Make Your Double Masking Effective: Do’s & Dont’s

India is battling through the second wave of the coronavirus pandemic. Believe it or not, every person plays a part towards recovery to a gradual and safe return to a pre-pandemic time. Especially, with the presence of new COVID-19 strains in India, it is crucial for every individual to follow safety guidelines diligently to mitigate the risk of spread. 

Just as hygiene and cleanliness are being prioritised, safety protocols also need to be given high priority. Wearing a mask, maintaining social distance, avoiding crowds are some precautions to be followed. Hand hygiene is of utmost importance and using hand sanitisers or soaps at frequent intervals is recommended. 

Getting vaccinated for protection is every individual’s responsibility. If a vaccine is not available, we advise you to mask up, stay protected!

The more particles that are blocked, the better you are protected against getting COVID-19. You should not wear two disposable masks or combine an N95 or KN95 with any other mask.

Dr. Ashish Bajaj, M.B.B.S., M.D. in Clinical Pharmacology and Toxicology

Double Masking: What Does it Mean?

Double masking is a preventive method, where one mask is worn on top of another. This helps improve the efficiency of the mask by improving the filtration rate and preventing the spread of the virus. It also limits the exhalation of droplets and the spread of droplets containing the virus. 

Types of Masks

For the prevention of COVID-19, there are generally three types of masks used:

• Cloth masks
• Disposable, surgical masks
• N95 masks

1. Cloth Masks

Cloth masks are made of breathable fabric. They are recommended for the general public and can be worn daily. The fabric should be multilayered and should block light when held up to a bright source of light. 

Cloth masks can be worn in public settings. It is not recommended for individuals with breathing issues. These masks can be washed frequently. However, wearing a mask must be combined with other safety protocols to ensure proper protection. 

Double masking should be done by using 2 surgical masks or 1 cloth and 1 surgical masks. There is no need for double masking with N95 masks. As per CDC double masking with proper fit blocks 85 percent of cough particles.

Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)

2. Disposable, Surgical Masks

Surgical masks are usually flat or rectangular in shape with pleats or folds. They have elastic bands to wear by looping the bands behind the ears. These masks are loose-fitting, designed to protect the wearer from large particle aerosols, sprays and so on. 

However, by design, they do not filter or block small particles transmitted via coughs or sneezes. Due to the loose fit between the surface of the mask and the face, these masks are advised to be worn underneath a cloth mask for added protection.

3. N95 Respirator Mask

An N95 mask is designed to protect from larger particles and smaller particles, such as bacteria. It contains a respirator, generally oval-shaped and some may have an exhalation valve. The edges of the respirator are designed to form a seal around the nose and mouth. KN95 masks are also similar to N95 masks. However, they do not have exhalation valves.

These are commonly used in healthcare settings and are considered the best mask for COVID-19 as well. It is essential to note that N95 respirators with exhalation valves should not be used by people with symptoms of COVID-19, asymptomatic people and when sterile conditions are required.

Why Should We Double Mask?

Based on research, it is advised to double mask as it not only prevents the transmission of the virus but also helps protect against the threat of more contagious variants. 

• Adding more layers to a mask reduces the number of respiratory droplets that come through or enter the mask.
• It provides a tighter, snug fit to protect against contagious settings.
• Closes any gaps that may be present between the mask and the face. 

Double Masking: The Do’s

Double masking should be followed while continuing to practice physical distancing and proper hygiene. Here, we outline some tips on double masking.

• How to double mask- There are two effective ways. One is to wear a cloth mask over a surgical mask. The cloth mask covers the regions the surgical mask is unable to. The second method is to knot the ear loops of a surgical mask, then tuck in and flatten the extra material close to the face. 
• Ensure that you can breathe well and there are no difficulties. 
• Assess the fit and comfort before stepping out. Fogging of glasses or forced blinking indicates air escaping from the mask. Make sure the mask covers all areas around the nose and mouth. 
• Use masks with nose wire, mask fitter or brace for added protection. 
• It is recommended to wash used cloth masks at regular intervals.
• Wash hands before putting on the mask.
• Face masks should be removed by touching the ear loops only and not the front of the mask. 

Double Masking: The Don’ts

According to research, double masking is effective because of the enhanced filtration and gap elimination, rather than just the addition of layers of masks. Here are some precautions to be taken while double masking. 

• Do not pair two masks of the same kind. For instance, pairing two surgical masks together.
• Do not combine an N95 or a KN95 mask with any other mask. 
• Do not wear the same combination of masks for consecutive days. 
• Do not use any form of chemical disinfectants on masks. It is advised to wash your cloth masks at a regular interval.
• Do not use the masks if there is visible damage or soiling. 
• If COVID-19 positive, do not use masks with valves as the exhaled air is unfiltered and may affect other individuals. 
• Avoid using masks made of leather, vinyl, or plastic. Use masks of recommended quality and material. 

Layers of Safety to Get Through the Pandemic

Records and research prove that double masking offers a stronger barrier against the virus. A single cloth mask blocks around 52 percent of aerosol particles and the surgical mask with a knot blocks around 70 percent. However, a combination of cloth masks and surgical masks, the most common of double masking methods, blocks aerosol particles up to 85 percent. This emphasizes the effectiveness of double masking. 

It is crucial to continue following safety guidelines such as social distancing, hand hygiene and restricting engagement with larger crowds. While double masking forms an essential tool to combat the ongoing pandemic, the road to recovery is possible when one also follows the rest of the safety guidelines.  

Update: As of 23rd March 2022, over 70% of the Indian population has been vaccinated with 10 vaccines approved in the country. Certain studies (domestic and international) also indicate a potential need for booster shots (getting a third vaccine injection). The year 2022 saw the rise of the Omicron variant, and with its higher transmissibility rate, it has made double masking even more relevant. Vaccination for children between the ages of 15-18 started to roll out at the beginning of 2022 with younger age groups set to be eligible later in the year.

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