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Sat Jan 30, 2021, 10:44 AM

Double Masking for COVID: Are Two Face Masks Better Than One?

https://www.aarp.org/health/conditions-treatments/info-2021/double-masking-against-covid.html

Double Masking for COVID: Are Two Face Masks Better Than One?
Experts suggest ways to add layers of protection against the coronavirus

by Michelle Crouch, AARP, January 25, 2021

With COVID-19 cases surging and the discovery of new, faster-spreading coronavirus strains in the U.S., it might be time to double down on face masks — literally — by wearing two at a time. Layering one mask over another can significantly boost your protection against the coronavirus, some experts say, especially if your ordinary mask is thin or loose-fitting.

"A mask is like an obstacle course for particles to get through,” said Linsey Marr, an expert in virus transmission and a professor of civil and environmental engineering at Virginia Tech. “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."

Marr especially recommends use of a disposable, nonwoven mask underneath a tightly fitted cloth mask, which she said should block about 90 percent of infectious particles.

Although COVID-19 vaccination has started, masking is still important because the virus will continue to spread and sicken people until most of the population is immunized. And with the discovery of new variants that could be up to 70 percent more transmissible, some experts say it's prudent to wear not just any face covering, but a high-quality one (or two).

"Last year, we wanted to get as many people to wear masks as possible,” Marr said. “This year, with new, more transmissible variants, we really need to think about improving our masks.”

😷 All masks are not created equal

Many Americans have been wearing the same cloth masks for months — in many cases, homemade versions originally created to ease a limited supply. These days, however, there are hundreds of options for sale, including nonmedical disposable surgical masks, and cloth versions with multiple layers and special filters.

Studies show that not all masks are created equal; construction, materials and fit make a difference.

"When I think of who I want to wear a mask with increased fit and filtration, I think of older adults and vulnerable people with underlying conditions,” said Monica Gandhi, M.D., an infectious disease doctor and professor of medicine at the University of California, San Francisco.

Gandhi and Marr wrote a recent commentary in Cell Press with recommendations about how to improve the protection you get from your mask.

Other countries have already taken steps to get people to wear higher-quality masks: Hong Kong distributed six-layer masks to all of its citizens; Austria sent high-grade medical masks (the equivalent of N95s) to residents over age 65; and Germany recently began mandating medical-grade masks in shops and on public transit.

The U.S. Centers for Disease Control and Prevention (CDC) says medical-grade surgical masks and N95s, the gold-standard masks in the U.S., still need to be reserved for health care personnel because they are in short supply.

A CDC division that oversees medical devices is working to develop filtration standards that will allow masks to include a label showing how well they block infectious particles. That work is expected to be completed by April, a spokeswoman said.

In addition, some U.S. scientists are calling on the federal government to increase production of medical-grade masks and make them more widely available.

Masks to Avoid

The CDC recommends against the following types of masks:

⚠ Masks that do not fit properly (too loose or with large gaps)
⚠ Masks made from loosely woven fabric, such as fabrics that let light pass through
⚠ Masks with one layer
⚠ Masks with exhalation valves or vents
⚠ Scarves or ski masks worn as a mask
⚠ Masks made from materials that are hard to breathe through (such as plastic or leather)



How to build a better face mask

For now, experts say you can still get excellent results from the cloth and nonmedical surgical masks that are widely available. For a high level of protection, they offer the following suggestions:


Illustration showing effective two-layer masks
Courtesy Linsey Marr and Jasper Marr Hester


Two options for maximum protection: disposable mask under cloth mask (left) or cloth mask with a filter insert (right).

Wear a disposable mask under your favorite cloth mask.

Start with double masking. You can maximize the protection your cloth mask offers simply by wearing a nonwoven disposable mask under it, Marr said.

Most disposable masks on the consumer market are not medical grade, but they are still made of polypropylene, a nonwoven fabric that electrostatically repulses viral particles. That means they should still score high marks when it comes to blocking the virus, Marr said. The problem is, their loose fit leaves too many gaps where viral particles can get in and out when worn alone.

"By themselves, surgical masks don't work great because they're so open on the sides,” Marr said. “If you put a tight-fitting cloth mask over it, that helps hold it down and reduce gaps to improve the fit.”

Marr said layering more than two masks will likely have diminishing returns as it becomes harder to breathe, making you less likely to keep them on.

Use a tightly woven cloth mask with a filter in the middle.

