“How serious could it be?”

“COVID tu tipu lah, takde ubat pun, sakit pun bagi paracetamol saja.”

These are some of the things heard amongst our fellow countrymen. Perhaps you could be thinking: it’s not as serious as it seems. It is disheartening that there are still people belittling the gravity of the pandemic. Clearly, we are not what we used to be; or rather, we are not where we used to be. In the span of a year, we have progressed from being one of the best in containing the pandemic to being at the top of the Daily newly confirmed COVID-19 cases per million people presented by Our World in Data. The situation is alarming! The confirmed cases are projected to increase further if the chain of infection is not broken.

With the various mutant COVID-19 strains on the loose and causing sporadic cases all over Malaysia, it is high time we up our game in defence to keep our loved ones safe. In a recent statement to the press on 22^nd May 2021, the Director-General of Health, Tan Sri Dr Noor Hisham Abdullah encouraged the Rakyat to double mask in public areas. This came from an update from the Centers for Disease Control and Prevention (CDC), US.

What is double masking?

Double masking literally means what its name suggests – wearing two masks over our faces.

Why should you double mask?

IMPROVED FIT

Let’s face it, not all medical and surgical masks that we are using now is a ‘one size for all’. Our faces are all sized differently and the universal masks do not fit perfectly. There may be gaps in between the mask and your face where air can flow through during breathing. This poses as a risk of spreading and contracting the virus when air droplets escape and enter through the imperfect seal.

Double masking aims to help with a better fit to ensure that the inner layer of the mask fits more snugly to your skin to create a better seal and protection in especially public areas.

INCREASED FILTRATION, LESSER EXPOSURE

According to Sickbert-Bennett et al. [1], by double masking a cloth face covering over a procedural mask, the fitted filtration efficiency (FFE) is improved greatly to a range of 66 – 81%. A single procedural mask can only provide a FFE of 43 – 62%, varying on individuals.

Another recent report on CDC by Brooks et al. [2] stated that when both individuals wore tightly fitted masks, the exposure towards potentially infectious droplets decreased to 95%. In this experiment, placing a cloth mask over a medical procedure mask OR knotting and tucking a medical procedural mask are considered as tightly fitting.

How to double mask [3]?

Since we have understood the basics and reasonings behind double masking, let us dive into the how’s of it.

1. Wear a disposable mask (Medical/ Surgical) properly

• • Be sure to choose a mask with a nose wire.
  • Press and bend the nose wire over your nose to fit the mask close to your face.
  • Pull the bottom to cover your chin.

2. Add on a second layer of cloth mask

• • Use a cloth mask with multiple layers.
  • Place the cloth mask OVER the disposable mask.
  • Ensure that you can breathe and see easily.

DO’s:

• Always wash the cloth mask after coming back from public areas.
• Dispose the first layer of face mask after each use.
• Try out your fit and breathability at home prior to use.

DON’Ts:

• Do not wear a cloth mask only.
• Do not wear the cloth mask under the disposable face mask.
• Do not double up disposable face masks/cloth masks.

Notes:

• Both disposable face masks and cloth masks are readily available in the market.
• Both are affordable.

Here are some other alternatives that can also improve your mask fit:

1. Knot and Tuck method

• • Use a 3-ply disposable face mask.
  • Knot the ear loops of the mask where they join at the edges of the mask.
  • Fold and tuck in the excess material.

2. N95 / KN95

• • N95 masks do not require double masking.
  • KN95 masks are similar to those N95 made in the United States but be sure to purchase KN95 masks that meet the requirements set by CDC’s National Institute for Occupational Safety and Health (NIOSH) for respirators.
  • There are a lot of counterfeit KN95 masks in the market. Be extra CAREFUL!

DON’Ts:

• Do not use a mask with only a single layer.
• Do not use a mask with exhalation valves or vents as droplets will still escape and enter through it.

Notes:

• N95 masks is the gold standard – no double masking required.
• KN95 masks that meet NIOSH requirements do not require double masking.
• Reserve both N95 and KN95 masks for healthcare workers.
• Both N95 and KN95 masks can be costly.
• Both N95 and KN95 masks should be disposed of after use in public areas.

It is advisable to double mask especially in public areas to further protect ourselves from the COVID-19 virus. In addition, you can use a face shield too to improve our protective gear. If one is unable to practice double masking due to reasons such as cost and breathing difficulties, the general rule is to WEAR A FACE MASK PROPERLY, albeit only one layer of mask. Make sure that the mask covers your nose and mouth and use the ‘Knot and Tuck’ method whenever possible.

As responsible citizens, we should all be aware of the severity of this pandemic and the consequences we would need to face if we do not execute our part well.

DOUBLE MASK UP everyone! For as the old saying goes, ‘prevention is better than cure’. We can all look forward to a better post-pandemic future when we all work together. #KitaJagaKita

The opinions expressed in the article are the writer’s own and do not reflect the view of MPS YPC. All information is updated as of publication date.

References:

1. Sickbert-Bennett, E., Samet, J., Prince, S., Chen, H., Zeman, K., Tong, H., & Bennett, W. (2021). Fitted Filtration Efficiency of Double Masking During the COVID-19 Pandemic. JAMA Internal Medicine. doi: 10.1001/jamainternmed.2021.2033

2. Brooks, J., Beezhold, D., Noti, J., Coyle, J., Derk, R., Blachere, F., & Lindsley, W. (2021). Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021. MMWR Morb Mortal Wkly Rep 2021;70:254–257. doi: http://dx.doi.org/10.15585/mmwr.mm7007e1

3. COVID-19 and Your Health. (2021). Retrieved 26 May 2021, from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/mask-fit-and-filtration.html

4. COVID-19 and Your Health. (2021). Retrieved 26 May 2021, from https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html

5. Double Masking: How, Why, and When You Should Double Up on Face Masks. (2021). Retrieved 26 May 2021, from https://www.healthline.com/health/double-masking#effectiveness