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To mask or not to mask?: Dr. Pradip Warghane

M3 India Newsdesk Mar 21, 2020

In light of the recent, massive outbreak of COVID-19 in India, it becomes essential to understand which type of masks can protect you while dealing with infected patients. Here, Dr. Pradip Warghane, provides a quick user guide on masks- surgical and N95 needed to be worn by healthcare personnel, while dealing with patients of COVID-19. 


For our comprehensive coverage and latest updates on COVID-19 click here.


Use of mask in COVID-19

If one is healthy, they only need to wear a mask if they are taking care of a person with suspected 2019-nCoV infection. Otherwise, a mask should be one if one is coughing or sneezing.

However, masks are effective only when other hygiene practices are followed such as frequent hand-washing with soap and water or disinfection with an alcohol-based hand rub.

If one must wear a mask, they must also know how to use it and dispose it properly.


How to wear mask

  1. Before putting on a mask, clean hands with alcohol-based hand rub or soap and water.
  2. Cover the mouth and nose with the mask and make sure there are no gaps between your face and the mask.
  3. Avoid touching the mask while using it; if you do, clean your hands with alcohol-based hand rub or soap and water.
  4. Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
  5. To remove the mask:
    1. Remove it from behind (do not touch the front of the mask)
    2. Discard immediately in a closed bin
    3. Clean hands with alcohol-based hand rub or soap and water
  6. Dispose surgical masks after each use.

Should a respirator be worn in public?

CDC does not recommend the routine use of respirators outside of workplace settings (in the community). Most often, the spread of respiratory viruses from person-to-person happens among close contacts (within 6 feet). CDC recommends everyday preventive actions to prevent the spread of respiratory viruses, such as avoiding people who are sick, avoiding touching the eyes or nose, and covering the mouth and nose while coughing or sneezing with a tissue.

People who are sick should stay home and not go into crowded public places or visit people in hospitals. Workers who are sick should follow CDC guidelines and stay home when they are sick.


What is a respirator?

A respirator is a personal protective device that is worn on the face or head and covers at least the nose and mouth. A respirator is used to reduce the wearer’s risk of inhaling hazardous airborne particles (including infectious agents), gases, or vapours. Respirators, including those intended for use in healthcare settings, are certified by the CDC/NIOSH.

What is an N95 filtering facepiece respirator (FFR)?

An N95 FFR is a type of respirator which removes particles from the air that are breathed through it. These respirators filter out at least 95% of very small (0.3 micron) particles. N95 FFRs can filter out all types of particles, including bacteria and viruses.

What makes N95 respirators different from facemasks (sometimes called a surgical mask)?

N95 respirators reduce the wearer’s exposure to airborne particles, from small particle aerosols to large droplets. They are tight-fitting respirators and filter out at least 95% of particles in the air, including large and small particles.

However, not everyone can wear a respirator due to medical conditions that may be made worse when breathing through it. Before using a respirator or getting fit-tested, workers must have a medical evaluation to make sure that they are able to wear a respirator safely.

Achieving an adequate seal to the face is essential. United States regulations require that workers undergo an annual fit test and conduct a user seal check each time the respirator is used. Workers must pass a fit test to confirm a proper seal before using a respirator in the workplace.

When properly fitted and worn, minimal leakage occurs around edges of the respirator when the user inhales. This means almost all of the air is directed through the filter media.

Unlike NIOSH-approved N95s, facemasks are loose-fitting and provide only barrier protection against droplets, including large respiratory particles. No fit testing or seal check is necessary with facemasks. Most facemasks do not effectively filter small particles from the air and do not prevent leakage around the edge of the mask when the user inhales.

The role of facemasks is for patient source control, to prevent contamination of the surrounding area when a person coughs or sneezes.  Patients with confirmed or suspected COVID-19 should wear a facemask until they are isolated in a hospital or at home. The patient does not need to wear a facemask while isolated.


What is a surgical N95 respirator and who needs to wear it?

A surgical N95 (also referred to as a medical respirator) is recommended only for use by healthcare personnel (HCP) who need protection from both airborne and fluid hazards (e.g., splashes, sprays). These respirators are not used or needed outside of healthcare settings. In times of shortage, only HCP who are working in a sterile field or who may be exposed to high-velocity splashes, sprays, or splatters of blood or body fluids should wear these respirators, such as in operative or procedural settings. Most HCP caring for confirmed or suspected COVID-19 patients do not need to use surgical N95 respirators and can use standard N95 respirators.

If a surgical N95 is not available for use in operative or procedural settings, then an unvalued N95 respirator may be used with a face shield to help block high-velocity streams of blood and body fluids.


Droplet precautions

A rectangular surgical face mask should be used for an infection that spreads via large droplets when someone coughs, sneezes, or talks. Infections like flu, whooping cough, and certain types of bacterial meningitis fall into this category. Both the person who is infected and the people caring for them should wear a face mask. It is important that caregivers dispose of the mask after every interaction and use a new one any time they are in close confines with an infected person.


Airborne precautions

Some lung or throat infections spread when small viral or bacterial particles stay suspended in the air and are breathed in by others. 2019-CoV, measles, SARS, chickenpox, and tuberculosis are a part of this category. In these cases, the infected person should wear a face mask. And all people coming into close contact should wear an N95 respirator, masks with a special air filter designed to protect themselves from tiny airborne particles. These masks fit a person’s face and are usually rounded in shape.

As researchers continue to learn more about how this new coronavirus spreads, the recommendations around masks focus on people who have the infection or are highly likely to be exposed. People who have the infection or are at high risk of being exposed should wear a surgical face mask. Anyone caring for someone infected in a medical setting should wear a respirator mask as part of airborne precautions.

For the rest of us, the best protection — hand washing, avoiding sick people, and not touching our face with unwashed hands — also helps prevent infection. If you choose to wear a surgical mask, make sure you have the best fit possible around your mouth and nose. Properly dispose of the mask and put on a new one anytime someone coughing or sneezing around you contaminates it.


For pet owners

As for pet owners putting face masks on their dogs, a Pomeranian dog in Hong Kong tested positive a "weak positive" for COVID-19. That dog is now in quarantine but is not showing symptoms of the disease, according to a March 5 piece in the South China Morning Post. However, it's unclear how the dog was tested for the illness. What's more, it doesn't appear that pets can transmit the virus to humans, and experts have informed people with pets not to panic. Rather than put face masks on pets, the CDC advises that people ill with COVID-19 avoid animals, just as they would other people.

 

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

The author, Dr. Pradip Warghane is a Cardiologist from Maharashtra.

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