Is Double Masking Necessary?

In the past, medical professionals used a new N95 mask for each patient they saw. So they’d don a mask, see a patient, discard the mask. Don a new mask, see the next patient, etc. With so many patients in the pandemic, and early shortages of N95’s, they needed to make those masks last as long as possible. The solution was to wear a base N95 and cover it with a cloth or surgical mask. That way, the outer mask could be discarded after each patient while preserving the N95 for longer wear.

Obviously, this isn’t a concern in the industrial realm as workers routinely wear the same N95 for a full day’s work. But with new, more contagious, and possibly more deadly strains of COVID-19 spreading around the world, people are beginning to ask if two masks might be better than one.

In a recent Today Show interview, Dr. Anthony Fauci explained that “if you have a physical covering with one layer, you put another layer on, it just makes common sense that it likely would be more effective. And that’s the reason why you see people either double masking or doing a version of an N95.”

While more protection sounds better, other physicians caution that two masks don’t double your protection. Dr. Graham Snyder, a Wake Med Emergency Physical in Raleigh, North Carolina recently explained in a local ABC7 news interview that two masks do “decrease the transmission of the virus” but “by a small amount.” He said it won’t mean there is no risk at all, and stressed that two masks do not provide a big jump in protection.

With an unknown boost in protection, it becomes a personal choice to double or single mask. But there are some situations that may make double masking a better idea.

1. If social distancing is a challenge – while we’re all supposed to stay 6 feet away from people outside our immediate household, this can sometimes be a challenge both in public places and sometimes even at work. If you find yourself in close contact with others frequently or for several minutes at a time, a second mask might help to up your protection.
2. If you don’t have access to masks with higher levels of protection – N95 disposable respirators are the gold standard in disposable masks, but they’re not always available. Other masks offer some protection, but a recent study showed significant differences in effectiveness.

If you only have cloth or medical-type masks available, it might make sense to add another layer of protection. Weighing into the debate, a recent study by the CDC showed that this specific combination (a cloth mask over a medical-type mask) may reduce exposure by 90% or more, in part because it fits the masks more tightly to the wearer's face.

There are three important factors to consider if you choose to double mask – comfort, safety, and the quality and reliability of your supply.

• Comfort when Double Masking – make sure you can breathe! An anecdotal test in our office showed that a tight-fitting cloth mask on top of an N95 produced a fairly claustrophobic feeling. A better idea might be to choose a mask with a snug fit like an N95 as your base layer, with a looser face covering like a gaiter on top. Be sure you leave room for air flow between the masks so you’re not just trying to suck air through thicker and thicker fabric.
• Safety when Double Masking – while two masks may impart more protection, that won’t be the case if one mask interferes with the other. For example, wearing two masks that both employ ear loops to stay on may actually make both masks more prone to falling off or gapping if the loops are too thick to stay snug behind your ears. Also, as in the example above, if the top mask is tight enough to cause the bottom mask to gap, you’re making yourself more vulnerable, not less.
• Quality and Uninterrupted Supply – the pandemic presented many challenges early on with poor quality masks and disrupted supply chains. Be sure the company supplying your gear is up to the task. Kelly Graham, Product Manager at Magid, leads a COVID-19 product task force that monitors inventory, new solutions, and quality. “Supply chain got more complicated in 2020 certainly, but solid relationships with our vendors and suppliers continues to allow us to provide reliable PPE without interruption or long lead times.”

As with most things in the pandemic, the science is still evolving and recommendations may change as we go along. For now, take all of these factors into account when deciding to single or double mask.