Should We Be Wearing Two Face Masks?

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, wears two protective face masks during a news conference in the White House. Chris Kleponis/CNP/Bloomberg via Getty Images

By now, in this unending coronavirus pandemic, we should all agree about the importance of wearing a mask. Anyone who doubts it, at this point, is either anti-science, stupidly stubborn, religiously opposed or libertarian to an alarming degree. Possibly all of those.

Way back, a year or more ago, the word might not have been so clear. Way back, as researchers and scientists wrestled with new data surrounding this novel virus, what the experts were saying about masks may have been a little confusing.

But it's 2021 now. More than 100 million people have been stricken by COVID-19, the disease that springs from this coronavirus infection. More than 2.2 million have died. Those are the facts.

The world's scientists now have enough data, enough proof, to definitively state: Masks work. This is now a fact, too.

"As frustrating as it is when you're in the community and you're getting information and it changes, this has actually been a great example of how science is supposed to work," says Marybeth Sexton, a professor in the Emory University School of Medicine's Division of Infectious Diseases. "You go with the best knowledge you have at the time, and as soon as you know something different, you let people know, you explain it, you change. And that's what has happened here."

Now, as the virus mutates into different variants, masks are as critical as ever. Now, some are suggesting doubling up — that's right, wearing two masks — to keep everyone safe and get this pandemic under control.

It's a notion that may send the anti-mask crowd into double fits of paroxysm.

"There's nothing wrong with people wearing two masks. I often, myself, wear two masks," Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Diseases, said in a White House news briefing Feb. 3, 2021. "Can we make a general recommendation that [has] scientific basis yet? No. But when the science comes along and tells us that it is better or not, then you will see a recommendation being made by the CDC [Centers for Disease Control and Prevention.]"

Roseman University Associate Professor of Pharmacy Dr. Christina Madison (left) wears two masks as she prepares to give Nevada resident Sharon Brockway her a Moderna COVID-19 vaccination.
Ethan Miller/Getty Images

How Masks Work

The severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, travels through the air. We need masks, as one measure among many, to keep it from spreading. Three examples of how mask usage has helped curb the virus' transmission:

Service members who wore masks on the USS Theodore Roosevelt, which experienced a COVID outbreak onboard in March 2020, were some 25 percent less likely to be infected than those who did not.
A study of 139 clients in a Missouri health salon showed that none were infected by two stylists who had COVID-19. Both workers wore masks, as did every one of the clients.
During a surge in Arizona in the summer of 2020, a statewide mask-wearing mandate (along with limits on large gatherings and more attention to social distancing) helped stabilize transmission rates, which then decreased by some 75 percent as the summer wore on.

According to the CDC, control of the virus through masking works in two fairly obvious ways. First, a mask stops those who have the virus from spreading it. Second, masks keep those without the virus from being infected. "The relationship between source control and personal protection is likely complementary and possibly synergistic," the CDC says, "so that individual benefit increases with increasing community mask use."

Physically speaking, though, how does a mask stop the wily and extremely tiny virus?

It's all about getting in the way.

"Even though the virus itself is incredibly small, the virus doesn't travel by itself," Sexton explains. "If you were infected with COVID, and you put the virus out into the environment, it's contained within these respiratory particles. There's a mix of what people call droplets and aerosols. Aerosols are a little smaller. But even an aerosol is so much bigger than the virus itself."

Think of those particles that show up in slo-mo pictures of a cough or sneeze (or even just talking). In each of those particles, potentially, are millions of SARS-CoV-2 molecules.

A mask helps trap those particles, coming and going. From a January 2021 article in the medical journal Cell:

Filtering is not sieving out things that are too large to pass through holes in the material. Rather, air must curve as it flows around individual, tightly packed fibers of the material, like a race car swerving around cones of an obstacle course. As the air curves, the aerosols it carries cannot make the sharp bends and therefore slam into the fibers, or they come too close to the fibers and stick to them.

The type of mask, of course, is important, as is how it's worn. The CDC recommends a mask that has at least two layers of washable, breathable material; that covers both your nose and your mouth fully (keep that nose in there!); and fits snugly around your face, without any gaps.

Remember, as of Feb. 2, 2021, masks are required on any form of public transportation and in transportation hubs like train and bus stations.

So, Time to Double Up?

"There's been a lot of conversation about, 'Should people wear two masks? Should people wear medical grade masks? What should people do?'" Sexton says. "And I think that what can get lost in some of that discussion, is that the MOST important thing is that everyone wears a mask." Some people, already, are doubling up in what Fauci calls a "commonsense" approach.

But new research from the CDC published in the agency's Feb. 10, 2021 Morbidity and Mortality Weekly Report says that wearing two masks — or a properly fitted single mask closely on your face — does prevent the spread of COVID-19 more than wearing just one mask.

"If having two masks on is actually going to make you have your hands on your face more, or it's uncomfortable and you keep moving it and putting it back on, if it's falling off your ear, or hanging off your ear on a loop ... all of those things are counterproductive. If that's happening, you should just focus on one that really is of good quality and fits you well," Sexton says. "If you can do two in such a way that actually improves the quality or improves the fit, that may make sense."

Now That's Interesting

More from the CDC on mask wearing: Wash (or sanitize) your hands before putting on your mask. (That kills any of those nasty viruses before you get your hands up around your face while putting on your mask.) Don't mess with it while it's on. Take it off carefully, handling only the ear loops or ties, and fold the outside edges together. (That keeps any viruses trapped.) Wash it regularly, especially if it's wet when you take it off. (Wet masks are less effective.) And, finally, if you're fiddling with it too much while wearing it, it probably doesn't fit. Try another one.

Originally Published: Feb 5, 2021