Save Face
MEDICAL AND MENTAL HEALTH UPDATE
Today is about protecting yourself—and SAVING FACE.
I’ve been getting a lot of questions from patients and readers about face coverings: masks, face shields, googles, and other eye protection.
So let’s go!
First, some reminders on how coronavirus is spread:
The primary mode of transmission is through large respiratory droplets that can travel multiple feet from our nose and mouth but that mostly fall to the ground within six feet. Which is why it makes intuitive sense—and thankfully is borne out in rigorous scientific studies—that MASKS WORK. Wearing a mask is one of the simplest and most effective ways to curb the spread of coronavirus and save lives.
Masks work by keeping the wearer’s respiratory droplets to themselves. In short, wearing a mask protects other people from your germs. Recent data also suggests that wearing a mask offers some protection to the wearer. Both of these concepts make intuitive sense, right? If you sneeze into a mask that snugly fits around your nose and mouth, you are less likely to sprinkle particles into the air and infect others in close proximity. And if someone sneezes near you, your mask should somewhat protect you from inhaling a full shower of potentially virus-containing particles.
One of the main reasons we’re in a pandemic is because of asymptomatic spread of the virus. In general, people who feel sick tend to know it and (we hope) seek medical care, self-isolate, and/or alert close contacts to quarantine, hence limiting spread. But the virus is surging in so many places around the country because people don’t know they are infected and are walking around (often unmasked) spreading coronavirus like wildfire!
Aerosolization—the spread of virus through tiny particles that can hang in the air longer—can and does happen, but it is not the major source of transmission. Sure, it happens when doctors are suctioning the mouth of a patient with COVID-19 in the ICU or when people crowd inside a humid bar without masks, but we just aren’t seeing many people get sick due to aerosols when following the rules that you know so well: MOSH PIT.
Masks alone are not enough to get us through this mess—particularly when wearing one has become politicized. However CDC Director Dr. Robert Redfield postulated that universal masking in the U.S. would end the pandemic in 4-8 weeks.
Upshot? Wear a mask.
So what masks work best, and what should you be wearing?
N95 masks definitely work best at reducing droplet spread by the wearer, but they are typically reserved for healthcare workers. N95 masks, when fitted properly by an infection control expert, also do a great job of protecting the wearer.
Robust data tells us that the best masks for general use are two-ply or three-ply surgical or three-ply cloth masks.
Single-ply cotton masks and bandanas are certainly a lot better than not wearing a mask at all but are not as good as the above masks at blocking respiratory droplets.
Gaiters were recently trashed in the news then resurrected into the mainstream. As of now, the evidence shows what makes intuitive sense to me: they are better than nothing, less good than surgical and three-ply cloth masks, and likely do not add risk by creating aerosols as previously postulated.
Fit matters—a lot! I’ve seen people wearing loose-fitting N95 masks that probably are doing less of a good job protecting others than a snugly-fitting two-ply homemade cloth mask.
Toss out any masks with one-way valves and vents! While they look cool and appear high-tech, these masks allow air to be exhaled through the vent! So use one of these babies when cleaning out your dusty attic or dressing as Bob the Builder for Halloween, but not to protect people from your germs, including coronavirus.
Upshot? Don’t overthink it! Wear the best mask you’ve got, and just make sure it fits.
What about face shields?
Face shields can significantly reduce the short-term exposure to larger aerosol particles but are less effective against smaller particles (which can be inhaled through gaps between the shield and face).
Face shields can be used in addition to masks for certain higher-risk activities like medical procedures or other close contact. For example, if I absolutely had to fly on an airplane (which I am avoiding), I personally would wear a mask AND a face shield because there’s no guarantee of being seated six feet apart from others. In other words, when you add risks like close contact with others or sitting in a closed space, you should ideally add risk mitigation measures.
Upshot? Face shields are not a substitute for masks but can’t hurt when added. And they add an essential layer of protection for high-risk situations like treating a sick COVID patient.
What about goggles and eye protection?
Recall that coronavirus enters the body through one of three portals or “mucosal surfaces”: the eyes, nose, and/or mouth. So theoretically you should protect all of these body parts.
However in reality we just aren’t seeing much, if any, transmission through the eyes.
You’d probably have to have someone sneeze or cough directly on your eyeball to contract COVID-19 given what we know about the high level of effectiveness of masks in reducing transmission. In other words, the risk of catching coronavirus through the eyes is probably very low.
Upshot? If it makes you feel better to wear eye protection, go for it. (As with face shields, this is where personal choice and relative risk matter!)
Want to see these gadgets and tools in action? I’m doing live demos of how to properly adorn each one on Facebook and Instagram live tomorrow! Until then, be well.