Romano Law Nurse Corner #24 - COVID-19 Mask-Wearing Revisited

Serving nearby areas by Palm Beach and West Palm Beach, Florida

Romano Law Nurse Corner #24 COVID-19

Mask-Wearing Revisited

Another week has flown by in the midst of the COVID-19 pandemic. It really is amazing that we have been dealing with this pandemic since March.  Even then, we did not expect this to be so bad going into the fall.  The news is full of stories of schools that have reopened and had to close due to outbreaks of the coronavirus.  The pictures show college parties with hundreds of people, none wearing masks.  With this kind of behavior, this pandemic will continue to drag on. 

There have been online claims that wearing a mask can cause Staphylococcus, an infection that often causes rashes on the face and much worse.

THE QUESTION

Can you get Staphylococcus (Aureus, Methicillin Resistant MRSA) by wearing a face mask?

THE ANSWER

According to Infectious Disease specialists, you would need to have an untreated wound or an open lesion on your face for wearing a mask to lead to a staph infection and it’s a pretty rare occurrence.

Staphylococcus bacteria live in people’s nose and mouth; it only enters our skin when there’s an open wound or cut. People should check with their doctor about wearing a mask if there’s a skin lesion on the face.  

There are certainly skin problems that can occur by wearing masks, but having a staph infection is a pretty rare occurrence and it usually involves multiple things for it to happen.

Even with these rarities, one of the easiest ways to protect yourself and those around you from spreading and/or contracting the virus -wearing a mask- is still a hardship for some- with many refusing to wear one, claiming anything from a right to be free of a mask to it is bad for my health.  Prior blogs have talked about this more in depth. It is worth revisiting. 

While masks are still a point of contention for many in our country, the continued mounting data and widespread expert recommendation is to wear one.  Evidence is continually showing that masks protect not only those around them but also the person wearing them. Spread of the virus has slowed and stopped in places with prior outbreaks. Masks mandates have shown slowdowns in daily COVID-19 growth rates. Some states mandate mask wearing while others do not. The map (originally published in USA Today) below shows what states currently require masks in public spaces. 

https://www.gannett-cdn.com/presto/2020/08/13/USAT/7a6e6b16-887b-44fb-bb80-46db2d87c6c3-map_Online_copy.png

 

Here is link to a listing of each state with written descriptions of the actual rules, as well as links to the state’s actual mandate: https://www.aarp.org/health/healthy-living/info-2020/states-mask-mandates-coronavirus.html

As you know, masks come in many different materials, shapes and sizes.  While any mask is helpful in decreasing droplet spread, some are definitely better than others for protection against COVID-19.  Since they have become the norm in our lives there are more and more types of masks out there. People are quite creative. Given the ongoing pandemic and varied types of masks, people are doing more studies on mask effectiveness based on the type of mask.

In a recent study done at Duke University, researchers used a simple technique to analyze the effectiveness of masks. The method they ended up using includes a laser beam and a cell phone to evaluate the efficiency of masks by studying the transmission of respiratory droplets during regular speech.

"We use a black box, a laser, and a camera," Martin Fischer, one of the authors of the study, told CNN. "The laser beam is expanded vertically to form a thin sheet of light, which we shine through slits on the left and right of the box."

In the front of the box is a hole where a speaker can talk into it. A cell phone camera is placed on the back of the box to record light that is scattered in all directions by the respiratory droplets that cut through the laser beam when they talk.

A simple computer algorithm then counts the droplets seen in the video.

The researchers tested 14 commonly available masks including a professionally fitted N95 mask, reserved for health care workers. The test was performed with a speaker talking without wearing a mask and then again while the speaker wore the mask. Each mask was tested 10 times. General results of this study showed some expected results and even a surprising result.

As expected, the fitted N95 was the most effective. Three layer surgical masks and cotton masks performed well. 

Neck fleeces, also called “gaiter masks” were the least effective.  Interestingly, these fleeces actually cause a higher number of droplets because the material broke down the larger particles into smaller particles that are more easily carried away with air.  The researchers were surprised to find the particle count higher with the mask than without it. Clearly, these types of masks do not work. Folded bandanas and knitted masks also did poorly, offering very little protection. They are better than nothing however.

This way of testing is an incredibly easy way for companies who are producing masks to test and improve their product overall.  The more we learn the better we can do to stop this virus that will not seem to stop spreading. 

As we have discussed homemade masks can be effective, however many of them have spaces near your nose and cheeks where droplets can get through to be inhaled. It is important for those making a homemade mask to ensure that they use it with the proper fit, minimizing spaces where particles can get through.

