Trending Clinical Topic: Double Masking

Ryan Syrek

Disclosures

February 12, 2021

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As the COVID-19 pandemic rages on and as more transmissible variants have been identified, many patients are asking questions about increased personal protection strategies. A new study from the Centers for Disease Control and Prevention (CDC) found that double masking can reduce the risk of acquiring the coronavirus by as much as 96.4%, if both the infected source and uninfected receiver are wearing double masks. This is in line with previous comments from Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, who has called the idea of double masking "common sense." Double masking has even become somewhat of a fad, as both poet Amanda Gorman and new Transportation Secretary Pete Buttigieg wore cloth masks over surgical masks at President Joe Biden's inauguration.

A recent commentary summarized the evidence on face masks used by the general public for coronavirus prevention. The authors concluded that a high-quality surgical mask or a fabric mask of at least two layers with high thread count provided basic protection. Their recommendations for maximal protection (> 90% for particles 1 µm and larger) are shown in the infographic below.

Since the beginning of the pandemic, doctors and other medical professionals have strongly advocated for widespread mask use. Now, they are specifically calling for patients to wear better masks and to adopt improved masking behaviors. Experts say the key is not only quality filtration but also having a good seal on the face, covering the nose, and ensuring that the mask goes down below the chin. As Fauci says, although these steps may seem like "common sense" to those inside medicine, the general public may still not understand these key points, even a year into the COVID-19 outbreak.

The CDC also recently advocated for the use of mask fitters. These are small, reusable devices that create a tighter fit against the face. At a media briefing with the Infectious Diseases Society of America, John Brooks, MD, chief medical officer of the CDC's COVID-19 response, said, "Fitters have been scientifically demonstrated to improve filtration performance by as much as 90% or more."

The rise of coronavirus "super strains" has prompted many conversations between doctors and patients about face masks. Alice Sato, MD, assistant professor of pediatric infectious diseases at the University of Nebraska Medical Center in Omaha, says, "We need people to wear the mask appropriately, and that means it conforms to your face at your nose, under your chin, and on your cheeks rather than gaping and letting air in." When it comes to wearing two masks, she explains, "Double layering is adding extra filtration, but a lot of the benefit also comes in making sure you are covering those gaps around the mask, because not every mask you put on fits equally."

Although double masking is this week's top trending clinical topic, the increased emphasis is really on "better masking" and better mask use, as the next phase of the pandemic may well be dominated by the fight against coronavirus super strains.

Read more about COVID-19 transmission.

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