We want to enjoy the last bits of nice weather but Hello, we’re still in a pandemic!
A Nurse’s perspective on the future of face coverings
We all love summer weather! Time to have fun outside before the fall and enjoy the weather just like every other year. Except this year is not like any other year. With COVID-19 cases at all-time highs in many areas, most states have some type of mandate for face coverings. This is in stark contrast to earlier in the year where it was only recommended to wash your hands and social distance.
Airborne Transmission of COVID-19?!!
Science has confirmed the suspicions of many in the medical community that the COVID-19 virus can be transmitted in the air just like colds, flu, tuberculosis, chickenpox, mumps, measles, and the more dangerous SARS & MERS. Many of these diseases have vaccines to protect the public from large outbreaks though the problem with COVID-19 is that no vaccine exists as this is a new virus. Interestingly, the virus that causes the flu mutates and has many different strains, hence the need to receive flu shots yearly. This article from the CDC provides great insight into how scientists from different countries collectively select the flu strain to focus on each year and the challenges they face with developing effective vaccines. The decision as to which flu strain to focus on has to take place long before the flu season as it takes at least six months to produce vaccines in sufficient quantities.
A vaccine may prevent you from acquiring the disease and in cases where you still obtain the disease, your symptoms may be milder and you can recover faster. Again, one of the main issues with COVID-19 is that this virus is new and there are no vaccines for it so until a vaccine is developed, we must use what we have to protect ourselves and those around us.
Protesting & Partying
Because COVID-19 can be spread by air, it means it can be spread when talking, sneezing, and even just breathing. This makes it especially important to wear a mask or face covering in public. Indeed, social distancing will prevent the larger droplets of the virus from coming on you. However, in closed spaces such as inside buildings or buses or airplanes, the limited ventilation of air and the smaller aerosolized particles of the virus allows it to spread much farther than 6 feet and remain in the air for hours. Those who do not wear face coverings or social distance are putting their families and workmates at risk. Likewise, crowded areas where people yell and refuse to social distance as in the case of protesting or partying in a bar also increases the likelihood of spreading the COVID-19 both by close contact and airborne transmission. A related article discusses whether protesting can eliminate racism and lessons we can implement to improve unity.
Who are more difficult to treat — patients from earthquakes, bombings, or COVID19?
One experienced physician who has treated patients after earthquakes, bombings, and tsunamis stated very clearly, “fighting against the Covid19 virus is easier than fighting against people’s stupidity!” He laments that many in the public are ignoring physicians and health authorities during a global pandemic. A CNN article provided a great photographic inside view of the exhaustion of some medical staff in his COVID-19 unit and a story of nurses on the unit becoming patients.
I’m pretty much fighting two wars: a war against COVID and a war against stupidity. And the problem is that the first one I have some hope about winning. But the second one is becoming more and more difficult to treat.
Dr. Jospeh Varon (Chief Medical Officer, Houston)
Mixed Messages to the Public
Most of the states have mandated some form of face coverings in public, while others leave it up to the county or city. Some national stores like Walmart, Target, Walgreens, and Costco now require face coverings to be worn while inside the store. This lack of unity on what should have been a public health standard gives mixed messages to the public and has even resulted in some groups protesting the mandate for face coverings. Robert Britt wrote a great article that summarizes the confusing messages given to the public when the pandemic first started in the US and the latest stance health officials currently provide. Another fellow Medium writer, Andy Slavitt, wrote an excellent piece on the steps the US could have taken if it threw everything against the coronavirus.
Although face coverings are now required in many parts of the country, some Americans are staunchly against it and believe it takes their rights away. Or perhaps they do not believe in masks just as some do not believe in God or religion. Interestingly, the ones who originally shouted that coronavirus is just like the flu are now strangely silent as the deaths from COVID-19 have already greatly surpassed those from the flu in just half a year as shown in an article by a physician from Johns Hopkins. This video provides a nice explanation for those visual learners on why COVID-19 is much worse than the flu as it is much more contagious and the risk of dying from it is much higher than the flu as well.
With all this scientific evidence supporting the use of face coverings, it is both appalling and sad to see how some become so angry when offered a free mask in California, a state that has mandated face coverings.
I have been in the middle of earthquakes, in the middle of bombings, in the middle of tsunamis. I’ve been involved in every possible catastrophe that you can imagine. And by far, this (COVID19 Crisis) is the worst.
Dr. Joseph Varon (Chief Medical Officer, Houston)
Another massive disadvantage of not having a national standard for face coverings is that it potentially allows an asymptomatic carrier to travel from an area where there are restrictions to spread it to another area where there are few or no restrictions. Some areas have started to implement a fine for not wearing a face covering which would make great sense since we are still in a public health pandemic.
The evidence supporting the use of face coverings:
Face coverings act as a barrier for preventing the larger droplets expelled from our mouth and nose from escaping and evaporating into smaller aerosolized droplets that can travel far in the air.
To add to the urgency of the situation, it has been confirmed that asymptomatic carriers can pass the COVID-19 to others without realizing it. In fact, the CDC estimates that 50% of COVID-19 cases are transmitted by pre-symptomatic or asymptomatic individuals. This makes it especially important for everyone to wear face coverings.
Experiments have confirmed that masks decrease the viral load of COVID-19 — the amount of virus inhaled. The less virus inhaled, the less sick you get. For ethical reasons, humans can not be subjected to experiments of how well surgical masks protect them from a virus causing a pandemic compared with those without masks. Though from experiments with mice and surgical masks, scientists found that surgical masks significantly reduced the likelihood of obtaining COVID-19 and had milder symptoms than those without the masks.
