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Fitted Filtration Efficiency of Double Masking During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Although global vaccination efforts against SARS-CoV-2 are underway, the public is urged to continue using face masks as a primary intervention to control transmission.1 Recently, US public health officials have also encouraged doubling masks as a strategy to counter elevated transmission associated with infectious SARS-CoV-2 variants.2 US Centers for Disease Control and Prevention investigators reported that doubling masks increased effectiveness, but their assessment was limited in type and combinations of masks tested, as well as by the use of head forms rather than humans. To address these limitations, this study compared the fitted filtration efficiency (FFE)3,4 of commonly available masks worn singly, doubled, or in combinations.

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Article Information

Accepted for Publication: March 26, 2021.

Published Online: April 16, 2021. doi:10.1001/jamainternmed.2021.2033

Corresponding Author: Emily E. Sickbert-Bennett, PhD, MS, Infection Prevention Department, UNC Medical Center, 101 Manning Dr, 1063 West Wing, Infection Prevention CB 7600, Chapel Hill, NC 27516 (emily.vavalle@unchealth.unc.edu).

Author Contributions: Dr Bennett had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sickbert-Bennett, Samet, Bennett.

Acquisition, analysis, or interpretation of data: Samet, Prince, Chen, Zeman, Tong, Bennett.

Drafting of the manuscript: Sickbert-Bennett, Samet, Prince, Bennett.

Critical revision of the manuscript for important intellectual content: Sickbert-Bennett, Samet, Chen, Zeman, Tong, Bennett.

Statistical analysis: Chen.

Obtained funding: Sickbert-Bennett.

Administrative, technical, or material support: Sickbert-Bennett, Samet, Prince, Tong, Bennett.

Supervision: Samet, Bennett.

Conflict of Interest Disclosures: Dr Bennett reported grants from the US Centers for Disease Control and Prevention and the US Environmental Protection Agency (EPA). No other disclosures were reported.

Funding/Support: This study was supported by the Duke University–University of North Carolina Prevention Epicenter Program for Prevention of Healthcare-Associated Infections (U54CK000483) through the US Centers for Disease Control and Prevention and a cooperative agreement between the University of North Carolina at Chapel Hill and the EPA (CR 83578501).

Role of the Funder/Sponsor: Members of the Duke University–University of North Carolina Prevention Epicenter Program for Prevention of Healthcare-Associated Infections were responsible for the design and conduct of the study. Investigators working under the cooperative agreement between the University of North Carolina at Chapel Hill and the EPA were responsible for the collection, management, analysis, and interpretation of the data.

Disclaimer: The research described in this article has been reviewed by the EPA’s Center for Public Health and Environmental Assessment and approved for publication. The contents of this article should not be construed to represent agency policy nor does mention of trade names or commercial products constitute endorsement or recommendation for use.

Additional Contributions: We thank Philip J. Clapp, PhD, of the Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina at Chapel Hill School of Medicine, for study design and critical review; Jon Berntsen, PhD, of TRC in Raleigh, North Carolina, for technical support; and David J. Weber, MD, MPH, of the Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, and Deverick J. Anderson, MD, MPH, of the Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, for critical review. No compensation was provided for their efforts.

References
1.
Honein  MA , Christie  A , Rose  DA ,  et al; CDC COVID-19 Response Team.  Summary of guidance for public health strategies to address high levels of community transmission of SARS-CoV-2 and related deaths, December 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(49):1860-1867. doi:10.15585/mmwr.mm6949e2 PubMedGoogle ScholarCrossref
2.
Brooks  JT , Beezhold  DH , Noti  JD ,  et al.  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(7):254-257. doi:10.15585/mmwr.mm7007e1 PubMedGoogle ScholarCrossref
3.
Clapp  PW , Sickbert-Bennett  EE , Samet  JM ,  et al; US Centers for Disease Control and Prevention Epicenters Program.  Evaluation of cloth masks and modified procedure masks as personal protective equipment for the public during the COVID-19 pandemic.   JAMA Intern Med. 2021;181(4):463-469. doi:10.1001/jamainternmed.2020.8168 PubMedGoogle ScholarCrossref
4.
Sickbert-Bennett  EE , Samet  JM , Clapp  PW ,  et al.  Filtration efficiency of hospital face mask alternatives available for use during the COVID-19 pandemic.   JAMA Intern Med. 2020;180(12):1607-1612. doi:10.1001/jamainternmed.2020.4221 PubMedGoogle ScholarCrossref
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