It might be time to double up, Michigan.
Three new, highly contagious mutations of coronavirus with origins in the United Kingdom, Brazil and South Africa are circulating in the U.S. — upping the stakes in the battle to stanch a pandemic that has already claimed the lives of more than 430,000 Americans, of whom about 14,500 are from Michigan.
It has led some public health experts, including Dr. Anthony Fauci, chief medical adviser to President Joe Biden on COVID-19, to recommend layering up on masks or opting for a more protective N95 mask when going out in public.
Masks cover the mouth and nose to limit respiratory droplets and virus particles from getting in or out, Fauci, who also is the director of the National Institute of Allergy and Infectious Diseases, explained on NBC’s “Today” show.
“So if you have a physical covering with one layer, you put another layer on, it just makes common sense that it likely would be more effective and that’s the reason why you see people either double masking or doing a version of an N95,” he said.
Dr. Matthew Sims, an infectious disease specialist at Beaumont Health, said it’s a strategy people should consider, especially given the rate at which these newer, more transmissible variants appear to spread.
“The idea with double masking … is that if the three layers in your surgical mask are good, put on three more layers, it holds it tighter to your face, and that’s better,” Sims said. “And it probably is because it’s just more filtration.”
Research published in the journal Matters supports the theory, finding that when a nylon layer is worn over a surgical-style mask, it improves the fit and effectiveness of filtration of virus particles from a range of 53%-75% to up to 90%.
At least 434 cases of the U.K. variant B.1.1.7 have been detected in 30 states, including Michigan, according to the U.S. Centers for Disease Control and Prevention. It is estimated to be about 50% more transmissible than previous strains of the virus, and scientists in the U.K. suggest it also could be more deadly, though studies are ongoing to determine that.
As of Friday afternoon, Michigan had 22 confirmed cases of the U.K. variant — 16 in Washtenaw County linked to an outbreak among student-athletes at the University of Michigan, and six cases in Wayne County, said Lynn Sutfin, a spokesperson for the state health department.
An additional 300 coronavirus tests were undergoing whole genome sequencing Friday in Michigan to see whether they, too, are of a variant strain. But, Sutfin noted, “this doesn’t mean we think there are 300 more (variant) cases at this time;” some of those samples are being sequenced as part of statewide surveillance.
The CDC warned earlier this month that its projections suggest the U.K. variant could become the dominant strain in the United States in March, and if that happens, it could drive up not only case rates, but hospitalizations and deaths.
How the U.K. variant spreads
Research is still underway to understand how the U.K. variant and others spread and what makes them so contagious.
“There are still a lot of unknowns about the variant that is circulating now,” said Amanda Valyko, director of infection prevention and epidemiology at Michigan Medicine, referring to the U.K. strain. “It might be that people who have it shed more virus. If you have more virus, there’s more opportunities to infect somebody. Perhaps it can bind more easily to cells.
“If something is 50% more transmissible, we usually describe disease transmission … using what we call the R0 (pronounced ‘R naught’) or the reproductive rate, which is essentially how many people become infected from one case.”
A virus with a reproductive rate of 1.2 would mean that if there are 10 infected people, they would go on to infect 12 new people.
“If you increase that by 50%, it makes your reproductive rate 1.8,” Valyko said. “That means 10 people infect 18 people instead of 12. So when you apply that on a population level, it’s many, many, many more cases and many, many, many more opportunities for people to get the virus, transmit the virus, become hospitalized with the virus, etc.”
Scientist also are tracking two other coronavirus variants that have popped up in the U.S. that are more contagious. One is called the B.1351 variant, which originated in South Africa and has some similar mutations as the U.K. strain. It has been detected in South Carolina and Maryland, and preliminary research suggests current COVID-19 vaccines and therapies may not be as effective.
“We are more concerned about the South African strain right now because when you do studies in the test tube … it shows that the ability of monoclonal antibodies that have been used for therapy … don’t nearly work as well as treatment,” Fauci said.
“There’s enough cushion with the vaccines that we have that we still consider them to be effective against both the U.K. strain and the South African strain. But we don’t want to take that lightly because these things continue to evolve.”
The two cases of the South African variant in South Carolina were among people who didn’t have contact with one another and didn’t travel internationally, said CDC Director Rochelle Walensky. That means there is likely community spread that has until last week gone undetected.
“We were always concerned that we had it here and we hadn’t yet detected it, and now we have evidence of these two cases in South Carolina that it is, in fact, here,” Walensky said. “The presumption is, at this point, that there has been community spread of this strain.