With mounting evidence from scientists across the world, CDC and WHO finally changed its policy on wearing face coverings. Some retrospective studies showed that even in high-risk cases, where people wore masks and had the coronavirus (but did not know it yet as they were asymptomatic) prevented those around them from obtaining it. One person with Coronavirus, who wore a mask on a flight and later the people nearest to him on the airplane were tested and did not get the virus. In another case, after some hairstylists, who wore masks, found out they had the Coronavirus informed authorities and they had all their clients tested and none of them tested positive for the coronavirus.
Initially, the CDC discouraged the use of face masks by the general public as there was a severe shortage in the country and medical staff was forced to reuse what they had. Now that the country has been receiving more supplies and ramped up domestic production, this gives more options to the public. Since we are all in a fight against an unseen enemy and with the CDC, the WHO, and even President Trump adjusting their stance and supporting the value of face coverings, we should discuss the various options available.
A nurse’s opinion on common face coverings
We’ll start with the face covering providing the most protection to the least:
- NIOSH N95 Respirators filter at least 95% of particulates in the air. These respirators must pass high standards and be approved by the US National Institute for Occupational Safety and Health (NIOSH). NIOSH is the federal agency that tests and approves all respirators used in occupational settings. There are actually respirators that provide even higher levels of protection than the N95s but they are difficult to find now and cost-prohibitive for most. Hospitals require a FIT test to ensure the N95 fits your face properly as not all N95s provide a tight seal depending on the shape of your face. If you have a beard, this will prevent a tight seal from your mask to your face and would defeat the purpose of having an N95. Due to its tight fit and blocking 95% particulates in the air, it does become a little difficult to breathe after some time. There are a lot of counterfeits for N95 so it would be best to stick with the approved NIOSH N95 on the list from the CDC
- Previously, CDC discouraged the public from using N95 due to the massive shortage and medical staff having to reuse their N95. That is gross. But now, there are more available to the public. If you want the best protection at relatively affordable prices when you are out shopping, you can consider the NIOSH N95 respirator. Note that these were designed for single use though the CDC permits reusing them during this crisis provided you follow the manufacturers’ guidance on decontamination.
- KN95 is rated to block out 95% of particulates in the air HOWEVER, as a nurse, I must point out a major design flaw with KN95. Unlike the N95s, it has an ear loop design just like the surgical masks or face masks where the bands from the mask wrap around your ears. This does NOT allow a tight fit as the distance between our mouth and ears is different for everyone and as a result, can allow particulates into your mouth and nose from the sides of the mask. Most US hospitals do NOT accept the use of KN95 and I do not recommend them. These KN95 be likened to an expensive surgical mask.
- Next are disposable ASTM Level 1–3 Surgical Masks. These masks have 3 layers and have been tested to their various levels of filtration effectiveness. These will provide a higher level of protection than the reusable cloth masks and neck gaiters. Like the N95s, these were designed for single use.
- I’m going to lump the non-medical civilian masks, cloth masks, and neck gaiters together. These are not tested for their filtration efficiency and should be considered the minimum level when in public. Some who have trouble breathing will find the cloth masks and neck gaiters easier to breathe in. Although it will not protect the wearer from inhaling the potential COVID-19, it will block much of your droplets from spreading to others — which is essential to slow the spread of a global pandemic.
- Please properly wear your masks to cover your mouth and nose. Don’t be like a rebellious kid or adult who is forced to wear a mask but then just puts it under his chin.
A Nurse’s Conclusion:
Ideally, an effective vaccine is developed and distributed to everyone. Realistically, it still seems a year away additionally. However, a vaccine is not a cure. Viruses like the coronavirus mutate. Just like the annual flu vaccine does not protect everyone. Perhaps more vaccines will need to be developed for the various strains of COVID-19 that mutate for the foreseeable future. Additionally, one of the world’s experts on infectious diseases and White House Coronavirus adviser Dr. Anthony Fauci indicated that they are hoping that a COVID-19 vaccine will be 75% effective but that the FDA will accept 50% effectiveness. This is on par with a normal flu vaccine. In hospitals, we can isolate patients who have contagious diseases. However, it is not possible to quarantine an entire country. The next best option is to make testing available for everyone as many asymptomatic individuals can pass the virus and those who test positive, can be isolated for a couple of weeks.
Since the US is based on the freedom of expression, perhaps these who feel the need to uniquely express themselves can try wearing fashionable face coverings. Now they come in many different colors and designs. Some companies will allow you to customize or use your own design for cloth face masks and neck gaiters. In some areas, face shields may count towards wearing a face covering or it can be used as an added layer of protection as face shields do not restrict breathing or vision. The CDC does not recommend children under 2 years of age or people with difficulty breathing and those unconscious to wear masks. For those with trouble breathing, perhaps they can consider wearing cloth masks or neck gaiters and/or face shields as these options are less restrictive and provide some protection for others while in public.
Although the US missed the opportunity to contain the outbreak early, we can all do our part to decrease the risk of transmission by wearing face coverings. The best thing we can do now is put on our face coverings, continue to social distance, hand hygiene, and also avoid crowds. Unfortunately, this may be the new normal until an effective vaccine is developed. Regardless if there is a mandate for face coverings or not, for the sheer sake of compassion for others, wearing a face covering will help those you love, your neighbors, and your community.
