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  #31  
Old 06-01-2020, 08:23 AM
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This is from April 1 [ignore the May 21 date to the right]

https://www.nejm.org/doi/full/10.1056/NEJMp2006372

Quote:
Universal Masking in Hospitals in the Covid-19 Era

Spoiler:
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.

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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.

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).

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

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.

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.

Such measures include vigorous screening of all patients coming to a facility for symptoms of Covid-19 and immediately getting them 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); 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. 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%.4,5 Modelers 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.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. 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.

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.

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.

Disclosure forms provided by the authors are available at NEJM.org.

This article was published on April 1, 2020, at NEJM.org.

Author Affiliations
From the Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute (M.K.), Brigham and Women’s Hospital (M.K., C.A.M., J.S., M.P.), Harvard Medical School (M.K., C.A.M., E.S.S.), and the Infection Control Unit and Division of Infectious Diseases, Massachusetts General Hospital (E.S.S.) — all in Boston.


References

Rothe C, Schunk M, Sothmann P, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020;382:970-971.

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2.Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020 February 21 (Epub ahead of print).

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3.Li R, Pei S, Chen B, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2). Science 2020 March 16 (Epub ahead of print).

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4.Hoehl S, Rabenau H, Berger A, et al. Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med 2020;382:1278-1280.

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5.Ng O-T, Marimuthu K, Chia P-Y, et al. SARS-CoV-2 infection among travelers returning from Wuhan, China. N Engl J Med 2020;382:1476-1478.

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  #32  
Old 06-01-2020, 08:47 AM
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Here is the archived original CDC guidance.

Quote:
Wear a facemask if you are sick
If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. Learn what to do if you are sick.
If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.
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  #33  
Old 06-03-2020, 06:02 AM
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Mary Pat Campbell
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https://www.cnet.com/health/pssst-yo...navirus-sorry/
Quote:
Pssst... Your face mask isn't a force field against the coronavirus. Sorry
Commentary: While COVID-19 quietly thrives, are some people letting their guard -- and masks -- down too early? Here's what I see where I live.


Spoiler:
My local Starbucks reopened to foot traffic last week. A sign on the door said to come on in, I've been missed. It also said that if you're not wearing a face mask, one would be issued to you. In my county, wearing a face covering in any building is required by order, and most grocery stores and shops demanded facial coverings anyway. A man followed me into the coffee shop, his face as naked as when he got out of bed. Nobody said a word. Nobody offered him a mask.

As I shop for food and supplies in my area, I can feel the mood lighten around me. The days are getting brighter and warmer. More businesses are reopening. Even as the US sweeps past its grimmest milestone yet -- over 100,000 people confirmed dead from COVID-19 -- I can't help but feel that a false sense of security has taken root, a seeming belief that wearing a face covering might keep someone from getting sick. As we face a potential second wave of coronavirus cases, this worries me. Just look at Wisconsin. Or where where I live.

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coronavirus-face-mask-sign-store-reopen
This store makes its face mask expectations pretty clear.

Jessica Dolcourt/CNET
Here's what I mean. There was the Starbucks barista in a flimsy mask who ventured beyond the Plexiglas divider and leaned in to bring me my drink, our faces inches apart. Fantastic service, ordinarily, but would she have done the same if we weren't both wearing a mask? Then there was the man at a jam-packed Costco who removed his face mask inside the store to take a sip from a water bottle. And another man a few feet away whose cloth mask covered his mouth only, his nostrils jutting out like binoculars. Let's not forget the woman in Trader Joe's who crossed the aisle right in front of me to grab an item from the shelf instead of waiting for me to move on, bringing our faces within spitting distance -- if it weren't for our masks, hers a cotton panel draped across her nose and mouth, mine conformed to my face, but so big I can't read my phone screen if I glance down.

Are these signs that people are becoming so comfortable wearing face masks that they feel invincible? Or is it more a function of human nature that warm weather and loosening restrictions make the invisible threat of serious disease somehow less urgent? Or maybe it's this: vigilance is exhausting.

I have a personal need to be cautious, to keep from acquiring or transmitting the coronavirus. My mother. Physically fragile (please don't tell her I said that,) but a woman of inner reserves who rises to the occasion, my septuagenarian mom is a recent widow.


Now playing: Coronavirus lockdown: Why social distancing saves lives
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Dad died on Feb. 2 -- from cancer, not the coronavirus -- robbing Mom of her life partner of 54 years. During a time when the physical embrace of family and friends would otherwise help ease the deep, ringing loss, seniors are urged to isolate to stay safe. My brother and I do Mom's shopping, help with chores, keep her company and tackle the unpleasant paperwork that must be dealt with in the wake of Dad's death. Every time I step inside, what else do I bring in?

If Mom got COVID-19 and I was the cause... that's not even a sentence I can finish.