A snug-fitting fabric mask with a filter can block 74 to 90 percent of infectious particles, Marr's research shows. Adding a nonwoven filter is important because it can help catch tiny aerosols that slip past the weave in even tightly woven fabrics.

You can buy a special HEPA filter designed to fit into a mask with a pocket, or cut up a vacuum bag. Several research studies that examine mask effectiveness have found vacuum bags to be among the best materials at catching tiny particles.

"Start with two layers of tightly woven cloth, put a plain old generic vacuum bag between them, and you've got a great blocker with effectiveness approaching that of an N95 mask,” Gandhi said.

Use hacks to make a disposable mask (or any mask) fit better.

If you usually wear a disposable mask, you can enhance the protection it offers by finding a way to tighten it so there are fewer gaps between it and your face.

For an easy fix, cross the ear loops and tuck in the corners of the mask to minimize gaps. In a Dec. 10 study published in JAMA Internal Medicine, that simple change increased a surgical mask's filtration efficiency from 38 percent to 60 percent.

Attaching the mask behind your neck with a claw hair clip or an ear guard offers a similar performance boost, the study showed, because it pulls the mask tight against your face.

You can also purchase a special mask brace or frame to go over your disposable mask and seal it against your face. A frame pushes the filtration efficiency of a surgical mask to about 80 percent, according to the JAMA Internal Medicine study.

Consider a KN95 mask.

Like N95 masks, KN95 masks are supposed to trap at least 95 percent of particles 0.3 microns in size. The only difference is that KN95s are manufactured to meet Chinese standards, rather than American ones.

KN95s were tough for consumers to find early in the pandemic because health care providers were snapping them up, but they are increasingly appearing on store shelves where ordinary shoppers can buy them. Marr said they can be a good option — as long as you're getting the real thing.

A study in September by ECRI, a nonprofit group that evaluates medical technology, found that as many as 70 percent of the KN95 masks being sold in the U.S. were counterfeit.

U.S. health officials have started testing the masks. The CDC publishes a list of the brands that did and did not meet its standards in batch tests. You may want to check the list before you buy.

In a statement, a CDC spokeswoman said that even those KN95s that don't pass muster to serve as medical-grade masks “are expected to provide source control (i.e., protect others) similar or better than gaiters, homemade, and most unregulated masks."


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Arrow 31 replies Author Time Post
Reply Double Masking for COVID: Are Two Face Masks Better Than One? (Original post)
NurseJackie Jan 30 OP
Wounded Bear Jan 30 #1
brewens Jan 30 #2
RAB910 Jan 30 #3
SlogginThroughIt Jan 30 #8
SouthernIrish Jan 30 #9
SlogginThroughIt Jan 30 #10
sheshe2 Jan 30 #4
Blues Heron Jan 30 #5
Ferrets are Cool Jan 30 #6
LiberalArkie Jan 30 #7
BrightKnight Jan 31 #11
myccrider Jan 31 #12
MustLoveBeagles Jan 31 #14
Chellee Jan 31 #16
MustLoveBeagles Jan 31 #19
moonscape Jan 31 #18
MustLoveBeagles Jan 31 #22
myccrider Jan 31 #29
MustLoveBeagles Jan 31 #31
MustLoveBeagles Jan 31 #13
Initech Jan 31 #15
Spider Jerusalem Jan 31 #17
Hortensis Jan 31 #26
NewJeffCT Jan 31 #27
greytdemocrat Jan 31 #20
NurseJackie Jan 31 #23
greenjar_01 Jan 31 #21
ananda Jan 31 #24
NurseJackie Jan 31 #25
ananda Jan 31 #28
StarfishSaver Jan 31 #30

Response to NurseJackie (Original post)

Sat Jan 30, 2021, 10:48 AM

1. K&R...nt

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Response to NurseJackie (Original post)

Sat Jan 30, 2021, 10:51 AM

2. Best is no mask because you don't need one if you're not around other people. But by all means

double up if in any doubt. It sure can't hurt.

It's easy for me being retired and single. I'm in double secret lockdown still. That's kind of a bummer since I recently lost a lot of weight, am looking good, and in much better shape. I'd love to meet a nice woman and get a relationship started. I'm really looking forward to getting vaccinated and getting back out there.

