Topic: Double masking – Medical masks

14^th August 2021, Saturday

9.30am-10.30am

Key points from the discussion

• The Covid-19 pandemic is not over yet and with newer variants emerging, it has become very important to protect ourselves from the virus.
• The delta variant is posing a challenge in India as well as globally.
• Wearing a mask, even with a vaccine, is one of the protective steps we can take during the impending third wave of the SARS-CoV-2.
• The best protective vaccine is MDH (mask, distancing and hand hygiene).
• Ignorance, indiscipline and stubbornness have resulted in failure to follow and sustain good Covid appropriate behavior.
• Different types of face masks, such as surgical masks and cloth masks have been used as a public and personal preventive and control measure against the spread of Covid-19.
• SARS-CoV-2 primarily spreads through respiratory droplets from a Covid infected person through coughing, sneezing and even laughing or talking.
• Masks reduce the exhaled respiratory droplets and aerosols from the infected wearers and reduce exposue of the uninfected wearer to these particles.
• Universal face masking is the most effective strategies recommended to slow the spread of the infection until vaccine-induced immunity is achieved.
• However, masks alone are not perfect barriers to spread and must be combined with other methods including physical distancing.
• Many remain unaware that they are carriers of the virus; double masking can greatly reduce the spread of Covid-19 in the community.
• In view of the impending third wave, it is important to strictly adhere to covid appropriate behaviors, such as wearing a double mask, social distancing and avoiding public places.
• Cloth masks offer little or no protection, which is subject to the material, number of layers and fit. Hence, double masking is a simple solution.
• The new CDC guidance recommends double mask to slow the spread of Covid-19. The closer fitting the mask is, the fewer gaps there are between the mask and face from where the respiratory droplets can enter.
• Double masking typically means layering of two masks one over the other. It was initially used by frontline healthcare warriors as it creates a tougher barrier for the virus.
• Even with two masks, you will still be able to inhale the oxygen you need and exhale the carbon dioxide. Two masks might not feel comfortable, but it is safer to wear them.
• Double masking is a usual practice in some sophisticated surgical procedures.
• Medical procedure masks are usually three-ply.
• If the two masks fit well, this combination should produce an overall efficiency of >90% for particles that are ≥ 1 micron.
• In the first layer, the dark blue (or green) side of the mask is the fluid repellent layer and is to be worn outward, while the white layer, the absorbent layer, should be on the inside.
• In the second layer, the dark blue (or green) side of the mask is to be worn inside, while the white layer, the absorbent layer, should be on the outside.
• The level 1 masks are for both surgical and procedure applications and have a fluid resistance of 80mmHg. They are meant for low-risk situations where there is no fluid, spray or aerosol.
• Level 2 masks have a resistance of 120 mmHg and provide a barrier against light or moderate aerosols, fluid and spray.
• The level 3 masks are for possible heavy exposure to aerosols, fluid and spray and have 160 mmHg fluid resistance.
• N95 masks have been widely recommended for people who are at risk of high exposure. They must have 5-6 layers. But these masks cannot be reused and may not be cost-effective for the general public. If used in low-risk situations, another mask over the N95 is not required. Wearing a cloth mask over this ensures proper fitting and is beneficial.
• The life of the virus is presumed to be 72 hours. Any N95 mask which is to be reused must be disinfected (alcohol-based disinfectant) and kept on a separate shelf for 72 hours before it is used. If used in high-risk situations, it is better to dispose these masks, instead of reusing them.
• The disinfection and reuse of these masks also requires proper protocols to deem them effective.
• Any mask will only be effective, if it is worn right. It is important to ensure a snug fit.
• Cloth masks must be worn after 8 hours of use.
• Double masking offers the advantage of adding a layer and making the mask well fitting.
• Hospital biomedical waste has been a source of infection. Proper disposal is very important.
• Washing with soap and water removes the greasy deposits on the skin.
• If you touch the mask from the outside, immediately disinfect the hands and change the mask.
• Proper use of mask and proper mask behavior is very vital to the prevention of the disease.
• Give a gap of at least 72 hours before recycling a mask.
• Patients with eczema aggravate their condition with the use of hand sanitisers.
• Hand sanitising is better than nothing; hand washing with soap and water is better than hand sanitising.

