Masks and Facial Covers

Several days ago I was asked to weigh in on the efficacy of varrious masks. I started a response several times and my phone kept dying before I could post. Then, when I finally had a response,  I couldn't find the post.  So I decided to write a blog post.  The following is my response to my friends question of the infogram comparing the efficacy of masks and face coverings:

Short answer:
The infogram is pretty much correct. N95 respirators are most effective, disposable surgical masks meant for one-time interaction use  are second best, and face coverings  provide the wearer no protection--they only protect others.

Longer answer:
I'm not sure about the percentages and some of the "filter" and "charcoal" activated masks.  However, the N95 (respirator) is superior. The surgical mask is second . And cloth masks come in at the bottom of the list, and protect others, not the wearer.

MOST people (80%ish) who test positive for C-19 do NOT require hospitalization.  They can self-quarentine and ride it out in the safety and comfort of their own home. They, and family members (who could possibly be unknowingly infected), should wear cloth masks to protect others with whom they come into contact.

Of the 20% who test positive and require hospitalization because their symptoms indicate they NEED hospitalization (maybe for fevers unresponsive to fever reducing meds, or IV fluids for dehydration, or O2 for hypoxia--low oxygen levels in their blood, etc..) only about half of the 20% hospitalzed will require ICU level of care--and of that number in ICU, only about half will require ventilation support.  Survival rates at this level of illnes for Covid-19 are about 50/50.

Nurses caring for hospitalized Covid-19 positive patients need N95 masks. Caring for the rest of the hospitalized patients, the surgical masks should suffice.

At my VA, we currently are issued up to 2 surgical masks a week. Veterans who are Covid rule outs (may have symproms and /or testing results are pending) are admitted to a designated ward. If a Veteran tests positive and requires hospitalization they are admitted to a ward exclusive to Covid positive patients. On all others wards, mine included, staff are issued up to 2 surgical masks each week.  We save them for direct interactions with our patients. The rest of the time we wear our cloth masks and face covers. Since my job only requires minimal interaction for assessment interviews,  I have only taken 1 mask a week, leaving the other mask for the RNs who are doing more hands-on  bedside care.

Is this optimal? No. These masks are disposable, and intended for one time/one patient interaction.  However, when people started panicking, the supplies that used to be freely available to everyone in every hallway (gowns, gloves, masks, and hand sanitizer) started coming up missing. It was so bad, the hospital had to keep the remainder under lock and key,  and require Staff and Visitors alike to request  a mask from the Staff at the Nurses Station.   Now, we are issued up to 2 masks each week. The issuance is recorded.  And we here in Texas have seen NOTHING like what is happening in NYC. This thievery and hoarding of supplies meant for the Front Line was totally uncalled for, and placed our Front Line staff at risk.

When I go to HEB or Sams for my groceries I wear a cloth mask--it does NOTHING for me. I wear it because, I MAY have come into contact with a Patient who eventially tests positive.  Because of this, even though I am asymptomatic (without symptoms) I could potentially be a vector and unknowingly pass the virus on to someone else.

You didn't ask (and the infogram did not mention gloves), but gloves are meant to be used once, for one patient, and then tossed into a trash bin (not the store parking lot ground which I see far too frequently).  Hand hygine is expected before and after glove use. All these people wearing gloves in stores are most likely not washing their hands in between contacts.

Gloves used incorrectly are worthless.

In fact, there is now the thought that the virus MAY live longer on gloves than human skin! (I do not know if this is valid or not--I have not read the study.)

Florence Nightingale pegged it when she said clean surroundings (disinfect all surfaces), air flow (in her day it was ventilating rooms by opening windows to create a cross breeze, now it's positive pressure rooms for hospitalized acutely ill patients with airborne illnesses), space between patients beds (social distancing), and HANDWASHING are key.

Science backs her observations. Handwashing is the single most effective way to break the cycle of transmission. The CDC recommends antibacterial soap and water, rubbing all parts of the hands (fingers, palms, backs, under and around nails,) and wrists for at least 20 seconds. For several years the CDC said even cold water with regular soap is okay--the mechanical friction--as long as it's not so aggressive that you break the skin--can remove a majority of the contaminants.   Scrubbing your hands in water too hot will compromise your skin integrity and will make it easier for viruses or other contaminates to enter.

