I’ve been wearing a mask for the past two weeks anytime I have to go to the grocery store. It’s an odd feeling for me to walk around and be the only person in the store wearing one. As a Nurse Practitioner, I know that a mask will protect me and others so I’m confused when I get disgusted glares and eye rolls. Interestingly, I see many people with gloves on- and that’s well received- but no masks. So what’s the truth about masks and why is there so much social shame over wearing one?
Last week my daughter and I went into the store with our masks on and met a shopper who was clearly disturbed by us. As we passed in the aisle she said to her husband, “This is absurd!! These people are nuts!” My daughter asked me if I heard what the woman said about us- it was a great teaching moment for me. I was able to explain to her that this will be a common situation she will encounter in life and that she needs to understand her convictions and not be swayed by the opinions- or disgust- of others. I also explained to her that this woman clearly was suffering from some form of anxiety or denial that our mere presence with masks on gave her such a visceral reaction. It was a way for me to show empathy for this woman instead of anger; to promote a more peaceful and loving way of living for my daughter.
As we were leaving the store we saw an elderly woman wearing a mask. I greeted her with a light-hearted, “Hello, my masked friend!”. She turned around ready to defend herself, but when she saw both of us in our masks her countenance relaxed and her eyes smiled. She said “You know, I’ve suffered a lot by wearing this mask out in public, but I don’t care. I’m 67 and my immune system isn’t what it used to be.” I lovingly affirmed her and told her if others wanted to shame or bully her, there was something incredibly wrong with them. After wishing her well, I turned around and right behind me was the angry woman we saw earlier, frozen and speechless. I am hopeful she heard our full exchange and in the future would choose to share compassion instead of anger.
There are many expensive and complex “respirators” available for purchase and use and two primary disposable face masks, the N95 and a surgical mask. The N95 is tight fitting and reduces exposure to large droplets, small particles and small particle aerosols. A surgical mask is loose fitting and protects the wearer against large droplets, splashes and sprays.
Surgical masks are made to fit loosely over your mouth and nose with elastic loops that wrap around your ears and a pliable metal strip to form along the nasal bridge. This mask does not completely filter all of the air you breathe in and out because it is loose on each side and allows air to “leak”. It does however, protect those around you from your respiratory droplets.
In the hospital, we wear these masks if we are sick so we do not infect other healthcare workers or patients, but we also wear them during a surgical or sterile procedure to protect the sterile field.
Wearing a mask like this in public will most certainly provide more protection than not wearing a mask at all. Primarily you will be protecting others from yourself. If everyone wears a mask when they go to the grocery or any other essential store, the chances of becoming infected or spreading infection will dramatically decrease. If you do not have a surgical mask, there are a variety of free patterns available online for use. If you’re not the Joann Fabrics type, the Surgeon General made this video which shows how to quickly make a nice mask!
There are different sizes of these masks; small, medium and large. “N” means “not resistant to oil”. When worn properly, these masks provide 95+% air filtration and eliminates small particles- like those from the coronavirus- from being inhaled. You must have a clean face to wear this mask properly (no beards or makeup). The coronavirus is 0.6 microns in size and can travel through other fabrics like cotton or surgical masks. Conversely, when not assessed for proper fit, the mask can “leak” and is ineffective.
Unfortunately, not everyone can wear these masks. This type of respirator can make breathing more difficult because of the carbon dioxide buildup inside of the mask, which in turn reduces the amount of oxygen inhaled and subsequent oxygen exchange thereby increasing your respiratory and heart rate. If you have one of the following health conditions, please check with your nurse practitioner or doctor before you decide to purchase and wear an N95:
- Chronic Obstructive Pulmonary Disease (COPD)
- Morbid Obesity (Body Mass Index > 40)
- Chronic Heart Disease
- Chronic Lung Disease
- Panic Attacks
President Trump announced new guidance this past Friday for people in the United States to wear some type of face covering when out in public. This recommendation is made in an effort to slow the spread of the coronavirus, which as you may recall was a reversal from their recommendations prior to last week.
The CDC “recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.” If you’re not sure how to properly wear a mask, the CDC has a fantastic website with most of what you need to know, like how to properly wear one, when to wash it, how to make one, what materials to use, and so on. If you’re a low maintenance/no fluff type of guy or gal, the US Surgeon General, Jerome Adams shows how to make a mask in 20 seconds out of common household items.
In order for us to know what type of mask may work, we need to know more about the coronavirus; it’s size and how it’s transmitted. Since the coronavirus is still so new to us, we truly don’t know exactly how protective different masks are against this virus. We can however, guess based on what we know from other masks and other viruses, but ultimately only with time and experience will we find the truth.
How is the Coronavirus Transmitted?
