When Should I Worry About...

Double Masking: With New COVID-19 Variants, Are Two Masks Better Than One?

Feb. 3, 2021 - Katie McCallum

Masks have become a way of life during this pandemic. You don't leave home without one. You have spares in your car, purse or backpack. You dress them up or dress them down, depending on the season or where you're going.

But with new — and potentially more infectious — COVID-19 variants arising and spreading, is it time to add a second mask to your regimen?

There's a lot of dispute on the topic at this point, as exemplified by Dr. Tony Fauci recommending double-masking, but somewhat softening his stance a few days later.

"Double-masking is when a person wears two masks, typically a cloth mask over a surgical mask," explains Dr. H. Dirk Sostman, executive vice president and chief academic officer of Houston Methodist. "Wearing a second mask has become more common over the last few months, particularly in the last few weeks as new COVID-19 variants have become more concerning. For example, I have been wearing two masks for the past few months, ever since the fall surge."

Does double-masking make a difference?

We already know that a mask can help protect you from both catching and spreading COVID-19. But are two masks really better than one? Or is double-masking just an unwarranted trend?

"When it comes to preventing the spread of infectious respiratory droplets, adding more layers probably isn't a bad thing — as long as you're doing so correctly," says Dr. Sostman.

If you're considering double-masking, Dr. Sostman recommends:

  • Wearing an ASTM-rated surgical mask underneath a cloth mask
  • Ensuring the cloth mask enhances the overall fit, sealing gaps along the edges of the surgical mask
  • Removing your cloth mask if it becomes dirty or contaminated
  • Washing your cloth mask frequently

"Meeting the criteria above is especially important for health care personnel who choose to double-mask," adds Dr. Sostman.

In addition, Dr. Sostman warns not to let wearing a second mask give you a false sense of added security.

"First, double-masking does not make it safer to be closer to another person. Second, wearing two low-quality masks does not mean double the filtration. Lastly, adding a second mask that negatively impacts the fit and seal of your surgical mask could do more harm than good," explains Dr. Sostman.

Finally, before deciding whether you should be double-masking, it's important to first make sure the mask you're already wearing is actually effective.

Double-masking or single-masking, make sure your mask is effective

There are a variety of mask options out there: Surgical masks. Heavier-duty masks, like N95 and KN95 masks. Cloth masks. Regardless of which you choose, you need to know what makes a mask effective.

"Surgical masks are made of three layers of plastic-based fabric. These are a cost-effective option that provides good protection, and you may consider adding a cloth mask on top to help improve the fit," recommends Dr. Sostman. "Heavier-duty masks are, of course, more protective, but N95s should ideally be reserved for health care workers in case a short supply arises. Also, N95 masks are not comfortable to wear for really long periods and they need to be fit properly to your face in order to achieve high filtration efficiency. A poorly fitting N95 mask is not helpful or safe."

And when it comes to cloth masks, Dr. Sostman points out that there's inconsistency between brands and options — so there are criteria to consider.

An effective cloth mask is one that:

  • Is made up of at least two layers of tight weave fabric, such as 100% cotton
  • Completely covers your mouth and nose
  • Fits snug against your face (without gaps on the sides)
  • Remains secure under your chin and behind your ears
  • Can be washed (and is washed frequently)

If your cloth mask is made of three layers of high thread count fabric, or if your cloth mask has a space to accommodate a high efficiency filter material, such as HEPA filter material, that's even better.

"The key to an effective mask is multiple layers and a snug fit. If the mask you want to wear doesn't meet these criteria, double masking with a surgical mask underneath can help," adds Dr. Sostman. "For instance, gaiters are a popular choice, but many are single-layered and made with very thin fabric, which isn't effective. If you prefer the look of wearing a gaiter, double-masking with a surgical mask underneath becomes a good alternative."

Lastly, given the highly contagious new COVID-19 variants and the continuing reality of this pandemic, doubling down on more than just your mask is crucial. This includes recommitting to: meticulous hand hygiene, social distancing, avoiding social gatherings and crowds, postponing nonessential errands and travel, and staying at home if you feel sick.

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Categories: When Should I Worry About...