The efficacy of double masking: What health experts have to say

With the discovery of new more contagious coronavirus variants across the world, some healthcare experts are now encouraging people to upgrade their cloth masks. Conventionally three types of masks are being used to prevent Covid-19 a cloth mask, surgical mask and an N95 mask. But now, questions are being raised against the efficacy of cloth and surgical masks in preventing Covid-19’s new strains.

Some health officials are now suggesting a practice popularly called as double masking simply the use of two face masks to increase the level of protection from the coronavirus.

The practice had generated buzz when US President Biden, Vice-President Kamala Harris, transportation secretary Pete Buttigieg and his husband, Chasten Buttigieg and other officials were clicked wearing two masks.

Top US infectious-disease specialist and chief medical adviser to President Joe Biden, Dr Anthony Fauci endorses double masking because “it just makes more sense” as layering masks reduces the porosity of your face covering and is more likely to do a better job of protecting you from infectious respiratory droplets.

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But even as Fauci and some experts recommend wearing two layers of face masks instead of just one, the US’ Centers for Disease Control (CDC) is yet to officially recommend double masking.

“Double mask is totally not required, and it is not as per guidelines. There is no benefit in wearing two masks. A single mask is enough to protect you. Some people think that wearing two masks will not cause infection and it will provide more protection, but this is totally false,” Dr Suresh Kumar, Director, Lok Nayak Jai Prakash Hospital told India Today.
Dr Kumar, author of Clinical approach to Covid-19 in India also said that there is no such study which says double masking will provide extra protection.

Dr Jugal Kishore, Director, Professor & Head, Department of Community Medicine, Safdarjung Hospital, said masks are advocated in high-risk areas. In the rest of the places, cloth masks are not even able to protect from common bacteria.

“Wearing two masks is not important at all. In high-risk areas, N-95 is a better mask to use because it has a better seal around the mouth, but it is a costly affair. However, double masking is not important. There is no research to back this claim,” Dr Kishore said.

“You can protect your fellow being from wearing a mask. The main aim of a mask is to prevent the droplets from our mouth while speaking to enter someone else’s mouth. Mask is for the person who is suffering and not for the healthy, but it is recommended because we are not aware of who is a carrier of the virus,” he added.

Dr. Harish Chafle, Consultant Intensivist and Chest Physician, Global Hospital said, “Nowadays, many people are seen wearing two masks which is only helpful if you wear a single layer cloth mask. Moreover, you must know that wearing two masks will reduce but not eliminate the risk of Covid. If you are wearing a single mask that has three layers of cloth then it is okay to wear only one mask.”

In countries like Germany and France, citizens are required to wear a medical-grade or surgical mask while using a public transport and while being in the public sphere like visiting a supermarket. Fabric masks are no longer permitted under the new mask rules in Germany, while in France, their use is strongly discouraged.

“While the current advice was to use a simple cloth or surgical mask for masses and N95 for HCW but with the new variants coming up, it is advisable for masses to upgrade to surgical mask superimposed by cloth mask or two cloth masks together. Two masks are certainly better than a single mask,” Dr Arun Gupta, President Delhi Medical Council.

“N95 is considered more effective but is not comfortable to wear as it is difficult to breathe in, so people may not wear them properly. The issue of compliance and availability will crop up,” said Dr Gupta.

Dr Tushau Prasad, Consultant Emergency Medicine, Wockhardt Hospital, Mumbai said, "Double masking is not needed if you are wearing an N-95 mask with sufficient filtering that is 95 per cent or more of airborne pathogens. You can go for double masking but make sure that you don’t have to sacrifice comfort or ventilation and wear it if you can breathe freely. If you wish to use two masks, wear a surgical mask first and then a cotton mask on top for added protection. Face fitting mask that fits properly (snugly around the nose and chin with no large gaps around the sides of the face) is important.”
Dr Om Shrivastava, Infectious Diseases Specialist, Jaslok Hospital, Mumbai, also said that there is no evidence that double mask provides better protection.

“Even an N95 mask is to be used at hospitals only where Covid patients are being treated. Which means an N95 mask for day-to-day life is not necessary. A 3-ply mask is enough for protection from Covid. There is no evidence to say that double masking provides more protection.”

