Dr. Cindy’s Diagnosis: Donate the right mask to the right healthcare provider

For my first blog post, I’m going to talk about the different types of masks used in the fight against coronavirus.  This is an important issue because it keeps medical personnel from getting infected and sick patients from infecting others.

One of our major issues right now is lack of Personal Protective Equipment (PPE).  PPE is our masks, respirators, goggles, face shields, hair covers, gowns and shoe covers.  Out of everything right now, those most important are the masks.  Please please please donate if you have extra masks around from construction, nail salons, painting or other type of work!  I have seen a lot of social media posts calling for cloth mask.  I love the intention but I also want to make clear they are NOT “better than nothing” for an ER physician.  In fact, there’s some evidence that a cloth mask in that setting might INCREASE the doctor’s risk of getting infected.  But because we are having to do extended wear and reusing the below mask, the cloth masks are being used by some as a splashguard to further protect the N95.

Should be worn by those directly working with COVID19-suspicious or confirmed patients, priority to those performing what we call “aerosolizing procedures” (intubations but also breathing treatments with nebulizer and the collection of a nasopharyngeal swab for testing).  But ideally should be worn in the ER by all, including environmental services (think of those cleaning the room after a patient has been sneezing and coughing hours inside of it).  I think paramedics should be wearing these as well, but at minimum they should be wearing a procedure mask like listed below.

Should be worn by all doing patient care that have already been screened as “healthy”.  We’re talking about the outpatient clinics that are part of a system where all the “sick” people are being sent elsewhere.  It’ll minimize the person becoming a vector between patients.  At these “healthy”-visit places, environmental services and registration should be wearing these at minimum.

I spent a summer in Taiwan during my undergrad years.  I actually still have a cloth mask somewhere from my time there.  I found it comfortable to wear while biking down the streets of Tainan.  I think this is another cultural aspect from our East Asian brothers and sisters that should be encouraged here (I think most Americans are learning the whole no-shoes-indoors part).

These are ideal for everybody else.  The administrative people that work in the hospital without direct patient care, the grocery store workers and pharmacy workers.  Police officers should be wearing at least these!  They often get spit upon too.

The only reasons all these people are not wearing masks right now is (1) there’s still some denial going on and (2) there aren’t enough.  We are reviewing and learning how to extend the life of the masks we have now.  Extended wear is always better than reusing.  It is extremely hard to reuse without contaminating yourself.  I have been practicing recently as my local place has not had a confirmed case yet, but I myself cannot take off and put back on between patients in a a completely safe way so I cannot in good conscience recommend reusing in that manner to others.  Regardless of the type of mask, it is far much safer to leave it on for longer periods of time than removing and reusing without being able to clean it.  If you see someone in line in the grocery store with a procedure mask and they use their hand to pull it down to below their chin, then later put in back over their mouth/nose… it defeats the purpose.  It’s a waste of a procedure mask, better used by a healthcare worker and also why cloth masks are better for the general public.

For the N95’s, we’re learning how to use dry heat (ovens) and UV-C light to sanitize and make it safer to reuse.  Doctors are carrying around paper bags with their designated N95 in between uses.  Remember though, these were designed to be used and discarded.  All these measures are desperate responses to the current need.  And some of us have long shifts: 12hrs, 24hrs, 36 hrs.  At some point we have to eat and pee (and pump).  There isn’t enough time to sanitize the mask during shift so removing and reusing (which is more dangerous than extended wear) becomes necessary.  Have you ever used an N95?  It is not easy to wear for hours upon hours. especially if you have allergies or asthma or claustrophobia.

If you are involved with making cloth masks, I ask that you think about the rest of your community: grocery store workers and police officers are examples I mentioned above.  I mean, look at everything HEB is doing for us!  If you want to target healthcare workers, I personally would rather you make hair covers (think surgical caps) and gowns that can be washed and reused every shift to help us protect our families from getting the same repeated exposures we’re getting at work.

Stay healthy (in your homes), mi gente 🙂