Attached below is a NEJM.org article discussing wearing masks in a healthcare setting and the ineffectiveness of the public wearing masks. My response is inline, below. Please excuse in advance this barely high school graduating truck driving poster from challenging multiple healthcare professionals, some of whom have Ph.Ds. The fundamental objective should be to minimize spread of Covid-19, which by necessity requires public participation that includes effective use of PPE. Universal Masking in Hospitals in the Covid-19 Era List of authors. Michael Klompas, M.D., M.P.H., Charles A. Morris, M.D., M.P.H., Julia Sinclair, M.B.A., Madelyn Pearson, D.N.P., R.N., and Erica S. Shenoy, M.D., Ph.D. Article Metrics 5 References 24 Citing Articles Letters As the SARS-CoV-2 pandemic continues to explode, hospital systems are scrambling to intensify their measures for protecting patients and health care workers from the virus. An increasing number of frontline providers are wondering whether this effort should include universal use of masks by all health care workers. Universal masking is already standard practice in Hong Kong, Singapore, and other parts of Asia and has recently been adopted by a handful of U.S. hospitals. We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic. If there ever was a time to nail down specifics with a statement like the one bolded above, that was the time. Imagine a Covid-19 infected patron in a resaurant or sporting event projecting their voice either because they got frustrated at having to repeat an order, cheering their team, or are hard of hearing, like a lot of long term truck drivers. We have already seen the massive spread of Covid-19 among members of a choir rehearsal group in Washington State. SIGN UP The calculus may be different, however, in health care settings. First and foremost, a mask is a core component of the personal protective equipment (PPE) clinicians need when caring for symptomatic patients with respiratory viral infections, in conjunction with gown, gloves, and eye protection. Masking in this context is already part of routine operations for most hospitals. What is less clear is whether a mask offers any further protection in health care settings in which the wearer has no direct interactions with symptomatic patients. There are two scenarios in which there may be possible benefits. How about the idea of reducing case loads through educating the public and creating more user friendly PPE? The first is during the care of a patient with unrecognized Covid-19. A mask alone in this setting will reduce risk only slightly, however, since it does not provide protection from droplets that may enter the eyes or from fomites on the patient or in the environment that providers may pick up on their hands and carry to their mucous membranes (particularly given the concern that mask wearers may have an increased tendency to touch their faces). Although it is easy to agree with this paragraph, it should be easy for most to see the need and proper utilization of PPE is not rocket science. We tell and expect school age children to wash their hands and not put potentially dirty things into their mouths. More compelling is the possibility that wearing a mask may reduce the likelihood of transmission from asymptomatic and minimally symptomatic health care workers with Covid-19 to other providers and patients. This concern increases as Covid-19 becomes more widespread in the community. We face a constant risk that a health care worker with early infection may bring the virus into our facilities and transmit it to others. Transmission from people with asymptomatic infection has been well documented, although it is unclear to what extent such transmission contributes to the overall spread of infection.1-3 Ok, if someone may have Covid-19, but not know it, but that someone happens to be infected and it may help reduce the chances of infecting someone else by wearing a mask, why would there not be an emphasis in teaching the public to wear masks properly? More insidious may be the health care worker who comes to work with mild and ambiguous symptoms, such as fatigue or muscle aches, or a scratchy throat and mild nasal congestion, that they attribute to working long hours or stress or seasonal allergies, rather than recognizing that they may have early or mild Covid-19. In our hospitals, we have already seen a number of instances in which staff members either came to work well but developed symptoms of Covid-19 partway through their shifts or worked with mild and ambiguous symptoms that were subsequently diagnosed as Covid-19. These cases have led to large numbers of our patients and staff members being exposed to the virus and a handful of potentially linked infections in health care workers. Masking all providers might limit transmission from these sources by stopping asymptomatic and minimally symptomatic health care workers from spreading virus-laden oral and nasal droplets. More support for my point that educating the public on proper use of PPE would be beneficial. What is clear, however, is that universal masking alone is not a panacea. A mask will not protect providers caring for a patient with active Covid-19 if it’s not accompanied by meticulous hand hygiene, eye protection, gloves, and a gown. A mask alone will not prevent health care workers with early Covid-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures. I have yet to see any members of the public wear goggles or gloves other than work gloves in spite of my extensive travels. A simple news conference by an official outlning the seriousness of Covid-19 and the steps to take to reduce infection chances would be beneficial. Such measures include vigorous screening of all patients coming to a facility for symptoms