Image from CDC website

COVID-19: TO MASK OR NOT TO MASK?

After 40 years in the operating room, sterile technique is second nature to me. So a couple of weeks ago, when I went supermarket for its 7am Senior Hour (which turned out to be a mob scene) I wore a mask and gloves. As I waited in the checkout line, a woman a couple of carts away called out to me, “You’re not supposed to be wearing a mask unless you’re sick.”

My answer was brief: “How do you know I’m not sick?”

She was well-informed about the CDC guidelines at that point in time. But a guideline is not a rule. It is a recommendation by an expert panel for best practices, based on available data and the current situation. Actual practice can vary according to good judgment.

In my case, I had flown home from Canada a few days earlier.

It was a long journey that required two plane changes. My husband and I were among 4 passengers on the flight from Montreal to Orlando. Although I felt perfectly fine, travel carries a risk of infection, and it is possible to be infected without symptoms.

I did not want to take a chance on spreading the disease.

There were good reasons for the prior recommendation that masks should only be used by people with symptoms or health care workers caring for sick patients.

Rationale against masks for the general public

Reason # 1: Rationing

Surgical and N95 masks are in short supply. They should be reserved for those who work on the front lines and have a great risk of exposure to the virus. A recommendation for the general public to wear masks could result in panic buying, with PPE selling like hot cakes or toilet paper.

Reason #2: Not necessary

The prior consensus was that social distancing and handwashing and urging people to stay home if they were sick would sufficiently reduce spread. The general belief was that COVID-19 is primarily transmitted by large droplets from coughing or sneezing and that people are exposed by touching contaminated surfaces.

Reason #3: Potential harm

Wearing a mask can produce a false sense of security and improper use by inexperienced people could actually increase your risk of exposure.

WHAT HAS CHANGED?

NOT Reason #1: Rationing

It is more important than ever to restrict use of medical grade masks to health care workers. Surgical and N95 masks have become critically scarce. Proper use of PPE involves discarding a mask after use, but now health care workers are often obliged to reuse them day after day. This is extremely dangerous both to these workers and patients. Medical grade masks should be conserved for exclusive use by those who put their own lives at risk to save others.

Reason #2: Masks now deemed vital

Our understanding of COVID-19 disease spread has evolved. It is now clear that distancing and handwashing are not enough. The virus can be transmitted in the air without sneezing or coughing. It can become suspended in the air during talking or singing, as shown by a tragic choir practice on March 10.

60 songsters showed up for rehearsal. No one was sick. They observed social distancing and did not share music. But in less than 3 weeks, 45 came down with COVID-19, and 2 were dead.

There is increasing evidence for the role of airborne transmission. Viral particles can be aerosolized during talking or even breathing. This poses a great risk to people serving the public. Recently, a Detroit bus driver posted an emotional video, bitterly complaining about passengers coughing without covering their mouths. Two weeks later, he died of COVID-19. Universal use of facemasks in public could avert tragedies like this.

Wide use of masks will reduce the spread of disease, and ultimately save lives. But the general public should use cloth masks rather than depleting supplies of medical grade masks.

Reason #3: Potential Harm, but outweighed by benefit

There is still a danger that wearing a mask could confer a false sense of security, with decreased vigilance in social distancing and hand washing. Wearing a mask does not prevent you from catching COVID-19. It does not filter out the smallest particles in the air, which are increasingly suspected in the transmission of the disease. Improper use of a mask could actually increase your risk of becoming infected. The chief purpose of the mask is to protect others. It is incumbent on all of us to use face masks and understand the proper way to wear them.

HOW TO USE A FACE MASK

A facemask should fit snugly over the nose and mouth and be constructed of at least two layers of tightly woven fabric. Knit fabrics, such as T-shirts, are too porous. Scarves are not an effective substitute for a mask because the ends can flutter around and touch contaminated surfaces. Moreover, they are usually constructed of very porous fabric.

The surgeon general posted a video demonstrating one way to make a mask using cloth and rubber bands.

The CDC has posted other methods for construction.

Proper use:

Wash your hands before putting on a mask. Do not touch it again until you are ready to take it off. Resist the urge to rub your nose. Don’t reach up under the mask for any reason If you sneeze and splatter mucus inside the mask, don’t immediately rip it off while you are still in a public space, no matter how gross or uncomfortable as it seems. But a wet mask is less effective and should be removed and replaced at the first opportunity.

In removing the mask, do not touch its front surface. Place it into a bag and then wash your hands again. Wash the mask between use with household detergent.

A FEW WORDS ABOUT GLOVES

Gloves can be very useful in protecting yourself from infection. They do not eliminate the need for hand washing, but can reduce exposure of your hands to contamination, especially when shopping. As with masks, proper use is essential.

Do not touch your face while wearing gloves. In fact, do not touch anything you don’t have to. A good habit is to keep your hands on the shopping cart when you are not picking up an item. Avoid touching items that you are not going to put into your own cart. Avoid the temptation to squeeze produce to select the perfect ripeness. I have seen too many people wearing gloves while holding a cell phone up to their face. Keep the phone stored away until you have removed the gloves and washed your hands. Use a blue tooth hands free connection if you have one. Keep your credit or debit card where it is easily accessible and sanitize it when you get home.

When you remove gloves, do not touch the outside with your bare hands. Grasp the outside of one glove and invert it over your hand without completely removing it at first. Then you still have covered fingers available to grasp the outside of the other glove and invert it. Finally, you can remove both gloves by grasping their exposed inner surfaces.

Dispose of single use gloves immediately, then wash or sanitized your hands. If you use re-usable gloves, they must be safely stored until you can wash them. One method is to bring along a plastic tub in your car. You can dump the gloves into that tub, and then when you get home, soak them in a cleaning agent.

As for hand cleaning, washing with warm soap and water for at least 20 seconds is the most effective method. Hand sanitizers are a stop gap in situations where water is not available, but they wipe the surface of the skin. Hand washing reaches into the cracks and cuticles. To be thorough, you should also clean under your nails.

BOTTOM LINE

This pandemic is a terrible public health disaster. While many of us will not get sick and hopefully the vast majority of us will stay well, the economic impact will not spare any of us. The incredibly high rate of critical illness and death are overwhelming the capacity of our health care system. Courageous health care workers are dying. Everyone else should do their part, just as citizens support their troops in a war. The most important thing any of us can do is to avoid getting sick and avoid spreading the disease.

The pandemic will not last forever. In the meantime, stay strong, stay home as much as possible, and when you go out,

WEAR A MASK

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Gaylewoodson

Gaylewoodson

Gayle Woodson is a semi-retired surgeon/educator. Her award winning novel, After Kilimanjaro, was inspired by her work in Tanzania.