megan srinivas

Indian American infectious diseases specialist says that adding more layers of material to a mask or wearing two masks reduces the number of respiratory droplets containing the virus that come through the mask. (LinkedIn photo)

American Medical Association member Dr. Megan Srinivas recently explained what doctors wished patients knew about double masking.

The AMA in a March 12 news release said that, with the news of more contagious coronavirus variants spreading across the U.S., further guidance has been released about mask wearing.

Maximizing the fit of cloth and medical masks is key to improving performance as well as reducing transmission and exposure of SARS-CoV-2. But wearing two masks—or double masking—can also help protect against the threat of more contagious variants, it said.

“Mask fit is really important because it's about creating an enclosure around any orifice that you could exude the virus particles from through a droplet,” Srinivas, an Indian American infectious diseases specialist and translational health policy research fellow at the University of North Carolina at Chapel Hill, said in the report. “That means covering your nose and mouth completely, but then doing it in a way that it is fitted against your skin.”

Here is what Srinivas, a delegate for the AMA Resident and Fellow Section, had to say about double masking and other ways to maximize fit and filtration to protect against COVID-19.

Double up to enhance mask fit

Adding more layers of material to a mask or wearing two masks reduces the number of respiratory droplets containing the virus that come through the mask. If one person is using a cloth mask over a surgical mask while the other person is not, it has been shown to block 85.4 percent of cough particles, says the JAMA Health Forum article, “CDC Studies Underscore Continued Importance of Masks to Prevent Coronavirus Spread.” When both people are double masking, potentially infectious aerosols decrease by 95 percent.

“By protecting the exterior of the [medical procedure mask] from droplets, you can throw away the outer mask or wash it if it's a cloth mask,” said Srinivas. “It’s basically the same concept that’s behind when the CDC came out with recommendations saying single-layer masks aren’t as useful as the double layer or masks with filters.”

That is “because it creates more layers of protection for droplets to have to go through to actually be extruded,” added Srinivas, noting that “when we’re wearing two masks, it creates that extra barrier.”

But “you can’t wear two N95s or surgical masks on top of each other—it wouldn’t be useful,” she said.

Knot and tuck mask ear loops

A cloth mask blocks about 50 percent of the particles from a simulated cough. But a knotted and tucked mask blocks 77 percent of those particles, according to the CDC.

To knot and tuck as mask, “pull back and then twist the ear loop behind your ear and knot it, so it makes it a tighter fit,” Srinivas said. “A lot of the surgical masks people buy are one size fits all, so this way we can make it fit to your face a little bit better.”

The tighter fit helps so that “things can’t seep out in between the crevices and helps to reduce spread to other people,” she said. “It has also helped to reduce your ability to contract from the environment around you, so things can’t sneak in through the crevices around your face.”

Use mask fitters or braces

Another option is to use a mask fitter or brace over a disposable or cloth mask, “which helps to push your mask against your face for a tighter fit,” she said. “The fitter helps to prevent air from leaking around the edges of the mask.”

These mask fitters and braces can be found on Amazon and other retail outlets. They can be solid or elastic and are worn over the mask, secured with head ties or ear loops. When secured over a medical mask, fitters can increase the wearer’s protection by about 90 percent, according to the CDC.

Remember to wash cloth masks

Many people often forget to wash their cloth masks after use, which is why “a lot of people have moved to disposable masks because it reminds them to get a new one,” Srinivas adds. “You don’t want to repeat using the same cloth mask more than one day in a row without washing it.

“I have a rotation of masks and when I come home, I just toss the one I’ve been using for the day in the laundry basket,” she said. “Then I wash them all at the end of the week.”

Pay attention to the mask seal

“When you start to feel like the seal of the mask is no longer fitting to your face, that's the time when you want to get a new one,” said Srinivas. “For the general public, just wearing a surgical mask is really sufficient.

“As far as double masking … once again, it's about the seal,” she continued. “If you feel like you're no longer getting the seal, that things are too loose, then toss” the disposable nonsurgical mask “and get a new one to wear underneath your cloth mask.”

Added protection against variants

The coronavirus variants first identified in the United Kingdom (B.1.1.7), Brazil (P.1) and South Africa (B.1.351) are far more transmissible and lead to higher severity of symptoms, said Srinivas.

The increased transmissibility, not knowing how effective the vaccines are against the variants and “the fact that more variants might pop up as this goes on makes it more important than ever that we continue to mask up.”

“The only way we’re really going to be able to rely on herd immunity is if we can bring the community transmission rates down low enough where the importance of prevention is more important than control,” she said. “With our positivity rates in the United States, we're still in that aspect of—in order to control, we really need masking to be in place.”

Keep wearing masks after vaccination

“One of the big things that people need to realize is that just because you get vaccinated, you can't stop masking because even though it's reduced the likelihood that you're a carrier, there is still a chance,” the doctor said. “We suspect that you can be a carrier for a short amount of time, so you want to protect the community around you.

“The best way to control spread is continuing to mask while you're vaccinated,” she added. “Once we get things under control down the line, hopefully masks can go away. But in the meantime, we still need to do these public health strategies to get our positivity down before we can just rely on prevention.”

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