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Response to NurseJackie (Original post)

Sat Jan 30, 2021, 11:05 AM

3. Face shields are really the underappreciated second level of defense

wear a mask and then increase the protection by keeping your face behind a sheet of plastic

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Response to RAB910 (Reply #3)

Sat Jan 30, 2021, 12:00 PM

8. Someone needs to explain this to me

 

I do not understand how faceshields help very much. I get that they guard against spittle and large particles but if we are talking about doubling up withrs that are super small to protect against aerosolized droplets that are wafting around in the air I don’t see how they offer much protection. Added protections for sure. Anyway I am not trying to disparage your point just wondering how much help they really give. I see some people wearing face shields only and no mask.

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Response to SlogginThroughIt (Reply #8)

Sat Jan 30, 2021, 02:26 PM

9. Because droplets can enter the eyes.

I work in Optometry and we have to wear them everytime we are in close contact with a patient.

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Response to SouthernIrish (Reply #9)

Sat Jan 30, 2021, 04:55 PM

10. Sure I get that.

 

But I just don’t see it actually doing much to help. If something is floating in the air the air is getting under the face shield. I am just not sure of the efficacy of it. I wonder if there are studies that show how much it prevents.

Like you breathe and draw air up and under the face shield. It seems to me that air would them get trapped under there and be more likely to enter the eye.


Make no mistake I am not saying people shpuldn’t wear them. I just would like to know how much they actually help..



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Response to NurseJackie (Original post)

Sat Jan 30, 2021, 11:05 AM

4. I don't go out much...

However I am double masking 😷 😷 when I do.

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Response to NurseJackie (Original post)

Sat Jan 30, 2021, 11:06 AM

5. fit fit and fit

if there are gaps, all bets are off. Flow is another concern - impeding the flow by stacking too many layers will force air around the sides. Fit and flow are important for long term mask wearing.

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Response to NurseJackie (Original post)

Sat Jan 30, 2021, 11:08 AM

6. When we went to get our vaccine shots yesterday, we had on TWO masks and a face shield.

No one laughed at us or even looked twice. Not that I would have cared if they had, but it was nice to see everyone masked up. There was only ONE buttwipe with it under his nose.

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Response to Ferrets are Cool (Reply #6)

Sat Jan 30, 2021, 11:40 AM

7. I think a lot of the "under the nose" is anxiety. Probably the same as I get at the dentist.

As soon as the dentist opens my mouth I start producing so much saliva I feel like I am going to drown.

I saw a manat the grocery put on his mask and sweat start pouring off his forehead a few seconds later.

Anxiety is a powerful force.

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 01:25 AM

11. Certified medical n95 are not available and 70% of kn95

masks failed when tested.

A good kn95 mask with head straps instead of ear straps is probably the option that you can actually get.

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 01:31 AM

12. I found a couple of mask designs that have 2 layers of tightly woven cotton, fit well, and...

have a pocket for a filter. My husband and I wear them whenever we’re out. We each have 3 masks so they can be washed in rotation. It’s worked so far...fingers and toes crossed.

We’re in SoCal, so it’s bad here. Several of our friends have had Covid. Luckily, none had to be hospitalized and most have fully recovered, so far. One is still struggling with fatigue and one hasn’t recovered her sense of smell or taste completely, yet, but no one died. Both got sick just before Christmas.

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Response to myccrider (Reply #12)

Sun Jan 31, 2021, 01:39 AM

14. Where did you get them?

I only see the single layer masks in the stores I frequent. I've seen the filters at Walgreens. I wear a disposable under my cloth mask.

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Response to MustLoveBeagles (Reply #14)

Sun Jan 31, 2021, 02:04 AM

16. Here's where I got mine.

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Response to Chellee (Reply #16)

Sun Jan 31, 2021, 02:15 AM

19. Thank you



They're pretty and are reasonably priced.

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Response to MustLoveBeagles (Reply #14)

Sun Jan 31, 2021, 02:14 AM

18. I'm a big fan of Vogmask. Used them

before the pandemic when they had valves because they were for protection from others. Now they make them without valves. 3 layers, very comfortable.

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Response to moonscape (Reply #18)

Sun Jan 31, 2021, 02:22 AM

22. Thank you

I'll check them out.

