For Joe Biden, two face masks are better than one in the era of COVID-19

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WASHINGTON – As President Donald Trump questioned the efficacy of mask wearing during a town hall Thursday night, Democratic challenger Joe Biden was doubling down.

Literally, as Biden likes to say.

The former vice president said he arrived at the National Constitution Center in Philadelphia for his separate town hall with an N95 mask under the blue surgical mask that he wore onto the stage.

"I walked in here with this mask, but I have one of the N95 masks underneath it. And I left it in the dressing room, the room I was in before I got here," Biden said when talking about the importance of masks to stop the spread of COVID-19 – and the importance of modeling good behavior.

"When a president doesn't wear a mask, or makes fun of folks, like me, when I was wearing a mask for a long time, then people say, well, it mustn't be that important," Biden said on ABC.

Photographs show Biden has worn double masks at other times on the campaign trail, including when he got off his plane in Fort Lauderdale Tuesday and when he boarded a plane to Michigan Friday.

A member of the charter aviation company that was on Tuesday's flight later tested positive for COVID-19. The campaign said Thursday that Biden didn't need to quarantine because he was never in close contact with the staffer. Biden wore his N95 mask throughout the flight, according to the campaign.

Biden's campaign did not respond to a request for comment on why he wears two masks and when he started the practice.

Wearing two face masks to reduce the risk posed by the coronavirus, Democratic presidential nominee Joe Biden boards a flight to Michigan at New Castle County Airport October 16, 2020 in New Castle, Delaware.
Wearing two face masks to reduce the risk posed by the coronavirus, Democratic presidential nominee Joe Biden boards a flight to Michigan at New Castle County Airport October 16, 2020 in New Castle, Delaware.

Dr. William Schaffner, a professor and infectious disease expert at the Vanderbilt University School of Medicine in Nashville, Tennessee, said he's not aware of any recommendation, or medical study, about wearing a surgical mask over an N95.

"It’s a practice with which I’m not familiar," he said. "I don't know that the surgical mask adds anything."

Worn properly, an N95 is "extremely effective" at preventing the mask wearer from both getting and spreading a virus, he said.

A second mask, Schaffner speculated, might be worn out of an abundance of caution and to "give the visual cue that they're taking mask wearing seriously."

"But certainly we don't do that in the health care setting," he added.

Dr. Sonja Rasmussen, a professor of pediatrics and epidemiology at the University of Florida College of Medicine and College of Public Health and Health Professions, said a surgical mask can protect the N95.

"It can serve as an outer barrier and extend its use by serving as a physical barrier to potentially infectious liquids and droplets," Rassmussen, who previously worked on pandemic planning at the Centers for Disease Control and Prevention, wrote in an email to USA TODAY.

Dennis Alex, a hospitalist nurse practitioner who has been caring for COVID-19 patients in Buffalo, N.Y., said he and his colleagues have been wearing surgical masks to preserve their N95s.

“If we had adequate supplies of PPE, we wouldn’t need to reuse n95s or double mask,” Alex wrote in an email.

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During Trump's town hall on NBC, he was asked whether contracting the virus changed his opinion about mask wearing – which he has insisted is a personal choice.

"No, because I was OK with the masks," Trump said. "I was good with it but I’ve heard many different stories on masks."

The president claimed there's a "statement that 85% of the people that wear masks catch it."

"People with masks are catching it all the time," Trump said of COVID-19.

Schaffner said Trump's comment is a "total misinterpretation of the data" from the CDC.

"Masks are fundamental," he said. "They are cheap. They work. And they're harmless."

ICU doctors: Many more Americans need to wear N95 masks to slow COVID-19

During the NBC town hall, moderator Savannah Guthrie noted that the White House's coronavirus task force cites the University of Washington's Institute for Health Metrics and Evaluation, which says that if everyone wore a mask it could cut the death rate in half. More than 215,000 Americans have died of COVID-19 so far.

"You have other places that say lots of other things,' Trump said, before conceding: "I'm fine with it. I have no problem."

Contributing: John Fritze and Bart Jansen.

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This article originally appeared on USA TODAY: Joe Biden, guarding against COVID-19, is wearing two face masks