COVID-19 Fact Check: Double-masking causes no breathing problem, even if you have respiratory issues

Editor’s Note: COVID-19 Fact check is a series where we speak to doctors and ask them burning questions about everything from COVID-19 treatments, vaccines to diagnostics. To quote the Mumbai Police, denim on denim is a fashion trend, but wearing two masks is a safety trend. Double-masking is the hot new phrase in town. While WhatsApp groups and Instagram DMs are full of folks discussing pros and cons, surprisingly, not a lot of them are practising double-masking. Along with following physical distancing, regular hand hygiene, avoiding large indoor gatherings and getting vaccinated, double-masking is the need of the hour. [caption id=“attachment_9621231” align=“alignnone” width=“1280”] You can’t wear two N95 masks or surgical masks on top of each other — it wouldn’t be useful. Image credit: Tech2/Abigail Banerji[/caption] Dr Tushar Tayal from the Department of Internal Medicine, CK Birla Hospital, Gurgaon, told Firstpost, “With the various mutants looming closer to us, the next step should be better safety measures, which means double layering of masks.” A study recently published in the journal JAMA Internal Medicine says wearing two masks nearly doubles their effectiveness and helps keep the virus at bay. Another reason to double-mask is also to eliminate any gaps or ill-fitting areas around your face. Megan Srinivas, an American Medical Association ( AMA) member and an infectious diseases specialist at the University of North Carolina, said the fit of a mask is important because it creates an “enclosure around any orifice” that can discharge virus particles. “That means covering your nose and mouth completely, but then doing it in a way that it is fitted against your skin”, says Srinivas.

Tayal adds, “The layering not only gives one strengthened protection by being a barrier to the infectious germs, but also reduces the contagiousness of infections. Double masking also improves the fit and filtration, which keeps the person safe especially in public and low-ventilation spaces.”

Mask up x 2

But is there a right or wrong way to double-mask? Srinivas says “you can’t wear two N95 masks or surgical masks on top of each other — it wouldn’t be useful.” For the best protection against SARS-CoV-2, pairing a surgical mask under a cloth mask is the way to go. Alternatively, you can also use a cloth mask that has multiple layers of fabric or stick to wearing a single N95 mask without a valve. There are some mask combinations that you should absolutely avoid, as mentioned by the CDC, eg. Pairing two surgical masks, a KN95 or N95 mask worn along with any other type of mask. These combinations can either make it hard to breathe or have no effect on ensuring a secure mask fit.

Face masks are mandatory in all work & public places!

Do 𝐃𝐨𝐮𝐛𝐥𝐞 𝐌𝐚𝐬𝐤𝐢𝐧𝐠 to fight #COVID19

𝗗𝗢𝘀

😷Surgical mask + Double/Triple layered cloth mask
👃Press the mask tightly on the nose bridge
🫁 Ensure breathing isn't blocked pic.twitter.com/MCBPIQAJlZ

— PIB India (@PIB_India) May 9, 2021

Some people refuse to wear masks because they feel they cannot breathe. However, Tayal says, “Masks are safe for everyone; while they can cause slight discomfort, they are the best course of action one can take during a pandemic. If one can’t wear a mask because of severe asthma or breathing distress, then they must protect themselves from COVID-19 by following standard COVID hygiene protocols.” Dr Rohan Sequeira, Consultant General Medicine, Jaslok Hospital and Research Centre, told Firstpost double-masking causes no breathing issues. “Double masking is for everybody; even if you have breathing problems, it won’t cause any issues. It is also increasingly recommended all over the world right now as double-masking is the new norm”, he says.

How can you improve the fit of a mask?

The JAMA study states that wearing any type of mask is better than not wearing a mask at all. A well-fitted mask works best to both block aerosol emissions as well as avoid exposure. An unknotted surgical mask or cloth mask can single-handedly block out around half of the aerosol projected during a cough simulated in the study. On the other hand, simply knotting and tucking a surgical mask can block around 77 percent of cough particles, while 85.4 percent can be blocked with a double mask – for example, wearing a cloth mask over a surgical mask. And when two people double-mask (with a proper fit), the study found the receiver’s exposure to the virus is reduced by more than 95 percent when compared to people not wearing a mask.

To check if the mask if properly fitted around your mouth and nose, follow these steps:

• Use a mask with a nose wire.
• Use a mask fitter or brace to prevent air from leaking out.
• Check for gaps by cupping your hands around the outer edges of the mask. Make sure no air escapes from the area near your eyes or from the sides of the mask.
• If the mask has a good fit, you will feel warm air filter through the front of the mask, and you may be able to see the mask material move in and out with every breath you take.
• You can also knot your three-ply face mask where the strings join the edge of the mask
• Fold and tuck the unneeded material under the edges. insert video
• Check if you can see clearly with the mask on and ensure your vision is not obscured in any way.

When to replace a mask

Cloth masks, according to Jeremy Biggs, medical director for occupational medicine at the University of Utah Health, should be washed every day, particularly if they’re worn for an extended period of time. You can go several days without washing them if you only wear them for five to ten minutes daily.

#IndiaFightsCorona:

📍How to wear a mask 😷

☑️Wear mask so nasal clip is over the nose. External pleats should face downwards.
☑️Open mask pleats so it covers mouth and nose.
☑️Tie upper strings first. Then lower strings. There should be no gap between face & mask.#StaySafe pic.twitter.com/VtD5392Iby

— #IndiaFightsCorona (@COVIDNewsByMIB) May 9, 2021

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If worn correctly, a medical mask will last for up to eight hours. If it gets damp in the middle, it must be discarded right away. If surgical masks are used for an extended period of time, they should be discarded every day. If used for a short period of time, they can be reused three or four times before being discarded.