- Respiratory Droplet: This is theorized to be the primary way the virus is spread. Droplets are large and heavy. They are released by an infected person when this person coughs, sneezes, talks or breathes. In a ballistic fashion they fly out about 6.5 feet before falling to the ground. Surgical masks, face clothes or a bandana around your nose and mouth area, would work to protect you against droplet transmission of the virus.
- Respiratory Aerosolization: This route of transmission is thought to be a secondary way of transmitting the virus and a big concern for healthcare workers. These particles of the virus are very tiny and can stay suspended in the air for minutes to hours. An N95 mask is needed to protect at-risk healthcare workers from contracting the virus from their infected patients, especially when intubating, suctioning or bagging an infected patient.
- Direct Contact: Virus particles can rest on an inanimate surface and also be transferred by human hands, thus being moved from one place or person to another. Depending on the type of surface the virus lands on, it can stay viable and infectious anywhere from four hours to three days. It is theorized that the cornavirus behaves in the same manner as other SARS viruses so it is still very very important to wash your hands and not touch your face even if you are wearing a mask. You need to wash your hands before AND after you put your facemask on and off.
Do Masks Work?
In a recent commentary in The Lancet, a group of UK and Hong Kong researchers looked at the existing scientific evidence for wearing a mask as well as the efficacy. They researchers recognize lack of supportive data for ubiquitous mask use but also note the inconsistencies in recommendations around the globe. They conclude that even though data is lacking, it is reasonable for those who are high risk, as well as those who are having symptoms to wear a mask when out in public. They also postulate that there is evidence of novel coronavirusa “community spread”, meaning the infection is being spread before people develop symptoms. Therefore, if an asymptomatic and unknowingly positive person wears a mask, he or she will be protecting others around them. They conclude with reminding us that wearing a mask is not a substitute for good hand hygiene and social distancing. It is “just one more layer of protection”.
What we absolutely do know is that the virus appears to not be as aggressive as measles which carries a 30% mortality and is highly infectious. For every one person with measles, that one person infects about another 12-13 persons.
Not so with COVID19: For every one person with the novel coronavirus, 2-3 other persons are infected. This has led scientists to assume that the virus is spread primarily through droplets and a surgical mask would probably be effective in reducing the risk or spread.
To back this up with some data, I read two studies that looked at penetration rates for different particles sizes based on the type of mask. (NIOSH, 2010 and Air Quality Reseachers, 2014). The results were widely discrepant and are on average, as follows:
- N95 > 90%
- Dental mask 60%
- Surgical Masks 40%
- Towel Masks 40%
- Sweatshirt Masks, 20-40%
- Scarf Masks 20%
- Shirt Masks 10%
- Handmade Cotton Masks 2% (one layer)-13% (four layers)
The authors did note that a lot of these masks did not control for “leakage” and that was identified as possibly one of the largest problems. They recommended using pantyhose to help the mask adhere to your face (Think Spanx) and in doing so, they noted you could decrease leakage to < 10% for homemade masks and < 1% for surgical masks.
So What Should You Do?
If you are healthy, you must continue to prioritize and fully participate in social distancing measures as this is the only 100% tried and true protection against transmission. You must also continue to avoid touching your face and wash your hands often; especially after you sneeze, cough or blow your nose. Of course, if you need to go out to the grocery store, you should continue to use social distancing measures plus choose some sort of facial covering when you are out. I know there’s a mad rush for surgical masks but considering the above data, a towel mask would work just a well – and also may be easier to get. Consider using a hand towel the way the US Attorney General did with a Tshirt and adding some Spanx on top of any other mask to prevent leakage. The study found that leakage was reduced to < 10% around a handkerchief and < 1% around a surgical mask.
If you develop any type of respiratory symptoms such as sore throat, runny nose, fevers or cough, please isolate yourself away from your immediate family- as well as others- and notify your nurse practitioner or doctor. If you do not have a nurse practitioner or doctor, you can use a TeleMedicine platform like LoginClinics. LoginClinics is currently providing free rapid virtual screenings for the coronavirus in an effort to educate and connect people to local resources, if indicated.
Finally, be loving and accepting towards others who decide to wear (or not wear) a mask out in public. Continue to maintain social distancing standards until instructed otherwise. Expect expert opinions to change with the tides of this illness. Something recommended yesterday may not be recommended tomorrow. Be patient – we are all learning together. Extend neighborly kindness to those you happen to encounter when you are out (and in on Zoom calls) as you do not know what trials and challenges they are facing today. Recognize that we are all in this together, as a nation and people. This too shall pass… doesn’t matter what type of mask we use (or don’t use).
About LoginClinics- Founded by Jaclyn Qualter, a nurse practitioner and health care mentor, in September 2019, LoginClinics provides its fee schedule on its website at www.LoginClinics.com along with FAQs on how to use the online service. More information can be found on its social media www.facebook.com/TelemedicineNC or @loginclinics on Instagram.
Author: Jaclyn Qualter, Founder, Nurse Practitioner and Healthcare Mentor