Excerpts from a presentation on “Double masking - Medical masks” by Prof Dr Ashok Gupta

Recipient of Padma Shri, Bombay Hospital Institute of Medical Sciences, Mumbai, India

Country Updates

• Philippines Update: Almost 13,000 positive cases in the last 24 hours; the total number of deaths are 28,000 and the total number of cases are 1.7 million. There have also been cases of healthcare workers who contracted mild Covid-19 after vaccination. The number of infections in children is rising. The hospitals in the capital and provinces are fully occupied.
• Japan Update: The country is experiencing the fifth wave now. There were about 20,000 positive cases. Severe infections are being reported in persons in their 40s and 50s. About 10% of patients in the ICU are in their 20s. One case of the lambda coronavirus variant has been reported in a person associated with the recently concluded Olympics.
• South Africa Update: About 13,000 cases are being reported daily; yesterday there were 13,941 cases. 15 million were tested and 2.5 million tested positive. Active cases are 150,000 and total deaths so far are 76,631, while the daily deaths are between 300-400. The recovery rate is 91.2%. Over 14,000 hospitalised patients across the country; over 2000 patients are receiving intensive care. Breakthrough infections are being reported among healthcare workers. The vaccination is slow and is not reaching the target; 160,000 people are being vaccinated per day, which is much less than the desired 300,000 vaccinations per day before December.
• Malaysia Update: More than 20,000 daily cases continue to be recorded. The number of daily deaths range between 200 and 300. About 26 million people have been vaccinated; about 9 million have received two doses. A major concern now is that many patients are being brought dead to hospitals. There were 96 such cases yesterday.
• Brazil Update: Cases and deaths are declining. Almost 50% of the population has received one dose of the vaccine. The delta variant is spreading in the country.
• Pakistan Update: The number of daily cases is increasing; now around 4000-5000 new cases are being reported every day. The delta variant is spreading. There is poor adherence to protection protocols. One-fifth of the population has been vaccinated. The government is considering booster dose if certain criteria are met such as presence of comorbidity, frontline workers ≥60 years.
• Bangladesh Update: The incidence of cases has come down due to the lockdown; new cases have reduced to 8000 per day from 16,000 per day. The number of deaths is around 200 per day. More than 8.5% population has been vaccinated with the first dose.
• India Update: Around 38K-40,000 cases continue to be recorded with contributions mainly by three states (Kerala, Maharashtra and the North Eastern). Cases in Maharashtra are declining, while cases in the state of Kerala are increasing with more than 20,000 daily cases. A death of a delta plus variant infection in a fully vaccinated person has been reported. Almost 46% people have received the first vaccine dose and 14% have received the double dose of the vaccine. But vaccination is picking up pace. No official stand yet on booster dose. Lockdown is regional with micro containment areas, but many parts of the country are opening up.
• Australia Update: NSW continues to record cases with 466 new cases in the last 24 hours. Lockdown continues in NSW, Victoria and Queensland. Vaccination (with two doses) may reach 80% by November.
• Singapore Update: Overall 82% vaccination with first dose and 74% have completed two doses. The focus is shifting to public health measures and vaccines rather than border restrictions and social restrictions.

Participants

Member National Medical Associations

Dr Yeh Woei Chong, Singapore, Chair CMAAO

Dr Ravi Naidu, Malaysia, Immediate Past President CMAAO

Dr Marthanda Pillai, India Member World Medical Council

Dr Angelique Coetzee, South Africa

Dr Akhtar Hussain, South Africa

Dr Salma Kundi, Pakistan

Dr Qaiser Sajjad, Pakistan

Dr Marie Uzawa Urabe, Japan

Dr Debora Cavacanti, Brazil

Dr Benito P Atienza, Philippines

Dr Md Jamaluddin Chowdhury, Bangladesh

Invitees

Dr Ashok Gupta

Dr Russell D’Souza, Australia UNESCO Chair in Bioethics

Dr Monica Vasudev, USA

Dr Mulazim Hussain Bukhari, Pakistan

Dr Yik Voon Lee, Past President SMA

Dr Vida Chou

Dr Jason Yip

Dr Li Ling Lim

Dr Sajeena Azeesu

Dr S Sharma, Editor IJCP Group

Moderator

Mr Saurabh Aggarwal