Is it time to ramp up protection with double-masking?

Increasing concerns over more infectious COVID-19 variants has led some to wonder whether our face masks need an upgrade.

Should we layer two masks on top of each other, as politicians and spectators at the U.S. presidential inauguration did earlier this month? Should we replace cloth masks with medicalgrade ones, like some countries in Europe are now recommending? And should we wear masks even when outside?

The Canadian Press asked medical experts these common questions. DOUBLE-MASKING

Dr. Anthony Fauci, the chief medical advisor to the U.S. president, said recently that wearing two masks “makes common sense,” but experts say there are caveats to that claim.

The idea behind wearing two masks is to add extra layers of filtration, making it harder for viral droplets to spread from person to person.

Dr. Jane Wang, a clinical instructor at UBC who’s studied face masks extensively, said in an email that double-masking might improve fit and can increase that “filtration efficiency.”

If the two masks aren’t snug around the face, however, that won’t matter.

Stephen Barr, an expert in viral pathogens at Western University says masks work by filtering air in and out as we breathe. If too much can sneak through gaps around the sides, “it’s not going to be as effective.”

So a proper-fitting single mask would be better than a doubled-down approach if gaps are still there.

Breathability can become an issue with layering masks, and Barr foresees people pulling at or removing their doubled-up face coverings more often, giving them

“more chance to get infected.”

The Public Health Agency of Canada (PHAC) doesn’t currently recommend double masking, saying in a statement that “Canada’s context is different from that of the U.S.”

“We will continue to monitor the situation and will adapt our guidance if further such evidence emerges,” PHAC said.

The U.S.-based CDC has also not issued guidance on wearing two masks at once.

WEARING MASKS OUTDOORS

Outdoor settings have generally proven safer as fresh air and the ability to spread out lowers risk of transmission. That should still hold true with the variants, Barr says, but we do need to be more careful.

Even a brief interaction, like walking by someone on a sidewalk, could be enough to transmit more contagious forms of the virus, Barr says, though the exact amount of time is yet to be determined.

Going for a solo walk with no one around may not necessitate a mask, but a crowded path might.

“It comes down to how long the virus is going to stay in the air,” he said. “Once it’s confirmed that the variant is conclusively more transmissible, I would definitely double the distance to 12 feet if I wasn’t wearing a mask.”

Dr. Lisa Bryski, a physician in Winnipeg, isn’t aware of any studies on double-masking efficacy, but she still agrees with Fauci’s claim.

Bryski says we should normalize wearing face masks whenever we leave our homes and suggests carrying multiples that can be switched out if one gets soiled.

The cold winter climate also makes masking outdoors easier, she adds, providing the extra benefit of warmth.

“Canada is lucky in some ways to have that,” she said with a laugh. “But I do think we should start wearing masks outdoors because we don’t know how much more contagious this virus is now and in what environmental capacities.

“We should take a step back and bump up our protections of each other and ourselves.”