Since the very beginning of the pandemic, the use of face masks, their utilitarian purpose and their benefits have been misunderstood. Many complained of mixed messages from the CDC on the topic and others were suspicious of masks usefulness as a mitigation strategy.
I believe to clear up some of the misunderstandings, it is instructive to understand and consider the use of masks in a hospital setting. There are generally two primary uses of protective masks in a hospital or other healthcare setting and two kinds of masks that fulfill the goals of the wearer.
If you are a patient lying on a table about to have a surgery, the area around you must be sterile. The area of your body where the surgery will be performed will be sterilized. The gloves that the surgeon and supporting clinicians wear are sterile and even the air in the room has been sterilized. The surgical suite must be as free of pathogens as possible to avoid contamination of the surgical area and an infection in the patient.
All operating department practitioners visit a scrubbing area prior to a surgery to clean any potential pathogens from their hands and arms. The same members of the operating team wear protective caps and gowns and shoe covers if they will be in close proximity to the patient.
With all of this effort to produce a sterile environment to safely operate in, it would be foolish to risk that the surgeon might have a viral or bacterial infection in their throat or nose that might contaminate the area of surgery and infect the patient.
For this reason, surgeons and those working in assistance roles, wear a surgical face mask that covers both their mouths and noses with minimal gaps to prevent the exhaling of airborne microbes. The doctors are also protecting themselves from the spray of any fluids from patients that might cause infection to the doctor, and so many doctors and other OR practitioners will also wear a face shield.
Physicians will also wear face masks when treating immuno-compromised patients in order to protect the patient from any virus or bacteria the doctor may have from existing illness or from visiting with the previous sick patient.
In these cases, the effort to protect the patient on the operating table will most often include the use of surgical masks much like those worn by many people during the pandemic. These surgical-style masks restrict the amount of airborne particles, that might be infected with virus, from being exhaled into the surrounding air. This protection can capture particles that are exhaled through breathing, talking, sneezing or coughing. This protects people who are close to the mask wearer. These masks don’t fully conform to the wearer’s face, but still act as a shield to subdue much of the particle load that is exhaled.
Just as a surgeon wears this type of mask to protect the patient on the table, the average person out in public, who wears this kind of mask, is protecting those around him or her just in case they might be exhaling the coronavirus.
The type of mask that is often associated with this style of mask is a multi-layer paper mask. Many people wear this type of mask or a cloth mask that also utilizes ear loops to hold it in place.
The Second Kind of Mask
Doctors and nurses and other care givers often have to enter rooms with patents who have a respiratory virus or other infectious disease. These patients pose a health hazard to the health care provider and any other patients that clinician might come in contact with subsequent to contact with the infected patient. This situation is somewhat different than the surgeon who wears a paper surgical mask and is focused on protecting the patient who s being operated on from infection. In these cases, the patient who has a contagious pathogen presents a health danger to the doctors or nurses providing treatment.
In the case of providing care to a patient with an infectious condition, there can be no gaps in the protective mask worn by the clinicians. A virus or bacteria is microscopic. A mask that has a gap or opening is like the Holland Tunnel. It offers little protection for the physician or nurse or respiratory technician who might be treating a highly-contagious patient.
In these cases, the clinician must wear a mask that conforms tightly to their face to assure that they are protected from airborne pathogens. In this case, the healthcare provider would wear an N-95 or N-99 respirator to block out most of the harmful pathogens they might breath in. This is a form of mask that is designed to protect the wearer primarily. Because of its design, it also protects those around the wearer.
When you heard about the short supply of personal protective equipment (PPE) during the early months of the pandemic, the N-95 medical grade respirator was one of the most important pieces of equipment in short supply for those treating COVID patients. That remains true today. With the new Delta variant, the need to protect those treating COVID patients is even more important.
The standard N-95 mask filters out both large and small particles when the wearer inhales. It contains an electro-static charge that also catches pathogens. Along with the N-99 respirator, these are really the only types of facial masks that really offer a great level of protection to the wearer from airborne or aerosol particles containing virus.
Two Different Objectives
So, considering the distinction between these two types of protective face masks, the goal of the wearer is either to protect themselves or those around them. If you are wearing a surgical-style mask, and those around you are also wearing a surgical-style mask, then the viral particles that people exhale, including you, are contained for the most part and not as prevalent in the air. This is particularly important in enclosed spaces and those indoor spaces that don’t offer adequate air circulation. This is the most common type of mask worn, along with cloth masks, and has been largely available since the first months of the pandemic.
The N-95 mask, which offers the wearer more protection, if the mask if fitted properly, remains in shorter supply to the general public because it is in great demand in hospitals and other healthcare settings. In general practice, this kind of mask needs to be replaced after it has been worn for several hours unless it has been sterilized using vaporized hydrogen peroxide. The problem with cleaning these masks is that they can lose their static charge and be rendered less effective. This is why this type of face mask will be required in large supplies if the Delta variant causes another prolonged surge in COVID cases that overwhelms hospitals and clinicians.
Another Misunderstanding
While this explanation helps clarify the role a face mask plays, along with the two classes of protective face masks, there remains some misunderstanding and mixed messages coming from organizations like the World Health Organization. While the surgical-style masks are believed to play an important role in reducing transmission of the virus, the role of masks worn by asymptomatic people is still debated. If a person with some level of viral load in their throat or nose is not coughing or sneezing, then the likelihood that they can transmit disease, if social distancing is maintained, comes into question.
In any case, the utilitarian purpose of a protective face mask is either to prevent viral particles from being exhaled into the air around the wearer or to block the inhaling of viral particles that would make the wearer ill. Since those who are vaccinated can still potentially spread viral particles to those around them, the more recent recommendation for all people to mask up has been to mitigate the spread of the more transmissible variants.
The CDC does not consider cloth face coverings to be PPE. Many of the “cloth masks,” that have become the most common choice of face mask, do not have multiple layers or a suitable fit. After they are worn in a potentially virus-rich environment, they should be washed with soap and water. The paper type masks can be disposed of and replaced.
Just as medical personnel have always worn medical-grade face masks, when in the surgical suite or treating those with contagious illnesses, the goal of the mask is simply to act as a barrier.
After entering seven or eight stores the other day, and wearing my worn out N-95 mask that has been doused with Lysol spray 50 times, I am keenly aware that wearing a mask is no fun. Nobody knows when you are smiling and often a mask will muffle what the wearer is saying. We can only hope that we see the day soon when all of our masks are relegated to the back of a drawer.
In the meantime; they are a necessary evil.
