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Double-masking not necessary, proper mask usage more important: Singapore experts

Wong Casandra
·Senior Reporter
·4-min read
People wait at an observation area after their vaccination at a coronavirus disease (COVID-19) vaccination center in Singapore March 8, 2021. REUTERS/Edgar Su
People wait at an observation area after their vaccination at a coronavirus disease vaccination centre in Singapore on 8 March, 2021. (PHOTO: Reuters)

SINGAPORE — There is no need to mandate double-masking in Singapore and what is more important in the fight against the COVID-19 pandemic is the proper use of face masks, local experts said.

Their comments come on the back of a report released last month by the US Centres for Disease Control and Prevention (CDC) showing that double-masking can significantly improve protection against the coronavirus, as does tying knots on the ear loops of surgical masks. The CDC in the same month updated its mask-wearing guidelines to reflect the findings.

In laboratory-based experiments conducted in January, CDC researchers found that by layering a tight-fitting cloth mask over a medical procedural mask, such as the ubiquitous blue surgical mask, 85.4 per cent of cough particles can be blocked from escaping an unmasked person.

Comparatively, a single medical mask or cloth mask blocked only 56.1 per cent and 51.4 per cent, respectively. When both parties – a "simulated" source and receiver – were double-masked, it reduced the cumulative exposure of the latter by 96.4 per cent.

The US CDC lab compared how effective different mask techniques are in blocking small viral particles – an unknotted and untucked surgical mask, a cloth mask over a surgical mask, and a knotted and tucked surgical mask. (PHOTOS: US CDC)
The US CDC lab compared how effective different mask techniques are in blocking small viral particles – an unknotted and untucked surgical mask, a cloth mask over a surgical mask, and a knotted and tucked surgical mask. (PHOTOS: US CDC)

However, Japanese supercomputer simulations in March contradicted these findings, with results indicating that double-masking brought limited benefit in blocking the spread of COVID-19, compared with a single properly fitted mask.

Dr Paul Tambyah, senior consultant at Singapore's National University Hospital and president-elect of the International Society of Infectious Diseases, pointed out that the data from the CDC applied to experimental settings, with “no strong evidence” that it is relevant to actual clinical conditions in the real world.

“In fact, without double-masking, the incidence of COVID-19 has dropped significantly worldwide,” said the infectious diseases expert.

While findings of the CDC’s study are highly useful and informative, Dr Kristen Coleman, senior research fellow at Duke-NUS Medical School Emerging Infectious Diseases programme, stressed that current measures in Singapore, such as legislating single-mask wearing, provide adequate protection to the population here.

Since 14 April last year, it was mandatory for people in Singapore aged six and above to wear a mask when they step out of their residences, with some exceptions. For instance, those engaging in exercise such as running or jogging can take them off, but they must put them back on after completing the activity.

Under the Ministry of Health guidelines, the general public is advised to wear “a mask that closely and completely covers the nose and mouth”.

Those who do not comply face a $300 fine for first-time offenders. Repeat offenders will face higher fines or prosecution in court for egregious cases.

However, if the COVID-19 situation in Singapore were to worsen with a spike in cases, authorities may have to consider making double-masking mandatory, according to Dr Coleman.

“Given the promising results of the study, double-masking – if feasible – or the use of tighter fitting masks should be encouraged, especially for those working in high-risk settings,” she added.

Dr Leong Hoe Nam, an infectious diseases specialist at Mount Elizabeth Novena Hospital, noted that while double-masking can be effective, the bigger issue is getting the general public to mask up properly – be it wearing a single mask or two.

“Using two masks is akin to wearing two seat belts. Yes, it does help in some situations but getting belted up is the more important measure,” said Dr Leong, adding that he does not expect authorities here to mandate double-masking.

“If there are compliance issues with wearing a single mask, wouldn't there be double the compliance issue with two masks?”

Rather, Dr Leong stressed, the general public must focus on getting the basics right by using a certified mask, and wearing it consistently and properly.

“Wearing a proper mask correctly saves lives. That is the bottom line,” he said.

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