Wearing masks is making it harder on people who have difficulty hearing.

A recent survey by the Hearing Loss Association of America found that 95% of respondents with hearing loss say masks and facial coverings have created communication barriers since the COVID-19 pandemic began.

Masks make it harder to communicate in multiple ways. It muffles sound, making it difficult to understand speech and some higher-pitched voices.

Masks also take away a person’s ability to read lips and see facial expressions, both of which help people better understand what is being communicated. This is true for everyone, but especially for those with hearing loss.

As government and public health officials increasingly recommend the practice of wearing two masks to help protect against new and more contagious variants of COVID-19, the American Speech-Language-Hearing Association is encouraging everyone to be aware of the challenges this measure will pose to the 48 million Americans who are deaf or hard of hearing and to take some simple steps to make communication more effective.

“ASHA strongly supports all public health measures designed to prevent the spread of COVID-19,” said A. Lynn Williams, ASHA president. “However, we also want to make the public aware of the tremendous challenges that people who are deaf or hard of hearing are experiencing right now, which are only poised to increase with double masks.

“When messages aren’t received correctly, this can result not only in frustration, but also put people at risk for serious harm, especially in medical or emergency situations. It’s important for everyone to do their part to make communication more effective.”

ASHA has previously urged the use of clear masks, when possible, to allow people who are deaf or hard of hearing to read lips and see facial expressions — particularly in health care settings.

ASHA recommends the following actions to help improve communication for those with hearing loss:

Move to a quiet place if you can.
Make sure you have your communication partner’s attention before speaking.
Face your partner directly, and make sure nothing is blocking your view.
Talk a little louder (but don’t shout).
Talk a little slower.
Use your hands and your body language.
Ask your partner if they understood you; if not, say it a different way or write it down.
If you’re talking with someone new, ask if there’s anything you can do to make communication easier for both of you.
Use other forms of communication if necessary, such as speech-to-text apps.

Article originally appeared on The Advocate