Generally, stay away from thicker materials in the mask, as they can interfere with breathing and could force air out the sides of the mask. They also said that any sort of filter inserts, which many masks have inside, will improve overall effectiveness.

Other researchers have studied masks as well.  Phillip Clapp, a postdoctoral researcher at the Center for Environmental Medicine, Asthma, and Lung Biology at the University of North Carolina, has been testing various homemade masks. When he studied three layers of cotton fabric, he saw that the material itself had efficiency of around 90%. However, once he wore the mask made from that material, its efficiency dropped below 50%.

And what that tells us is that it really has to do with how well that mask will fit your face, as to how well you'll be protected, Dr. Clapp said. 

The mask should cover both your nose and mouth. The CDC has published a lot of material on masks in general as well as tutorials on making face masks, including masks with elastic ear loops as well as tie strings. If you choose to make a mask with tie strings, it is important to make sure the straps fit correctly around the head so the mask does not fall down or leave spaces.  Once again the closer it can be to the face without any gaps, the better off you and those around you will be. 

Mask Safety Tips

Given that masks seem like they will be the norm for quite a while, let’s talk about the latest information on cleaning your mask.

General principles-treat your mask like a biohazard after you have been out in public with it.  Isolate it from your family.  When you put the mask on and off, avoid touching the mask, put it on and off by touching the elastic, ties or ear straps.  Always wash your hands with soap and water when putting your mask on or taking it off and after touching your mask in any way.

N95 masks, which should be reserved for healthcare workers, should not be cleaned at home. They can be reused with proper care.  There is some evidence that the coronavirus can live on these masks for 7 days which is longer than the time it lasts on the other cloth materials.  Experts recommend isolating the mask in a breathable sealed bag for 7 days, leaving it at room temperature.  After those 7 days, it should be safe to use the mask again.  Clapp said that N95 masks that are expired are just as effective, however the elastic on the ear loops might deteriorate. 

Disposable surgical masks vary in effectiveness. They are basically made to protect the face from large particles like blood and body fluids. Depending on the manufacturer and type of mask, they can vary in effectiveness.  Generally, they are less effective than N95 because they are not fitted to the face so there is space for air to get in. Experts recommend not buying these to use so there is not a shortage for healthcare workers however if you have some already it is effective.  They should not be washed as liquid damages the filter.  They can be put in a loose bag (not plastic it holds moisture) and left at room temperature for 2 days after which the virus will no longer be active.

Homemade cloth face masks should be run through the washer, using laundry detergent, and the temperature of the water does not matter.  If you do not have a washing machine, you can hand wash it using soap.  You can also put it in a loose sealed paper bag for at least 2 days and any virus will no longer be active.

As nurses we cannot urge you enough to wear a mask.  Science does not lie. 

Sources:

https://www.usatoday.com/in-depth/news/2020/04/27/how-clean-care-for-store-and-reuse-masks-protect-coronavirus-n-95-elastometric-homemade-covid-19/5148025002/

https://www.cnn.com/2020/08/08/us/duke-university-face-mask-test-trnd/index.html

Susan

Susan Ramsey is both an attorney and an RN. Ms. Ramsey’s professional experience began as a Registered Nurse in the Intensive Care Unit at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program. During her time with the Program, Ms. Ramsey counseled sexual assault survivors and performed seminars for local police departments, universities, and high schools. During her time working as a registered nurse, Ms. Ramsey decided to attend law school. Ms. Ramsey graduated from CUNY Law School, and has practiced law in several different State and Federal Courts.  She is a Florida Heath Care Risk Manager and a member of the Palm Beach County Sober Home Task Force.  Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of survivors, cases include injuries suffered by victims of professional negligence, product liability and medical negligence.

Amie 

Amie Goldberg is both an attorney and a certified APRN.  After completing a Bachelor of Arts Degree at Whittier College, Ms. Goldberg attended nursing school at Emory University.  Ms. Goldberg’s professional experience started as a Registered Nurse at Egleston Children’s Hospital taking care of children with congenital heart disease. After a few years, she continued working in all areas of the hospital while attending Kennesaw State University on weekends in order to get her Master’s Degree in Nursing with a specialty of Primary Care Nurse Practitioner/Family Nurse Practitioner.  During her time as an APRN, Ms. Goldberg decided to attend law school at St. Thomas University in Miami, Florida.   Since graduating, she has mainly practiced in the areas of personal injury and worker’s compensation, fighting for the rights of injured people. Since joining the Romano Law Group, Ms. Goldberg has been the Director of the Opioid Litigation Project.  Ms. Goldberg also practices in the area of medical malpractice and nursing home negligence, bringing an inside perspective and knowledge to help get justice for our clients. 

Stay Safe,

Susan

Amie