“When viruses mutate and they develop strains and dominant strains, they usually do so for some advantage to the virus that may come to the tune of our vaccines not working as well.”
COVID-19 vaccine manufacturer Moderna said it is testing the possibility of offering a third booster shot to further protect people from the South African strain of the virus.
A third highly transmissible variant called P.1, which originated in Brazil, also has been identified in a person in the Minneapolis/St. Paul area of Minnesota. The person reported recent travel to Brazil and is in quarantine. It is not yet known whether the P.1 variant causes more severe illness, though some research suggests this strain of the virus might lead to cases of reinfection.
Choosing a mask (or two)
Masks are just one tool the public can use to protect themselves, said Sims, whose research earlier in the pandemic showed masks were effective in slowing the spread of coronavirus among health care workers.
The state health department requires Michiganders to wear masks anytime they are within 6 feet of others not from their household. And the CDC issued a public health order requiring masks on planes, buses, trains, and other forms of public transportation, including airports, train and bus stations, beginning Feb. 2.
But even before these highly contagious variants began to circulate in the U.S., masks were never expected to reduce the transmission rate to zero, he said. But they do slow the spread, and research suggests that mask-wearers who still end up contracting the virus are more likely to be asymptomatic carriers.
N95s were shown to be most protective, Sims said, followed by surgical masks and multiple-layer cloth masks. The worst outcomes came with wearing no mask at all.
“If you wore a better mask, you get a lot less infections, and you also got more asymptomatic infections,” Sims said of his research. “So, even though somebody might have gotten it if they were wearing an N95, they were less likely to develop symptoms, probably because they only got a little bit of virus a lower inoculum, a lower viral load.
“Gaiters, bandannas, those sort of things, probably don’t do very much at all, but they’re better than nothing.”
Wearing more than one mask can help boost your protection, Valyko said, in certain circumstances.
‘If you don’t have a well-fitting mask or you have a really thin single-layer mask, it might help enhance the filtration and give you better coverage or a better seal around your nose and mouth,” she said.
“If you do opt to double up on masks, you want to make sure you don’t impede your breathing with too many layers. You want to make sure that you’re really helping to enhance the seal around your face and hold your mask in place.”
And if the urge to adjust your masks is too much to resist, Valyko warned that double masking might not be for you.
“One pitfall that I often observe is that probably unknowingly they’re adjusting their masks more,” she said, when they double up. “They’re putting their hands on their face more. One really critical piece of mask wearing is once you put it on, really try to avoid touching it. If you have to adjust it a lot, maybe it’s not a good fit.
“If you do need to adjust it, make sure you do that with clean hands. It is really key to not cause cross contamination and put yourself at risk. And doubling up on your mask layers … doesn’t negate the need for distancing and hand washing.”
Still, the U.S. Centers for Disease Control and Prevention isn’t recommending doubling up on masks and neither are state health officials, who say people ideally should consider one of these options:
- A three-layered, washable cloth mask
- A medical-grade disposable masks, such as a surgical mask
- An approved N95 or KN95 mask
But even if you have one of these recommended masks, it won’t do you any good if you don’t wear it properly.
“Your mask should be worn over your mouth and your nose every time you’ll be around someone who is outside of your household,” said Dr. Joneigh Khaldun, the state’s chief medical executive. “A mask is not effective if it’s only over your mouth or if it’s around your chin.
“Wearing a mask is still one of the most important things you can do to slow the spread of COVID-19, including the new variants,” she said. “You want to at least wear a multiple-layer cloth mask. Masks that have a single layer are not as protective. You can also wear a KN95 mask, or a multiple-layer disposable mask.
“You can also wear a face shield over your mask for additional protection, but please remember that face shields alone, without a mask over the mouth and nose, are not as protective so you want to wear both.”
It could be quite some time before mask restrictions are lifted, Sims said. Even if you are among the roughly 175,000 Michiganders who’ve already gotten their second dose of a COVID-19 vaccine, he said it’s still important to wear a mask.
“We don’t know for sure whether they can transmit the virus to other people,” Sims said, “but it’s certainly possible. There are studies going on looking at that
“Even with very good vaccines, they’re not perfect. And so even at best, 1 in 20 people did not get full protection, 5%. The whole goal of this is to get the country to herd immunity. To do that we need … a large number of people to be vaccinated, and we’re nowhere close to that yet.
“I’ve gotten the vaccine … and every time I walk out of this house, I’m still wearing a mask. … We need a large portion of the population vaccinated before we’re going to be able to walk around without masks.”
Contact Kristen Shamus: [email protected] Follow her on Twitter @kristenshamus.