Explained: Why health experts in the US are now recommending ‘double masking’

The practice generated buzz after US President Joe Biden and Vice President Kamala Harris’ inauguration ceremony, where several officials and celebrities were photographed wearing two face masks.

With the spread of more contagious coronavirus variants around the world, healthcare experts are now encouraging the use of two face masks, a practice popularly called ‘double masking’, to help create a stronger barrier against the deadly disease.

In the face of more virulent strains of coronavirus, doubling up your face masks just “makes common sense” as it is likely to be more effective, according to the US’ top infectious disease expert Dr Anthony Fauci. “That’s the reason why you see people either double masking or doing a version of an N95,” he said in an interview with NBC News’ ‘Today’.

The practice generated buzz after US President Joe Biden and Vice President Kamala Harris’ inauguration ceremony, where several officials and celebrities were photographed wearing two face masks. But in reality, how effective is this method?

Is double masking really more effective?

Healthcare experts, including Fauci, recommend wearing two layers of face masks instead of just one as viruses, in theory, will have a tougher time penetrating both layers as opposed to a single layer. But the US’ Centers for Disease Control (CDC) is yet to officially recommend double masking.

A report published in the journal Med recommends wearing at least a “high-quality surgical mask or a fabric mask of at least two layers with high thread count”. The commentary, authored by Monica Gandhi and Linsey C Marr, shows that wearing a surgical mask under a cloth mask offers better protection against viruses as the surgical mask acts as a filter and the cloth mask provides an extra layer of filtration, while also improving the fit.

“A mask is like an obstacle course for particles to get through,” Lindsey Marr, a virus transmission expert told US NGO AARP. “Adding a second mask adds another obstacle course, increasing the chance that the particle will be trapped before it gets through to the other side.”

Experts say that in places where social distancing is difficult to maintain, such as in a plane or at a busy store or event, two masks will help provide extra protection. While N95 masks are believed to be the best in terms of protecting you against Covid-19 as they are said to filter 95 per cent of airborne particles, these are difficult to come by. But a cloth mask covering a surgical mask is the next best option, medical professionals say.

Another study published in the peer-reviewed journal Matter in July stated that double masking could increase protection from viruses by 50-75 per cent. “We found that the particle removal efficiency of many surgical style masks could be improved by up to 50% by simply snugging the mask material to the face [with another mask],” one of the authors of the study, Dr Loretta Fernandez, told USA Today.

“In the lab, we did this by adding a nylon stocking, but also tested other elastic layers such as gators and tights and found that they also solved the problem of cutting off air leaking in from around the mask,” she added.

Cloth vs surgical masks — which is better?

During the initial days of the pandemic, when surgical and N95 masks were hard to come by, people who were not frontline workers were encouraged to opt for cloth face coverings. But now, as new, more contagious variants of Covid-19 continue to spread across the world, many people are stepping away from cloth masks and opting for sturdier surgical or N95 masks.

In some countries, such as Germany and France, all citizens are required to wear a medical-grade or surgical mask while travelling in a bus, train or tram and even while visiting the supermarket. Fabric masks are no longer permitted under the new mask rules in Germany, while in France their use is strongly discouraged.

A study conducted by Duke University last year suggested that a disposable surgical mask made out of a plastic-derived material called polypropylene was the next best option after the N95 respirator with no valve. But according to some studies, a multi-layer cloth mask can offer as much protection as a surgical mask, the CDC website states.

Still, both surgical masks and cloth face coverings may not be effective in blocking very small virus particles transmitted through coughs or sneezes. This is why many researchers recommend double masking for extra security.

So, what is the best way to ‘double mask’?

Healthcare experts recommend wearing a double-layer fabric mask on top of a medical-grade mask, such as a regular surgical mask or a KN95 respirators. The major difference between the KN95 and the N95 respirator is that the former is typically regulated by the Chinese government, while the latter is regulated by the National Institute for Occupational Safety and Health in the US.

Apart from adding an extra layer of protection and helping to hold down the surgical mask better, the top fabric layer also helps to keep the medical-grade mask underneath dry and clean. Many healthcare experts warn against wearing more than two masks as it makes breathing difficult, which then leads to air and particles entering the mask from gaps along the side.

What has the Biden administration done to encourage mask wearing?

Despite the United States reporting the highest number of Covid-19 cases (over 25 million) and deaths (more than 4.25 lakh) in the world, wearing face masks has been a bone of contention ever since the pandemic first gripped the country.

Hundreds of anti-mask protestors gathered in states like Utah, Florida and California last year, claiming that making wearing a mask mandatory is merely a tool to spread fear. The fact that former President Donald Trump was constantly playing down the effectiveness of face masks didn’t help either.

In his first day in office, President Biden signed a number of executive orders — several of which specifically focussed on combating the pandemic. He launched a ‘100 Days Masking’ challenge to encourage Americans to wear face masks as Covid-19 cases and deaths continue to rise steadily across the country. He has also introduced a mask mandate that will make social distancing and wearing face coverings compulsory for everyone in federal buildings and land.

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