of Covid-19 and immediately getting them The authors forgot about asymptomatic spread of Covid-19 already? masked and into a room; early implementation of contact and droplet precautions, including eye protection, for all symptomatic patients and erring on the side of caution when in doubt; rescreening all admitted patients daily for signs and symptoms of Covid-19 in case an infection was incubating on admission or they were exposed to the virus in the hospital; having a low threshold for testing patients with even mild symptoms potentially attributable to a viral respiratory infection (this includes patients with pneumonia, given that a third or more of pneumonias are caused by viruses rather than bacteria); requiring employees to attest that they have no symptoms before starting work each day; being attentive to physical distancing between staff members in all settings (including potentially neglected settings such as elevators, hospital shuttle buses, clinical rounds, and work rooms); Almost sounds like the authors are admitting Covid-19 could hang in the air and stay active on surfaces for a while... restricting and screening visitors; and increasing the frequency and reliability of hand hygiene. The extent of marginal benefit of universal masking over and above these foundational measures is debatable. We live in a new reality. It is time for our society to adapt. There are more viruses coming our way, whether through nature or my man. The bumbling effort by our healthcare and political leadership has exposed systemic vulnerability to a biological attack by a group of almost any size. We might as well get our procedures down now before we face an even more dire threat ahead. It depends on the prevalence of health care workers with asymptomatic and minimally symptomatic infections as well as the relative contribution of this population to the spread of infection. It is informative, in this regard, that the prevalence of Covid-19 among asymptomatic evacuees from Wuhan during the height of the epidemic there was only 1 to 3%.4,5Modelers assessing the spread of infection in Wuhan have noted the importance of undiagnosed infections in fueling the spread of Covid-19 while also acknowledging that the transmission risk from this population is likely to be lower than the risk of spread from symptomatic patients. Any number of asymptomatic spreaders are a problem because of continual reinfection issues of the general population, especially given the fact there is no long term immunity to this virus after infection. Again, this virus spread from a Wuhan, China open food market to the world in a few months. Most any pockets of active Covid-19 will spread in our connected world and will reinfect us over and over again, just like the flu and its various strains. 3 And then the potential benefits of universal masking need to be balanced against the future risk of running out of masks and thereby exposing clinicians to the much greater risk of caring for symptomatic patients without a mask. This just in: Mask manufacturers have increased mask production. If a mandate for even more production is needed, then so be it. If we are going to get serious about combatting Covid-19 and future viruses, we need to make sure all the tools are in place, including masks. Providing each health care worker with one mask per day for extended use, however, may paradoxically improve inventory control by reducing one-time uses and facilitating centralized workflows for allocating masks without risk assessments at the individual-employee level. If extended use of each set of PPE is necessary, perhaps a dedicated UV room with a conveyor belt system can be used. Obviously, each medical practitioner would need to have more than one set of PPE, but is this not fundamental when dealing with infectious diseases? There may be additional benefits to broad masking policies that extend beyond their technical contribution to reducing pathogen transmission. Masks are visible reminders of an otherwise invisible yet widely prevalent pathogen and may remind people of the importance of social distancing and other infection-control measures. Now these guys are finally starting to make sense. It is also clear that masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis. One might argue that fear and anxiety are better countered with data and education than with a marginally beneficial mask, particularly in light of the worldwide mask shortage, but it is difficult to get clinicians to hear this message in the heat of the current crisis. Expanded masking protocols’ greatest contribution may be to reduce the transmission of anxiety, over and above whatever role they may play in reducing transmission of Covid-19. The potential value of universal masking in giving health care workers the confidence to absorb and implement the more foundational infection-prevention practices described above may be its greatest contribution. The big question is to require mandatory PPE for those in public, at work, and in school. Certaintly those who travel, who would make contact tracing nearly impossible and those who interact with a lot of people. It seems many health care professionals do not believe the public can learn or is willing to learn the proper use of PPE. This is a mistake that will mean Covid-19 will dominate our conversations and health for years to come. https://www.nejm.org/doi/full/10.1056/NEJMp2006372?query=recirc_mostViewed_railB_article
I dont see people in my area wearing masks in open outdoor spaces.....only when they are inside stores or groceries or other indoor places where people are more closely together and pass within close proximity often to make sure they are protecting spreading to others as others are protecting from spreading to them.
