May 26th: COVID-19 and Masks
(Updated 7/21/2020) Seeing lots of posts these days about masks. People are using every means necessary to justify not wearing a mask because everyone is tired of social distancing and wearing masks and not doing the same things they used to do. So a lot of what I’m seeing is trying to use science to put down others for wearing masks. I had one conversation yesterday in which it was suggested that we need a refresher in when, where, and how to wear masks. So let’s talk about masking.
1. DO MASKS PROTECT ME? This comes down to explaining the purpose of the mask. The surgical mask or cloth mask (not the N95) is designed to protect the environment and others from the wearer. In the OR, masks to protect the patient’s surgical field from being contaminated by wearers’ breath and droplets that come out of their mouth and nose. They do not offer the protection to the wearer like a properly fitted N95, but that was never their purpose. That does not mean that we shouldn’t wear them, though.
2. SO WHY WEAR A MASK? To protect those around you. This is the main reason to wear masks. We wear masks in the hospital (well, we did pre-COVID) to avoid transmitting whatever germs we’re harboring between patients (same reason we wear those plastic gowns and then remove them). Like so many aspects of healthcare, this requires everyone, not just healthcare workers, to consider those around them as much as, if not more than, themselves. If two people come within close quarters of each other, each wearer’s mask provides a modicum of protection to the other.
3. DO MASKS ACTUALLY WORK AGAINST VIRAL TRANSMISSION? To an extent, yes. Below is a link to a study where they compared multiple fabrics to surgical masks and an N95 mask against droplets. The droplets are larger than the aerosolized particles that are particularly worrisome (the same transmission method in pulmonary tuberculosis), but most of the evidence points toward droplet as the method of transmission for SARS-CoV-2, except in cases like BiPAP, intubation, bronchoscopy, or what we call “aerosol-generating procedures.” But check it out – when used in multiple layers, with non-porous fabrics like high thread count cotton, and when properly fitting, they can be really efficacious at reducing transmission of viral droplets. Which is easier said than done, because you have to put it on properly and there shouldn’t be a gap. Link in comments.
4. SO WHY SHOULDN’T I WEAR AN N95 MASK? You need proper fit-testing first (try mask on, go under little hood, Employee Health nurse sprays scent in, honestly judge if you still smell it). Prior to COVID-19, most healthcare workers (HCWs) were a bit lax about this – not anymore. This is why I shaved my beard for COVID – the mask can’t seal onto my face if there’s facial hair. The second reason is simply that there are not enough N95s for HCWs, let alone for the general public, so the priority must unfortunately fall to the folks who have to get up close and personal with known positive patients, to protect themselves.
5. WHY DO I NEED TO WEAR A MASK IF I’M DISTANCING? WHY DO I NEED TO DISTANCE IF I’M WEARING A MASK? For the same reason seatbelts/airbags/traffic lanes/traffic lights are all utilized and required for safety. Not one of those things is 100% effective in preventing bodily harm in accidents, but all of them in combination provide some level of protection and are important for the safety not only for the driver, but the other folks on the road. In the same way, the mask provides at least some filtration of droplets and prevents them from spreading to others, but with issues like improper fit, they aren’t always as effective as they could be. Thus we have continued physical distancing, maintaining the gap between people of different households to avoid spread between asymptomatic carriers.
6. I’M A YOUNG AND HEALTHY PERSON, WHY DO I NEED TO BOTHER WITH ALL OF THIS? WHAT IF I JUST WANT TO LIVE MY LIFE? Because it’s not just about you. You as a young and healthy person can still get it and be hospitalized, and even if you don’t get symptoms or the infection, you can spread it to others. I’ve had too many patients that, even though they mostly did the right thing, all it took was one accidental exposure to result in their hospitalization.
7. WHERE DO I GET A MASK? HOW SHOULD I WEAR MY MASK? There are many people, both around you and online, making masks and ear savers (to make wearing them easier); you can also get templates online and make our own! In addition, the Surgeon General and a few others have put out great videos demonstrating how to make (multi-layered) cloth masks without sewing, with just a handkerchief and rubber bands. Make them cute! Find fun patterns, make them unique to you! Just try to make sure they’re non-porous materials (high thread count cotton). The mask should cover your nose and mouth, enough that when you talk it should stay over your mouth and nose. You should wear it anytime you’re going to be around people that aren’t in your household. And once it’s on, DON’T TOUCH IT! We’re a tactile species, so don’t let the germs that get on your hand get to your mask/face. And keep sanitizing.
8. WHAT ABOUT CARBON DIOXIDE POISONING FROM THE MASK? That doesn’t actually happen. The one study that seemed to point to that had less than ten patients, used a different mask, and results are unable to be replicated in subsequent studies. Besides, if surgical masks caused carbon dioxide poisoning, surgeons would be suffering its effects every day. That doesn’t happen. Not even after the longest of surgeries.
As always, ask questions. I know this is a frustrating time, and no one actually wants to wear a mask or take these other precautions. We wouldn’t be recommending or pushing for this if the situation wasn’t still potentially dangerous. And as things reopen, businesses are doing their best to make things work and keep their customers safe. So do try to cut them some slack! Credit to Dr. Megan Ranney for sharing the article.
1. There are few, if any, medical exemptions to wearing a mask. People with asthma, COPD, and cystic fibrosis can all wear masks. If you have a condition where your breathing is made more difficult by just putting on a mask, you should not be walking around a store or other public place. You should consider going to see your doctor/NP/PA. Also, the ADA does not provide any grounds for you to walk around without a mask.
2. If you feel lightheaded or your anxiety is exacerbated by a mask, you should seek out alternate means of making your purchase - curbside pickup, delivery, friends. And, for a lack of better option, see your counselor/psychiatrist, because unfortunately the need is not going away.
3. Cloth and surgical masks do not filter gas molecules. So they cannot affect your oxygen or carbon dioxide levels. They cannot affect your oxygen or carbon dioxide levels. They cannot affect your oxygen or carbon dioxide levels.
4. Every major medical body, as well as the CDC (despite attempts to discredit them), NIOSH, and OSHA, all recommend the use of masks.
5. Again, cloth/surgical masks protect others from your oral/nasal droplets. If you happen to be an asymptomatic carrier, the mask is a simple way to help ensure that others do not get infected (not 100% effective, but at least it’s something). Others wearing masks protect you from their droplets. If everyone wears masks, we can prevent the spread.
Aerosol Filtration of Masks: