We have just returned from a very short cross-country trip to visit an elderly relative. It has been more than a year since we saw this person and the trip was essential. Trust me when I tell you that traveling is tricky! Double masking is the best way to protect yourself when you are crowded together with lots of people in places with poor ventilation.
Nose Breathers:
First, many people are not wearing masks, or if they are wearing masks, they are not doing so correctly. Lots of folks seem to think that wearing a mask under their nose will somehow allow them to skate by. It won’t! If you have SARS-CoV-2, you are spreading the virus every time you breathe air out your nose. And if you are not infected, you are exposing yourself to possible infection from the person in the next seat. The mask won’t work unless it covers both nose and mouth.
Ear Straps:
Second, a lot of people are using masks that don’t fit well. My informal guess is roughly 90-95% of people have masks with elastic bands that go behind the ears. That alone is a problem because this system does not generally create a tight fit. Then add on the fact that breath escapes around the nose, cheeks and under the chin. If you wear glasses and your glasses fog up, your breath is escaping.
Airline Hypocrisy:
Third, the flight attendants on every flight stated unequivocally that everyone on the flight needed to wear a face mask over their mouth and nose at all times. But during the flight, the same flight attendants served beverages and snacks. Not surprisingly, most people removed their masks to eat and drink. Duh! And on our flight out, every seat was occupied!
The Forgotten Six-Foot Rule:
Fourth, in the terminal there were signs: “Stay 6 feet apart if possible.” The airport was jammed. We were smooshed together on the escalator down to the tram that connects to the main terminal. And then everyone was crammed close together on the tram. Ditto on the bus to the rental car facility. You know the ventilation on those trains and buses sucks. There is a fair amount of research that demonstrates people can easily catch COVID in such places.
Is Everyone Vaccinated?
Fifth, although we are fully vaccinated, we suspect that many individuals are not. That’s because a lot of the air travelers we encountered were in their teens or early twenties. They are the least likely to have been on the early vaccination lists. The majority were either not wearing masks, wearing masks under their noses or wearing poorly fitting masks.
Is COVID Over and Done?
A lot of the people we saw in the airport, on the planes or at our destination were behaving as if COVID-19 is no longer a problem. Some may think it’s “not a real pandemic,” like rocker Ted Nugent.
Mr. Nugent recently tested positive for COVID-19:
“I thought I was dying. I literally could hardly crawl out of bed the last few days.”
How Many Vaccinations? How Many New Cases?
According to the CDC (April 22, 2021), over 135 million Americans have had at least one shot. Roughly 90 million people are fully vaccinated. And yet we are still averaging over 60,000 new COVID cases daily. That hasn’t changed much over the last two months. Deaths are down, yet over 700 people died from COVID on April 21, 2021.
A lot of people are still catching SARS-CoV-2 and dying every day. We hope you will not be one of them!
Why Double Masking Makes Sense:
When it comes to protecting you from COVID, two masks might be better than one. Scientists at the University of North Carolina at Chapel Hill have looked at the filtration efficiency of face masks (JAMA Internal Medicine, online April 16, 2021). They used a specialized exposure chamber to assess how well the masks worked to keep aerosols away from the nose and mouth.
Disposable procedure masks are commonly worn by the general public because they are readily available and inexpensive. Moreover, they are made of the same nonwoven polypropylene material that is used in highly effective respirators like N95s.
But the medical procedure face masks don’t fit closely to the face. The test showed that such masks are from 40 to 60 percent efficient at blocking aerosols. On the other hand, adding a second mask improved the efficiency.
The researchers conclude:
“In fact, it is notable that enhancements that improve the seal between the mask and the facial skin dramatically improve FFE [fitted filtration efficiency] performance, suggesting that fit, not material, is the intrinsic limiting factor for procedure masks.”
Cloth masks, bandanas and neck gaiters are only about 40 percent efficient by themselves. However, wearing a surgical mask underneath any of these face coverings increases the efficiency significantly.
Apparently, this is because double masking reduces gaps between the mask and the face and thus cuts down on leaks.
The investigators report:
“Results of this quality improvement study demonstrated that wearing a medical procedure mask underneath a cloth mask provided the best improvement to FFE of all the combinations evaluated. The improvement in the FFE of procedure masks when doubled or when worn underneath reusable cloth face coverings is consistent with minimizing leaks between the mask and facial skin, including the bridge of the nose…the present results support the overall conclusion that double masking improves FFE.”
Other Ways to Improve Face Mask Fit:
The CDC recommends (April 6, 2021) that you should:
“Make sure your mask fits snugly against your face. Gaps can let air with respiratory droplets leak in and out around the edges of the mask
“Use a mask fitter or brace over a disposable mask or a cloth mask to prevent air from leaking around the edges of the mask.”
“Check that it fits snugly over your nose, mouth, and chin
• Check for gaps by cupping your hands around the outside edges of the mask.
• Make sure no air is flowing from the area near your eyes or from the sides of the mask.
• If the mask has a good fit, you will feel warm air come through the front of the mask and may be able to see the mask material move in and out with each breath.”
What Is a Mask Fitter or Brace?
Here is a link to the Badger Seal (Mask Fitter). The photo demonstrates the difference in air leakage with and without the mask fitter.
Here is another example of a mask fitter with “Nose Cushions.”
If you want to really nerd out on face masks and double masking, here is a YouTube video which demonstrates the science behind filtration efficiency.
An inexpensive solution to greatly improve the fit of your cloth masks is to slip a tube cut from a nylon stocking or pantyhose over it. This double masking technique is described in an NPR interview.
The People’s Pharmacy Perspective on Double Masking:
We are comforted to see that over the last one to two weeks, COVID cases are dropping slightly and deaths are also down a tiny bit. Hospitalizations are up modestly, but we remain optimistic that vaccinations are making a difference.
They have had a huge impact in Israel. The Times of Israel (April 20, 2021) reports:
“Prominent scientists say the transformation of Israel from a COVID-19 hotspot to a vaccination success story underlines that any developed country can subdue the virus.
“They estimate that a relatively small number of vaccinations are needed to take a country out of crisis mode. The moment that half of the population aged 60-plus is inoculated, authorities can expect a dramatic drop in cases and hospitals are safe from being overwhelmed, they conclude.”
Over 200 million COVID shots have been administered in the US. That’s impressive. But we still have a way to go before we can say with assurance that we have beaten back COVID-19. Michigan is still a mess. Cases in Tennessee, Nebraska, Washington, Oregon and Alabama have been increasing by double digits over the last week (The Washington Post, April 22, 2021).
If you want to learn more about ventilation and air quality, why not take a few minutes to listen to Dr. Linsey Marr? She is arguably one of the world’s foremost authorities on the transmission of airborne viruses. We were fortunate enough to interview her two weeks ago for our syndicated public radio show. She will tell you why a good fit for a face mask is a critical factor in reducing the spread of COVID-19. Here is a link.
Show 1253: The Lessons of COVID-19 on How to Avoid Airborne Viral Transmission
Evidence shows that SARS-CoV-2, the coronavirus that causes COVID-19, moves like an aerosol. How can we avoid airborne viral transmission?
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