COVID-19: A mask mini-manual

Should we all be wearing face masks? Do they protect us? Is one kind better than another?

 

Mask requirements can now be found in at least 44 states. Some mandates apply to only certain “essential” workers in specific cities. Others are broader. Los Angeles County mandates a mask for anyone who goes out in public.

 

It’s important to understand what masks can and cannot do, and which masks work better than others. And it’s always wise to learn from an expert.

 

At City of Hope, one such expert is Tyler Seto, M.D.

 

As vice president of Enterprise Quality and Patient Safety, Seto pulls together resources and strategic thinking from many sources to ensure everyone at City of Hope is well protected from the coronavirus.

 

He began addressing this challenge immediately following the first reports of infection in Wuhan, China, assembling a response team that prepared for a series of contingencies. At first the team took a conservative approach, but as the number of infections in the state and nation climbed, “tipping points” were reached and Seto realized “we now have to protect ourselves … from ourselves!”

 

So the rules got stricter.

 

Now every staff member or patient entering City of Hope stops first at a tent for a temperature check and must answer a series of questions about possible symptoms or exposures. Patients scheduled for “interventional” treatments are tested in advance for the COVID-19 virus. Visitors are no longer allowed in patient care areas, with a few exceptions. 

 

And everybody wears a mask.

 

It’s more than common sense. It’s the laws of physics. Masks help block the movement of those virus-laden “droplets” sent out by coughs, sneezes, breathing and speech. Exactly how much is blocked and how well depends on the mask, but there’s little doubt that if more people wore masks in public, transmission rates would fall.

 

“If I have an active COVID-19 infection,” explained Seto, “and I have a mask, and the next person [near me] also has a mask, that’s considered a low risk of exposure. But if one of us doesn’t wear a mask, the risk jumps to ‘medium’ or even ‘high,’ which could mandate a 14-day quarantine.”

 

Such exposures can snowball rapidly; a single, nonmasked infected individual could easily throw dozens of people into quarantine; whole facilities could be shut down because one person wasn’t careful.

 

If he had his way, Seto would give every American a mask right now, confident it would help reduce the spread of the virus. Not to mention the message it would send. “It’s a sign of respect,” he said.

 

But what kind of mask?

 

Basically you have three choices.

From bandanas to cut-up T-shirts, folks turned to cloth alternatives when more conventional masks were not available. Now, of course, the cloth market has become its own phenomenon, with a dizzying array of mask choices, including those that leave room for an added filter.

 

Cloth masks are economical because you can launder and re-use them. And they do the job, up to a point. They will prevent you from infecting someone else. They’re less effective at protecting you from others. The thicker the cloth, the more layers, the better, but cloth is still considered the lowest level of protection. Nevertheless, “If we all wore cloth, we’d all be protected,” Seto said.

These masks are meant to be worn once and discarded. They’re usually made of layers of paper-like or other nonwoven synthetic material. A true “surgical” mask  — many look the part but don’t qualify (the Food and Drug Administration regulates them) – “provides the best protection in most cases, for you and for others,” said Seto.

 

However, because of their relatively loose fit, these masks will not protect you from smaller “aerosolized” virus droplets that can hang in the air in close quarters or places where the virus is concentrated … like a patient’s room.

 

These masks also become less effective when people use the same mask multiple times, or if they become wet or soiled.

 

Everyone who enters a clinical location at City of Hope is issued one surgical mask per day. Employees also receive three cloth masks – enough to make sure a fresh one is always available while the others are in the wash.

Studies show that properly fit N95 respirator masks protect hospital workers even better than surgical masks, filtering out as much as 95% of airborne particles of all sizes, according to the Centers for Disease Control and Prevention. These masks are also designed for single use, or can be cleaned using special equipment. 

 

The CDC does not recommend N95s for the general public. They need to be saved for health care professionals treating coronavirus patients in virus-heavy environments, like a COVID-19 isolation ward. Furthermore, you can’t simply buy an N95, throw it on and expect to be safe.

 

“They come in different sizes and each has to be fit-tested to each individual face,” explained Seto.  “And you have to repeat the fit testing every year, because faces change.”

 

It is also important to handle masks properly, whether surgical, cloth or N95. You should wash your hands before placing your mask on your face, and only touch the straps. Make sure you store your mask on a clean surface or in an unused paper bag.  

 

Whichever mask you choose, Seto says, remember to use it in tandem with another weapon, probably the most potent one: Frequently wash your hands!

 

“That’s your best protection, because really, that’s how it spreads,” he stressed.

 

“Most people with COVID-19 can’t tell you who coughed on them. What probably happened is that someone coughed, the virus went into the air, landed on a surface, someone else came along, touched that surface, and then touched his face.”

 

Seto acknowledges there’s a lot of fear out there. It’s only natural.

 

“Nobody’s fearless. But look at what City of Hope has done with that fear,” he marveled. “They’ve channeled it, stepping up, fighting fear through their actions.”

 

“It’s invigorating to see.”