California urges double masking to prevent COVID spread as Texas relaxes mask rules

California officials are joining the growing call for the public to consider wearing two masks in public settings as extra protection against the coronavirus.

In new guidance released Thursday by the California Department of Public Health, officials said double masking “is an effective way to improve fit and filtration.”

“A close-fitting cloth mask can be worn on top of a surgical/disposable mask to improve the seal of the mask to the face,” the advisory says. “Layering more than two masks is not recommended as this could be difficult to breathe through. Also, it is not recommended to wear two medical masks, or to wear a medical mask on top of a KN95 or an N95.”

At a public event Thursday, Gov. Gavin Newsom reiterated that advice, saying that even though some states have decided to relax their mask rules, Californians should double down on face coverings.

“We will not be walking down their path. We’re mindful of your health and our future,” he said.

Texas this week lifted its face mask rule, joining a rapidly growing movement by governors and other leaders across the U.S. to loosen COVID-19 restrictions despite pleas from health officials to not let down their guard. President Biden later criticized the move.

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California health experts, however, are still recommending extra protection, including recommendations now on double masking:

• In indoor spaces, with people from outside your household.
• In close quarters with other people where social distancing is not possible (examples: riding a crowded bus, waiting in line at a crowded airport terminal).
• In any public place for people who are older or who have medical conditions that put them at higher risk of severe COVID illness.

A federal report released in February also recommended wearing two masks in some cases. The Centers for Disease Control and Prevention found wearing a cloth mask over a medical one can substantially reduce a wearer’s exposure to potentially infectious aerosols. Adjusting a medical mask to fit more tightly can also provide similar protection, the report said.

Recent lab tests conducted with dummies found that both the cloth-medical mask combination and the tighter-fitting medical mask decreased exposure by about 95%, the CDC said.

That should come as little surprise, given that the coronavirus spreads most commonly in the air, when someone inhales infectious droplets or other tiny respiratory particles. Experts and officials have long noted that properly fitted masks and other face coverings can help prevent person-to-person transmission.

The CDC report is not without caveats, though. Its takeaways are limited by the nature of the experiments, which “were conducted with one type of medical procedure mask and one type of cloth mask” and “did not include any other combinations of masks, such as cloth over cloth, medical procedure mask over medical procedure mask, or medical procedure mask over cloth.”

Still, securing additional protection remains an important consideration, officials say, especially as potentially more contagious coronavirus variants continue to circulate across the country.

“Until vaccine-induced population immunity is achieved, universal masking is a highly effective means to slow the spread ... when combined with other protective measures, such as physical distancing, avoiding crowds and poorly ventilated indoor spaces and good hand hygiene,” the report states. “Innovative efforts to improve the fit of cloth and medical procedure masks to enhance their performance merit attention.”

Double masking is not the only way to achieve enhanced protection. The report found that knotting the ear loops and tucking in the extra material of a medical procedure mask provided beefed-up protection as well, and health officials noted that using mask-fitter devices “or placing a sleeve made of sheer nylon hosiery material around the neck and pulling it up over either a cloth or medical procedure mask” also could afford additional benefit.

Wearing two masks also isn’t for everyone, as doing so “might impede breathing or obstruct peripheral vision for some wearers,” according to the CDC report.

The recent experiments’ findings also “might not be generalizable to children because of their smaller size or to men with beards and other facial hair, which interfere with fit,” the report stated.