COVID-19: It’s time to wear a mask

Mar 20, 2020

As I’ve mentioned all along, recommendations around the COVID-19 pandemic can and will change. Back less than three weeks ago on the issue of face masks I wrote, “Currently, the CDC does not recommend asymptomatic people wear a mask. However, wearing a mask can serve as a reminder to you to avoid touching your nose and mouth. Sick people with concern for COVID-19 entering health care facilities like ours will be offered masks to limit the spread of the virus.“ We believe it’s time to make a change. While the answer still isn’t as assured as a Michael Jordan slam dunk, at this time we are going to be a bit stronger in our counsel.

We now recommend that you put on a face mask when you leave home and may have contact with others.

At some point we will be going back to work. And it won’t be when we are all immune or when there’s a perfect treatment or preventive tool. We will go back to work and school when there is still risk out there. Let’s start now demonstrating the habits that will be needed to reduce the ongoing transmission and impact of the pandemic.

Convincing data are still lacking as to whether this will play a role in reducing the impact of the epidemic. Yet I ask, what data is sufficient to recommend something that might save your neighbor, or save someone else’s neighbor?

Is there new information that is guiding this recommendation?

In a report published on March 27, half of the nursing home residents in Kirkland, WA who were tested positive for SARS-CoV-2 were asymptomatic. A similar percentage was found on the Diamond Princess cruise ship. It is suggested that half of all infections are transmitted from an asymptomatic person to one who is susceptible. There is a trove of information gathered on the benefit of face mask use. Thanks to patient Pete for directing me there.

We originally thought that someone had to cough or sneeze a large droplet for another to acquire the infection. This may not be true. There are people who have the infection for days before demonstrating symptoms; there are also folks who get infected and clear the infection without ever exhibiting symptoms—we definitely need to learn more about that.

Until we have a more comprehensive testing program to identify and isolate these individuals, we need to protect ourselves. Also, if we are one of these people who is infected but not symptomatic, we need to protect others. A Washington Post perspective from Saturday made a strong push for mask use.

What else? Two prominent hospitals – Massachusetts General Hospital (Partners Health Care) in Boston and The University of Chicago Medical Center – are recommending that all employees now wear masks at work when they’re around the public.

There is a growing push by leading scientists for the WHO and CDC to advocate for public face mask use. It’s time.

What kind of mask?

We DO NOT recommend a surgical mask—or certainly not an N95 mask—as you walk around. Until local supplies are full, surgical masks should be reserved for healthcare workers. N95 masks should be reserved for health care workers who are in close contact with a known COVID-19 patient. Yet please don’t judge! If you see someone on the street with a surgical mask (or even an N95), be generous of spirit and assume that the person is a healthcare worker and not a hoarder. Look, if I see someone in my office I am having them wear a surgical mask when they’re in the office, and then they can keep it to wear around.

Right now we recommend cloth masks. While one can imagine that these masks won’t be as good as the others, they serve a purpose. KK Cheng, a public health expert at the University of Birmingham said in an article from Saturday on this issue: “Just imagine you’re traveling in the New York [City] subway on a busy morning. If everyone wears a mask, I’m sure that it would reduce the transmission,” he says, adding, “Don’t ask me to show you a clinical trial that it works.”

I’m sure they’re available on Amazon. Yet this is the type of thing that I go to Etsy for. If you’re handy, or know someone who is handy, you could make a mask yourself. Here is a link to instructions on how to do so. Please contact us if you are handy and are interested in making and contributing masks to vulnerable patients/medical professionals in and outside our practice. 

What if I already have or are suspected to have COVID-19?

If you have COVID-19 or your doctor believes you do in the absence of testing, you must ISOLATE. This means you should not go outside at all! You must commit to this, as we don’t want you to be a super-spreader. If you live with others and leave your room and are out and about in your home, put on a mask.

When you recover, still wear a mask. It’s not clear how long you may be infectious after your illness resolves. And until those who recover are wearing the Scarlet “I” for immune, you’ll soon look like a pariah if you’re not wearing a mask. We suspect the WHO and CDC will eventually recommend all folks wear a mask in public.

Do I still need to social distance?

YES! The mask does not protect you without you still protecting yourself with the six-feet zone of safety, the commitment to handwashing and the mindfulness of the potential for fomites to infect you.

So, get or make a cloth mask and start wearing it when you go to the grocery store or pick up your food from a local restaurant. Please let me or your provider know if you have questions.

More to come,

Dr. Will

P.S. We have gotten some feedback to make the emails shorter. So much information we want to pass on, so it’s difficult to keep it short. Will keep trying.

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