I see plenty of folks wearing them outside. I saw folks wearing them at the beach, which makes no sense at all, but whatever.
The posting was too lengthy to read in it's entirety. In any event, the first line was a false premise and so I stopped there.
There is "some" benefit for wearing a mask, regardless.... even if it's only to catch the larger aerosols. 2 masks are better than one. 1 mask is better than none. Don't be stupid. Wear a mask when out in public!! Maybe the virus will subside in a couple of years. If so, we can all forget about masks. Until then, don't be "penny wise and pound foolish".
Quick summary: Covid-19 is nasty; wear PPE. Here is something you’ll read: The Trump Administration with the help of congress and businesses have done an awe-inspiring job in keeping the economy together. I may be delivering sand to sand mines and partial loads half way cross country, but it looks like a negative economic feedback loop has been avoided. My load board shows we are at 15 month highs of 45,000 loads(Spot market) and trucking freight rates have rebounded sharply. Also impressive are the abundant help wanted signs I see when I pick up and deliver loads around the country. Some industries are still hurting and may lag for years, but business and consumer confidence may recover enough to keep things going without continued intervention in the near future.
There are lot of nasty features to this virus that affect more than old people. In this thread I will post articles related to these features in case there are still people who think Covid-19 is a hoax. Besides, learning how to wear PPE and creating disaster preparation plans adds another layer of protection when it comes to national defense.
Ok, clarification..... we wear masks to protect ourselves or protect others? If it’s to protect ourselves, then only N95 masks and worn properly will make an impact. If it’s to protect others, reducing the amount of aerosols, then why are people wearing masks with respirator valves? They make it nice for the wearer but does little for stopping your germs from getting out.
You like the NEJM... they seem to have it right. Aerosol spread... little evidence of significant spread. Outdoor spread over short periods of time...little or no evidence of significant spread. People yelling at you indoors or out... with or without at mask... .watch out. People talking over loud sounds... watch out. People singing or screaming... watch out. Crowds of sick people and bad ventilation... of course Masks themselves may do more harm than good. Sick people get dirty masks... then they touch their mask and surfaces. Sick people singing or talking through dirty masks... how much exposure are you really saving? Its common sense... There is only a limited amount of time that a mask is useful, clean and worn properly. That benefit is probably overwhelmed by non healthcare professionals not handling their dirty masks well. There is little evidence that masks alone are useful overall. Universal Masking in Hospitals in the Covid-19 Era List of authors. Michael Klompas, M.D., M.P.H., Charles A. Morris, M.D., M.P.H., Julia Sinclair, M.B.A., Madelyn Pearson, D.N.P., R.N., and Erica S. Shenoy, M.D., Ph.D. Article Metrics 5 References 24 Citing Articles Letters As the SARS-CoV-2 pandemic continues to explode, hospital systems are scrambling to intensify their measures for protecting patients and health care workers from the virus. An increasing number of frontline providers are wondering whether this effort should include universal use of masks by all health care workers. Universal masking is already standard practice in Hong Kong, Singapore, and other parts of Asia and has recently been adopted by a handful of U.S. hospitals. We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic. The NEJM seems to be exactly right... its mostly symbolic to quell fear. People are not getting it passing by outdoors. Its spreading indoors after exposure over time time to a viral load. If you are singing in a Chair and you are shedding virus... How long before your mask is filthy and you are now blow concentrated virus through the mask. if you are putting the time indoors next to or in a room with a spreader... is the mask really going to help you. For every person it may help... there are probably multiple more who touched their filthy mask and then touched the thing that someone else was about to touch. A spread that may not have happened without a mask. The calculus may be different, however, in health care settings. First and foremost, a mask is a core component of the personal protective equipment (PPE) clinicians need when caring for symptomatic patients with respiratory viral infections, in conjunction with gown, gloves, and eye protection. Masking in this context is already part of routine operations for most hospitals. What is less clear is whether a mask offers any further protection in health care settings in which the wearer has no direct interactions with symptomatic patients. There are two scenarios in which there may be