As you may know, I work as a Nurse Practitioner and have done so for the last 26 years. The Era of Covid has been the most unique medical experience of my life. The fact that this process was politicized so badly has made the process even harder to manage.
One of the issues that keeps coming up in my practice (and among the general public that I deal with) is the matter of face masks. I want to give you the best data that I have on masking.
The following quote comes from the CDC. Now before you turn me off (I know the CDC has flip-flopped, and disappointed us repeatedly), please stay with me to the end of the article....
"Personal preventive measures — If community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is present, residents are generally encouraged to practice social distancing by avoiding crowds and maintaining a distance of six feet (two meters) from others when in public. In particular, individuals should avoid close contact with ill individuals. Individuals are also encouraged to wear masks when out in public."
Why would the CDC recommend wearing masks?
Is there any rationale for it?
"The rationale for wearing masks in the community is primarily
1. To contain secretions of and prevent transmission from individuals with infection, including those who have asymptomatic or pre-symptomatic infection. Masks can also
2.Reduce exposure to SARS-CoV-2 for the wearer.
Here are some of the studies which support the use of face masks and justify the above statements.
●Source control – Several studies support the use of masks to provide source control and reduce transmission in the community.
1. In a retrospective study of 124 patients with confirmed COVID-19 and their
families in Beijing, China, secondary transmission occurred in 41 families;
use of masks by family members (including the index patient) prior to
illness onset in the index patient was independently associated with a
reduced risk of infection. The type of mask used (medical or cloth) was not
specified.
2. In a case report of two hair stylists with COVID-19 who worked while
symptomatic prior to the diagnosis but wore face coverings, there were no
subsequent COVID-19 diagnoses among 139 clients with close contact, all
of whom were also wearing face coverings; both medical masks and cloth
face coverings were used.
3. In epidemiologic studies, government-issued mask mandates and high rates
of self-reported mask wearing have each been associated with decreased
community incidence rates and, in some cases, decreased COVID-19
hospitalization rates. Although limited by assumptions and estimates,
modeling studies have also suggested that high adoption of mask-wearing
by the general public can reduce transmission, even if masks are only
moderately effective in containing infectious respiratory secretions.
●Prevent exposure – Mask-wearing in the community may also be associated with protection for the wearer.
1. In a report of 382 service members who were surveyed about personal
preventive strategies in the setting of a SARS-CoV-2 outbreak on a United
States Navy aircraft carrier, self-report of wearing a face cover was
independently associated with a lower likelihood of infection (odds ratio
[OR] 0.3), as were avoiding common areas (OR 0.6) and observing social
distancing (OR 0.5).
2. In a retrospective analysis of 1060 individuals identified by contact tracing
following clusters of infections in Thailand, wearing a mask all the time was
associated with a lower odds of infection compared with not wearing a
mask; there was no significant association between wearing a mask some
of the time and infection rate.
3. A randomized trial from Denmark did not identify a decreased rate of
infection among individuals who were provided with surgical masks and
advised to wear them when outside of the house for a month (1.8 versus
2.1 percent among individuals who were not given masks or the
recommendation); however, clear conclusions about mask efficacy cannot
be made from this study because of a low rate of community transmission
during the time of the study and other limitations.
Mask-wearing has also been hypothesized to reduce the viral inoculum, even if it doesn't eliminate exposure, and thereby reduce the risk of severe illness.
Further, when considering this matter, and why the CDC is recommending masks as part of an overall strategy of containment for this virus, one must also investigate the filtering capability of the various types of masks....
●Filtration efficacy –
When looking at the following data, please keep in mind that the Covid virus can range in size from .02 micrometers (20 nanometers) to 0.5 micrometers (500 nanometers).
1. Filtering face-piece respirators (FFR) have the highest filtration efficacy. In the United States, the prototypical FFR is the N95 respirator, which filters at least 95 percent of 0.3 micrometer particles. (Although all virus particles will not effectively be filtered out, you can see that many will be - based on size of particles and filtration ability).
2. Medical masks have lower filtration efficacy, which depends on how closely the mask lies against the face. In one study, medical masks with ties versus ear loops filtered 72 and 38 percent of particles, respectively (approximately 0.02 to 3.00 micrometers). Other strategies to improve the fit of a medical mask, such as using a cloth mask over it or knotting the ear loops to eliminate gaps, also appear to increase filtration efficacy.
3. Studies on the filtration efficacy of fabrics suggest that certain fabrics (eg, tea towel fabric [termed dish towel fabric in the United States], cotton-polypropylene blends), particularly when double-layered, can approach the filtration efficacy of medical masks. Tight-weave fabric, two or more layers, and a tight fit are essential for adequate filtration.
Despite the variability in filtration efficacy of different masks (respirators, medical masks, cloth masks) in experimental settings, data on clinical efficacy differences in preventing transmission of SARS-CoV-2 are lacking.
"The following general measures are additionally recommended to reduce transmission of infection:
●Diligent hand washing, particularly after touching surfaces in public. Use of hand
sanitizer that contains at least 60% alcohol is a reasonable alternative if the hands are not visibly dirty. The importance of hand hygiene was illustrated by a study in which mucus specimens inoculated with cultured SARS-CoV-2 virus were applied to human skin collected from autopsy. SARS-CoV-2 remained viable on the skin for about nine hours but was completely inactivated within 15 seconds of exposure to 80% alcohol.
●Respiratory hygiene (eg, covering the cough or sneeze).
●Avoiding touching the face (in particular eyes, nose, and mouth). The American Academy of Ophthalmology suggests that people not wear contact lenses, because they make people touch their eyes more frequently.
●Cleaning and disinfecting objects and surfaces that are frequently touched. The United States Centers for Disease Control and Prevention (CDC) has issued guidance on disinfection in the home setting; a list of Environmental Protection Agency-registered products can be found here.
●Ensure adequate ventilation of indoor spaces. This includes opening windows and doors, placing fans in front of windows to exhaust air to the outside, running heating/air conditioning fans continuously, and using portable high-efficiency particulate air (HEPA) filtration systems.
These measures should be followed by all individuals when there is community transmission of SARS-CoV-2 but should be emphasized for older adults and individuals with chronic medical conditions, in particular."
One of the areas that my current clinic services has seen Covid cases increase, in the last week, by 600%. Our staff has reinstated basic respiratory precautions to try to prevent staff from getting Covid, and YES, one of those measures is masking with N-95 respirators.
I had to work in a brick and mortar clinic the other day (I usually work Telemedicine), and you can rest assured that I wore my N-95 Respirator. Was I forced to? No. I wanted to. I know that it does not provide absolute protection, but it does provide some protection.
I know that tempers are flaring. I know that nerves are frayed. I know that individual liberty is prized. I know that stubbornness is at a premium! I know that politics is corrupt. But here is my recommendation to you.....
Learn the facts about masks, what they can and cannot offer, and then act accordingly for your best interest, your families best interest, and the best interest of your health!
* This information is from a reliable, peer reviewed medical site.