When soap and water are unavailable, hand sanitizer with at least 60% alcohol is acceptable--EXCEPT in the case of diarrhea. Especially c.dif diarrhea (usually occurs with recent/concurrent antibiotic use). In this instance ONLY handwashing is effective. Again, the process with hand sanitizer is 20 seconds just like handwashing above.

Most people don't perform adequate hand hygiene.

In addition to hand hygiene, other measures that break the cycle of transmisson include:
Covering your cough/coughing into your sleeve or a tissue (then discarding the tissue and washing your hands).  It's the same with sneezing--into your sleeve or a quickly discarded tissue, followed by hand hygiene, social distancing, and sanitizing frequently touched surfaces, like phones, doorknobs, counters, and tables, etc.  Each of these interventions play an important role in managing this pandemic.

It is my belief that we have not yet peaked here in Texas. Therefore, I will continue to wear my mask in public, avoid physical contact, and I will continue to support my local businesses from afar. I applaude the businesses who are waiting a little while longer before returning to even 25% capacity as our Texas plan allows for this week. I will not be the unwitting reason anyone who comes into contact with me contracts Covid-19. I hope, and I pray, that I am wrong; however, I believe the numbers of Covid-19 positives in Texas  will rise.  I do not believe we have peaup--ked yet.

I am heartened to know VA has stepped up to the Covid-19 challenge. Nation-wide we have sent volunteers to the hardest hit areas.  We have streamlined the hiring process and have added more staff. We have provided care to nonVeterans in hard hit areas where the public heathcare systems are overburdened. We have shifted resources, like ventilators, masks, and gloves, to the hard-hit places they have been needed.

VAs social distancing measures have proven successful in helping to #FlattenTheCurve. We have no visitors. All Staff, Contractors, Vendors, and Veterans must wear a mask from the time they enter VA grounds (even in their cars) until they leave VA grounds.  Each person on campus has their temps taken, and first line screened, while still in their cars. Those failing the first line screen, are sent/taken for a second screening. NonVeterans failing the second screen are escorted off campus and referred to their healthcare providers (at least here since our area hospitals have  not been overburdened).

And even though we at VA are limiting our mask usage,  VA Staff nationwide are testing Covid-19 positive at less than 0.01 percent.  Other healthcare systems have tested positive between 2.0-4.0 percent. (From one of the Directors emails this week, I am unsure of how/where to confirm the information; however, I CAN attest to very low numbers of Covid-19 positives that have required hospitalization here in Central Texas.)

Because VA values our at risk Veteran population we have taken extreme measures to protect them, and we have shifted resources nationwide to the hardest hit areas. Once again VA provides excellent healthcare and role-models  cooperation and appropriate use of resources--and once again, the media does not give VA credit. They like to focus on negatives (that are found in EVERY health care system) and blow things out of proportion.  Sensationalism sells.

But I digress.  The take away is this:
***Wash your hands frequently using proper techique.
***Use appropriate hand sanitizers when soap and water are not available.
***Cover your cough (e.g. cough into your sleeve, or a tissue that you appropriately discard immediately--then perform adequate hand hygiene).
***Don't touch your face (i.e. especially your eyes, nose, or mouth). If you do, perform adequate hand hygiene.
***Disinfect frequently touched surfaces (e.g. phones, door handles, counter and table tops, desks and office equipment,  etc.).
***Practice social distancing for the time being.  It helps #FlattenTheCurve, #MaintainThePlatau; thereby reducing the massive burden on health care systems we have seen in places like NYC, Italy, and China.
***Wear cloth face covers in public knowing you are responsibly protecting the vulnerable in our society.
***Leave medical supplies to the front line so they have access to the protective supplies they need in order to provide care for the truely ill.

Everyone's circumstance is different, but Covid-19 effects us all--just  in different ways and varrying degrees. It is vital we remain supportive and  compassionate.