possible benefits. Transparent and useful data would go along way to making the public agree to work in unison. When are leaders said nothing doing the riots... compliance fell dramatically by my observations. The first is during the care of a patient with unrecognized Covid-19. A mask alone in this setting will reduce risk only slightly, however, since it does not provide protection from droplets that may enter the eyes or from fomites on the patient or in the environment that providers may pick up on their hands and carry to their mucous membranes (particularly given the concern that mask wearers may have an increased tendency to touch their faces). Although it is easy to agree with this paragraph, it should be easy for most to see the need and proper utilization of PPE is not rocket science. We tell and expect school age children to wash their hands and not put potentially dirty things into their mouths. Try as you may to put lipstick on this pig of an idea... masks alone may do more damage than good. Distancing, closed borders and contact tracing is the real role of govt here... not this bullshit about wearing masks which may not even work on the whole. More compelling is the possibility that wearing a mask may reduce the likelihood of transmission from asymptomatic and minimally symptomatic health care workers with Covid-19 to other providers and patients. This concern increases as Covid-19 becomes more widespread in the community. We face a constant risk that a health care worker with early infection may bring the virus into our facilities and transmit it to others. Transmission from people with asymptomatic infection has been well documented, although it is unclear to what extent such transmission contributes to the overall spread of infection.1-3 Ok, if someone may have Covid-19, but not know it, but that someone happens to be infected and it may help reduce the chances of infecting someone else by wearing a mask, why would there not be an emphasis in teaching the public to wear masks properly? Per the WHO the limited data they had showed that asymptomatic spread is rare. If that has changed... bring on useful data. More insidious may be the health care worker who comes to work with mild and ambiguous symptoms, such as fatigue or muscle aches, or a scratchy throat and mild nasal congestion, that they attribute to working long hours or stress or seasonal allergies, rather than recognizing that they may have early or mild Covid-19. In our hospitals, we have already seen a number of instances in which staff members either came to work well but developed symptoms of Covid-19 partway through their shifts or worked with mild and ambiguous symptoms that were subsequently diagnosed as Covid-19. These cases have led to large numbers of our patients and staff members being exposed to the virus and a handful of potentially linked infections in health care workers. Masking all providers might limit transmission from these sources by stopping asymptomatic and minimally symptomatic health care workers from spreading virus-laden oral and nasal droplets. More support for my point that educating the public on proper use of PPE would be beneficial. I thought all health care workers in the US wore PPE now. What is clear, however, is that universal masking alone is not a panacea. A mask will not protect providers caring for a patient with active Covid-19 if it’s not accompanied by meticulous hand hygiene, eye protection, gloves, and a gown. A mask alone will not prevent health care workers with early Covid-19 from contaminating their hands and spreading the virus to patients and colleagues. Focusing on universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures. I have yet to see any members of the public wear goggles or gloves other than work gloves in spite of my extensive travels. A simple news conference by an official outlning the seriousness of Covid-19 and the steps to take to reduce infection chances would be beneficial. The useful steps are staying away from people hacking and coughing... or expelling large volumes of air indoors... The govt should be testing and tracing clusters. If you are high risk stay home. Such measures include vigorous screening of all patients coming to a facility for symptoms of Covid-19 and immediately getting them The authors forgot about asymptomatic spread of Covid-19 already? masked and into a room; early implementation of contact and droplet precautions, including eye protection, for all symptomatic patients and erring on the side of caution when in doubt; rescreening all admitted patients daily for signs and symptoms of Covid-19 in case an infection was incubating on admission or they were exposed to the virus in the hospital; having a low threshold for testing patients with even mild symptoms potentially attributable to a viral respiratory infection (this includes patients with pneumonia, given that a third or more of pneumonias are caused by viruses rather than bacteria); requiring employees to attest that they have no symptoms before starting work each