Face masks aren't a silver bullet
Face masks caught on for a reason. With a plea for civilians to stop buying medical masks and donate the ones they had, cloth masks you can easily make at home or buy became the preferred way to cover up. But medical professionals have never promised that a face mask alone can keep you from getting sick with COVID-19 or passing it on to others.

In fact, every recommendation emphasizes the need to also socially distance and thoroughly wash your hands in addition to covering your face and mouth.

The practice of wearing a nonmedical mask in the US as a guard against the coronavirus began before the official recommendation issued by the Centers for Disease Control and Prevention. A grassroots effort to do something coincided with a growing desperation within the medical community over the severe shortage of medical-grade masks like N95 and surgical masks. The surge in cases of the highly contagious COVID-19 overwhelmed hospitals, necessitating a spike in the number of N95 masks needed to protect exhausted clinicians, nurses and staff.

Coronavirus Reopen Starbucks Welcome Back
I'm all for businesses reopening -- responsibly. Where I live, that means wearing a face mask.

Jessica Dolcourt/CNET
Here's what we know about nonmedical face masks. They've been found to help block large particles that you might eject unknowingly through sneezing, coughing, singing, speaking and spitting. Face coverings may be more effective at protecting others from you than the other way around, though common sense dictates that you're probably better off wearing one than not. They work better when they conform to your face without gaps, but cloth coverings aren't designed to fit your face the same way that a medical-grade mask like an N95 can, and obviously the masks you make at home or buy from vendors online aren't certified by an agency the way N95s are.

Most importantly, wearing a nonmedical face mask is no guarantee that you won't acquire or transmit the virus. It isn't a force field. It's simply one measure in a group of recommended behaviors to help lessen the spread of disease among communities, especially vulnerable populations more likely to be killed by COVID-19, like older people and those with underlying conditions. Like my mom.

Face masks won't be as effective if you remove them in a crowd, and expose your nose and mouth. There's no current evidence that they can block small respiratory particles containing the virus. N95 masks, meanwhile, are known to slow the spread of respiratory particles, though even they may not be able to fully stop transmission. It's possible that some behaviors could still increase your risk of acquiring or transmitting the coronavirus even if you do wear a mask, say -- and I'm speculating here -- if you sit inches away from someone for several hours in an unventilated room, or attend a crowded music festival.

coronavirus-facemask-face-mask-health-7499
Look, I don't love wearing face masks, either, but I also don't want to get sick -- or unknowingly pass it along.

James Martin/CNET
Months ago, when I first wrote about the topic that cloth face masks aren't a silver bullet against getting the coronavirus (without a vaccine, there is none), some people became angry and upset, including people I know and respect. My friend whose mom helped make cloth masks early on, assembly-line style, to donate to hospitals (admirable work). A nurse who told me that I had no idea how desperate the situation was in hospitals (she's right). The chorus of those saying that anything is better than nothing (I don't disagree).

There were also people who thanked me. One friend with cancer who was worried that misinformation would lead people to believe they could do anything they want as long as they wear a mask. Another friend who works in healthcare and was sick with the virus, who appreciated the distinction being made between N95, surgical masks (PDF) and cloth masks. A politician with a passion for public health and education, who wanted to share the limitations of cloth masks with constituents so they wouldn't depend on masks alone to protect their health.

I'm not a virologist. I'm not a scientist. I am a concerned civilian who dutifully wears a face mask in businesses as mandated by local law. But even after it isn't, I will probably continue to wear a mask in crowded public places or with people outside my household until a vaccine becomes available -- for the sake of my mom if not for myself. A nonmedical face mask may not be able to stop me from acquiring or transmitting illness, but if it helps keep me aware that the coronavirus is an ongoing threat -- even when the sun is shining and I long to return to "normal" life -- I'm buying in.


links from the piece:
CDC surgical v N95 masks https://www.cdc.gov/niosh/npptl/pdfs...raphic-508.pdf

CDC PPE FAQ
https://www.cdc.gov/coronavirus/2019...r-use-faq.html

American Lung Association on PPE
https://www.lung.org/blog/from-frontlines-ppe

CDC on cloth masks [references on page]
https://www.cdc.gov/coronavirus/2019...ace-cover.html
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  #34  
Old 06-07-2020, 07:35 PM
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WHO changed their guidance.

https://www.vox.com/2020/6/6/2128210...ines-cloth-n95

Quote:
The new guidance recommends that the general public wear cloth masks made from at least three layers of fabric “on public transport, in shops, or in other confined or crowded environments.” It also says people over 60 or with preexisting conditions should wear medical masks in areas where there’s community transmission of the coronavirus and physical distancing is impossible, and that all workers in clinical settings should wear medical masks in areas with widespread transmission.
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  #35  
Old 06-07-2020, 09:20 PM
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This would be useful for people who attend a protest.
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Originally Posted by Incredible Hulctuary View Post
This company is selling a repurposed snorkeling mask, with a KN95 filter in the top piece.

https://tekwase.com/products/ninja-s...odification-v2
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