With inputs from Pankaj Jain in Delhi and Mustafa Shaikh in Mumbai.
With the discovery of new more contagious coronavirus variants across the world, some healthcare experts are now encouraging people to upgrade their cloth masks. Conventionally three types of masks are being used to prevent Covid-19 a cloth mask, surgical mask and an N95 mask. But now, questions are being raised against the efficacy of cloth and surgical masks in preventing Covid-19’s new strains.

Some health officials are now suggesting a practice popularly called as double masking simply the use of two face masks to increase the level of protection from the coronavirus.

The practice had generated buzz when US President Biden, Vice-President Kamala Harris, transportation secretary Pete Buttigieg and his husband, Chasten Buttigieg and other officials were clicked wearing two masks.

Top US infectious-disease specialist and chief medical adviser to President Joe Biden, Dr Anthony Fauci endorses double masking because “it just makes more sense” as layering masks reduces the porosity of your face covering and is more likely to do a better job of protecting you from infectious respiratory droplets.

But even as Fauci and some experts recommend wearing two layers of face masks instead of just one, the US’ Centers for Disease Control (CDC) is yet to officially recommend double masking.

“Double mask is totally not required, and it is not as per guidelines. There is no benefit in wearing two masks. A single mask is enough to protect you. Some people think that wearing two masks will not cause infection and it will provide more protection, but this is totally false,” Dr Suresh Kumar, Director, Lok Nayak Jai Prakash Hospital told India Today.
Dr Kumar, author of Clinical approach to Covid-19 in India also said that there is no such study which says double masking will provide extra protection.

Dr Jugal Kishore, Director, Professor & Head, Department of Community Medicine, Safdarjung Hospital, said masks are advocated in high-risk areas. In the rest of the places, cloth masks are not even able to protect from common bacteria.

“Wearing two masks is not important at all. In high-risk areas, N-95 is a better mask to use because it has a better seal around the mouth, but it is a costly affair. However, double masking is not important. There is no research to back this claim,” Dr Kishore said.

“You can protect your fellow being from wearing a mask. The main aim of a mask is to prevent the droplets from our mouth while speaking to enter someone else’s mouth. Mask is for the person who is suffering and not for the healthy, but it is recommended because we are not aware of who is a carrier of the virus,” he added.

Dr. Harish Chafle, Consultant Intensivist and Chest Physician, Global Hospital said, “Nowadays, many people are seen wearing two masks which is only helpful if you wear a single layer cloth mask. Moreover, you must know that wearing two masks will reduce but not eliminate the risk of Covid. If you are wearing a single mask that has three layers of cloth then it is okay to wear only one mask.”

In countries like Germany and France, citizens are required to wear a medical-grade or surgical mask while using a public transport and while being in the public sphere like visiting a supermarket. Fabric masks are no longer permitted under the new mask rules in Germany, while in France, their use is strongly discouraged.

“While the current advice was to use a simple cloth or surgical mask for masses and N95 for HCW but with the new variants coming up, it is advisable for masses to upgrade to surgical mask superimposed by cloth mask or two cloth masks together. Two masks are certainly better than a single mask,” Dr Arun Gupta, President Delhi Medical Council.

“N95 is considered more effective but is not comfortable to wear as it is difficult to breathe in, so people may not wear them properly. The issue of compliance and availability will crop up,” said Dr Gupta.

Dr Tushau Prasad, Consultant Emergency Medicine, Wockhardt Hospital, Mumbai said, "Double masking is not needed if you are wearing an N-95 mask with sufficient filtering that is 95 per cent or more of airborne pathogens. You can go for double masking but make sure that you don’t have to sacrifice comfort or ventilation and wear it if you can breathe freely. If you wish to use two masks, wear a surgical mask first and then a cotton mask on top for added protection. Face fitting mask that fits properly (snugly around the nose and chin with no large gaps around the sides of the face) is important.”
Dr Om Shrivastava, Infectious Diseases Specialist, Jaslok Hospital, Mumbai, also said that there is no evidence that double mask provides better protection.

“Even an N95 mask is to be used at hospitals only where Covid patients are being treated. Which means an N95 mask for day-to-day life is not necessary. A 3-ply mask is enough for protection from Covid. There is no evidence to say that double masking provides more protection.”

With inputs from Pankaj Jain in Delhi and Mustafa Shaikh in Mumbai.