day; being attentive to physical distancing between staff members in all settings (including potentially neglected settings such as elevators, hospital shuttle buses, clinical rounds, and work rooms); Almost sounds like the authors are admitting Covid-19 could hang in the air and stay active on surfaces for a while... restricting and screening visitors; and increasing the frequency and reliability of hand hygiene. The extent of marginal benefit of universal masking over and above these foundational measures is debatable. We live in a new reality. It is time for our society to adapt. There are more viruses coming our way, whether through nature or my man. The bumbling effort by our healthcare and political leadership has exposed systemic vulnerability to a biological attack by a group of almost any size. We might as well get our procedures down now before we face an even more dire threat ahead. It depends on the prevalence of health care workers with asymptomatic and minimally symptomatic infections as well as the relative contribution of this population to the spread of infection. It is informative, in this regard, that the prevalence of Covid-19 among asymptomatic evacuees from Wuhan during the height of the epidemic there was only 1 to 3%.4,5Modelers assessing the spread of infection in Wuhan have noted the importance of undiagnosed infections in fueling the spread of Covid-19 while also acknowledging that the transmission risk from this population is likely to be lower than the risk of spread from symptomatic patients. Any number of asymptomatic spreaders are a problem because of continual reinfection issues of the general population, especially given the fact there is no long term immunity to this virus after infection. Again, this virus spread from a Wuhan, China open food market to the world in a few months. Most any pockets of active Covid-19 will spread in our connected world and will reinfect us over and over again, just like the flu and its various strains. 3 And then the potential benefits of universal masking need to be balanced against the future risk of running out of masks and thereby exposing clinicians to the much greater risk of caring for symptomatic patients without a mask. This just in: Mask manufacturers have increased mask production. If a mandate for even more production is needed, then so be it. If we are going to get serious about combatting Covid-19 and future viruses, we need to make sure all the tools are in place, including masks. Providing each health care worker with one mask per day for extended use, however, may paradoxically improve inventory control by reducing one-time uses and facilitating centralized workflows for allocating masks without risk assessments at the individual-employee level. If extended use of each set of PPE is necessary, perhaps a dedicated UV room with a conveyor belt system can be used. Obviously, each medical practitioner would need to have more than one set of PPE, but is this not fundamental when dealing with infectious diseases? There may be additional benefits to broad masking policies that extend beyond their technical contribution to reducing pathogen transmission. Masks are visible reminders of an otherwise invisible yet widely prevalent pathogen and may remind people of the importance of social distancing and other infection-control measures. Now these guys are finally starting to make sense. It is also clear that masks serve symbolic roles. Masks are not only tools, they are also talismans that may help increase health care workers’ perceived sense of safety, well-being, and trust in their hospitals. Although such reactions may not be strictly logical, we are all subject to fear and anxiety, especially during times of crisis. One might argue that fear and anxiety are better countered with data and education than with a marginally beneficial mask, particularly in light of the worldwide mask shortage, but it is difficult to get clinicians to hear this message in the heat of the current crisis. Expanded masking protocols’ greatest contribution may be to reduce the transmission of anxiety, over and above whatever role they may play in reducing transmission of Covid-19. The potential value of universal masking in giving health care workers the confidence to absorb and implement the more foundational infection-prevention practices described above may be its greatest contribution. The big question is to require mandatory PPE for those in public, at work, and in school. Certaintly those who travel, who would make contact tracing nearly impossible and those who interact with a lot of people. It seems many health care professionals do not believe the public can learn or is willing to learn the proper use of PPE. This is a mistake that will mean Covid-19 will dominate our conversations and health for years to come. https://www.nejm.org/doi/full/10.1056/NEJMp2006372?query=recirc_mostViewed_railB_article [/QUOTE]
Wouldn't that depend on the windiness, crowd size, personal risk factors, and closeness to people outside of your household?