If you’re outside, do your glasses fog up? Does it get harder to breathe if you use the sides of your hands to press the mask edges tightly to your face? Yes, to these questions means that your mask leaks,’ Redfield said in an email to BuzzFeed News.

“Tightening the straps or changing the shape of the nose wire may help, but you may need to simply try a new mask, she said. To test how well your mask filters air, Redfield said to see how hard it is to blow air through it when it’s pressed against your mouth. ‘If it’s almost as easy as without the mask, then the mask is not a good filter,’ she said. ‘If it's very hard to blow air through the mask, then the mask may be too tight a filter, making it more likely that air will be forced to go around it rather than through it.’

“Experts recommend getting several washable, multilayered cloth masks with a filter or a filter pocket. Gandhi said you can also sew a filter or vacuum bag in between two layers of fabric. ‘If you’re wearing a single ply, particularly if you're not vaccinated, I personally would go to double-masking or upgrade the quality of the mask, whichever one is convenient,’ said Wachter.

“Until more people are vaccinated, keep distancing and wearing masks, and avoid mixing 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. That message has been stressed by public health officials since the beginning of the pandemic, and though it’s sparked fights in some states, President Joe Biden has said he is working to depoliticize safety measures like mask-wearing.

“More than a year into the coronavirus outbreak, Adalja said everyone should be ‘much more meticulous’ about the precautions they take when outside their homes, and when you are eligible to get the vaccine, go get it. ‘Whatever it is, try to do a little bit better job at both the masking and all the different prevention steps that you and we have been doing to try to get everybody past that finish line where we have enough people vaccinated to spend less attention on these things,’ Huffman said” (BuzzFeed).