13:44 GMT28 February 2021
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    Nearly a year ago, Norwegian health officials said masks were "a cultural thing" typical of parts of Asia and suggested they had few benefits. Now, Norway is considering changing its recommendations to include double masking.

    Despite previous scepticism, Norwegian health authorities are now considering recommending the use of two face masks on top of each other, after a US study suggested that it can provide better protection against coronavirus, national broadcaster NRK reported.

    The US Centres for Disease Control and Prevention (CDC) published a study on Wednesday, which concludes that the use of two masks sitting tightly around the face can drastically increase protection against COVID-19.

    Norway's Assistant Director of Health Espen Rostrup Nakstad agreed that it can provide a better effect and admitted that the National Institute of Public Health will look at the new advice from the CDC and assess whether Norway should also recommend cloth masks on top of surgical masks in certain cases.

    "It can give great effect to actively cover leaks from face masks that do not fit optimally in the face. This can be done by using an external fastening device or a cloth mask that presses the edges of the surgical mask closer to the face, so that no air leaks on the sides", Nakstad told NRK, reminding fellow Norwegians to always check that the mask covers over the tip of the chin and the nose, and to squeeze the noseband around the bridge of the nose to prevent air leakage.

    Senior adviser at the National Institute of Public Health Mette Fagernes said the American study confirms the importance of masks fitting as tightly as possible.

    "Many people have a lot to gain when it comes to making the masks sit tightly. Some of those on the market have a poor fit. Therefore, we have previously recommended that you can consider tying a knot on the elastics to shorten them, and this is seen in this study to have an effect", Fagernes mused.

    She, too, didn't rule out that the National Institute of Public Health will update its recommendations, but said that there are some challenges with using two masks.

    "It can, among other things, affect breathing. Some people find it uncomfortable to wear a face mask, and if you go with two on top of each other, it will make it even more uncomfortable. We know that when it feels uncomfortable, you will feel the need to fiddle with it a bit and pull at it to get more air in. Then it is important to remember the advice to avoid touching the mask", Fagernes told NRK.

    She said that the National Institute of Public Health currently has no objections to putting something on the outside of the mask for a better fit.

    This indicates a considerable evolution in Norway's approach to masks. In January 2021, the very same Nakstad said that there is no infection control justification for recommending double masks. In January 2020, chief physician at the National Institute of Public Health Preben Aavitsland said it was "a cultural thing in parts of Asia" to wear masks against viruses such as the flu, emphasising there are "no good indications" it has anything to show for itself.

    In the CDC study, researchers found that wearing a surgical mask underneath a cloth mask – a concept known as double masking – provides substantial benefits, reducing the risk of infectious aerosols by 90 percent. In comparison, a medical mask without a knot shut out 42 percent of the aerosols, whereas a cloth mask blocked 44.3 percent.

    US disease chief Anthony Fauci has so far been one of the most high-profile proponents of double masking, suggesting that it "made sense". Photographs of Fauci wearing two masks have previously drawn scepticism and ridicule online.

    Norway has so far seen over 65,000 cases of COVID-19, with nearly 600 deaths. However, the country has introduced a number of regional and national restrictions and cancelled international events, including NATO drills and sports tournaments, for fear of spreading mutated corona strains.

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