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Response to MustLoveBeagles (Reply #14)

Sun Jan 31, 2021, 01:06 PM

29. I found them on Amazon.

This is my favorite design. It’s very comfortable and very well made, but the most expensive at $25. It has 3 layers plus a pocket for a filter. The loops go over your head but can be modified to go behind the ears. I find the overhead design to be the most comfortable, no behind the ear irritation, better fit to the face. It does mess up your hair, though, but you can easily pull it down to hang around your neck and put it back on again in seconds. I’ve washed mine several times and it’s still comfortable and functional.

Link: https://www.amazon.com/gp/product/B08LW4DL6R/ref=ppx_yo_dt_b_search_asin_image?ie=UTF8&th=1

Hmmmmm, second fave isn’t being sold anymore. Sorry, no link.

Third design I like. This one comes in 3 sizes, so you can get a slightly better fit. I wear S/M, hub wears M/L. It doesn’t have a pocket for a filter, but it has 3 layers, the middle one a filtration layer. You can choose over head or over ear design.

Link: https://www.amazon.com/gp/product/B08GRLL6X1/ref=ppx_yo_dt_b_search_asin_image?ie=UTF8&th=1


ps: we tried some of the disposable and one-layer cheap masks early on but decided it was worth the cost for better protection and more comfort.


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Response to myccrider (Reply #29)

Sun Jan 31, 2021, 08:02 PM

31. Thanks for providing more links

I appreciate it. I'll look through those too and determine which ones are the best for us. If I pick the over the head design I can just put my hair in a pony tail so it doesn't pull my hair.

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 01:36 AM

13. I started double masking last month

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 01:47 AM

15. Ugh, this just gets worse and worse.

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 02:08 AM

17. I am using a KN95 with a cloth mask with filter when I go out shopping etc

especially with the new, more transmissible variants, it seems like probably a wise precaution (I also carry a pocket-size bottle of alcohol-based hand sanitiser with me).

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Response to Spider Jerusalem (Reply #17)

Sun Jan 31, 2021, 09:48 AM

26. Mostly the same here. We've been double masking for a while now,

3-layer cloth masks over one of the blue paper surgical-look masks, helping it fit snug, or over one of our small supply of N95s if we have to spend time inside, such as a medical appointment. And hand sanitizer. And a box of nitrile gloves in the car.

As you say about the new variants.

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Response to Spider Jerusalem (Reply #17)

Sun Jan 31, 2021, 10:05 AM

27. I've had KN95 masks from the beginning of the pandemic

but, if I try to put another mask on top of it, both masks seem slip out of place and create gaps, whereas the single KN95 fits snugly on my face.

By the way, I know a manufacturer in China that was willing to ship thousands of KN95 to the US for use here in the early days of the Trump pandemic to donate to hospitals & medical facilities. This is a legit manufacturer that has been doing business with the US for years. However, the masks were sitting in customs for WEEKS. I wonder how many others have similar stories?

The masks finally got here in May of 2020 when they had been shipped in March.

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 02:17 AM

20. No

Not double masking.

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Response to greytdemocrat (Reply #20)

Sun Jan 31, 2021, 08:29 AM

23. Hmmm... does that mean you *refuse* to double-mask? Or that you're not *currently* double-masking?

In my case... I'm not currently double-masking, but I'm certainly willing to do so.

Stay safe!

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 02:18 AM

21. When I go to the supermarket

I wear a disposable surgical mask underneath a cloth mask with a filter insert.

When I go for a run, I wear no mask, but have a bandana on that I pull up if people are heading in my direction.

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 09:31 AM

24. For any indoor space, I double mask with..

a cloth face mask and a large plastic face shield
that I can see through. That covers my eyes
and outer edges of my head.

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Response to ananda (Reply #24)

Sun Jan 31, 2021, 09:45 AM

25. On the CBS drama "All Rise" some of the characters wear unique face shields...

On the CBS drama "All Rise" some of the characters wear unique face shields that I've never seen anywhere else. The shield is attached to a semi-circle plastic ring that "clips" around a person's neck, and the shield points upward.

Prior to that I had never seen shields like that. Now I see them often. I wonder if they're effective protection for the wearer?

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Response to NurseJackie (Reply #25)

Sun Jan 31, 2021, 10:23 AM

28. Does that really protect the eyes (from above)?

Mine loops around my head and points down.

I think mine is better because it completely protects
my eyes. I already wear a cloth mask under it for
my mouth and nose

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Response to NurseJackie (Original post)

Sun Jan 31, 2021, 04:01 PM

30. This is great info. Thanks, Jackie!

Bookmarking

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