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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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
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 (firstname.lastname@example.org).
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.
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