Mass–k Confusion about Coronavirus, or “Who is that masked man/woman?”


To paraphrase the catchphrase from the Lone Ranger, that is a pretty good question.

The current discussions of mask-wearing relative to coronavirus can be confusing. Actually, though, the guidelines are pretty straightforward. Unfortunately, the messaging often isn’t. Depending on the situation, the masked person may well be a clinician, a household member providing care, a patient or “just some guy.”

Perhaps you have heard the term N95 in the discussion of face masks. N95 refers to a certain type of face mask that is part of the Personal Protective Equipment (PPE) ensemble. This ensemble includes barrier garments like a gown, eye protection like a face shield, and in the case of coronavirus, nitrile gloves.

These items are recommended to keep the wearer from being exposed to hazards. Often such hazards are materials such as smoke, biologically harmful dusts, or industrial contaminants. In the case of coronavirus, these items are used to keep the virus entering the body in the usual respiratory-virus ways: through the eyes, nose and mouth.

Why all the fuss?

In part, the fuss has arisen because there are still many unknowns about the disease caused by the current coronavirus. Given the uncertainty, caution and protection are important. We in the medical community are still learning about this illness, including both the short-term and long-term effects.

Questions about the coronavirus that still need answering include the following:

· How bad is it? That remains to be determined. According to an article in journal of the American Medical association (JAMA), thus far the disease seems to generallybe more severe in the elderly, especially older people with underlying health considerations. Children seem to have less severe illness. https://jamanetwork.com/journals/jama/fullarticle/2762130

· How easy is it to catch? This is still being determined, but current evidence suggests it is about as easy to catch as some other respiratory viruses.

· How is it caught? Again, the answer appears to be “the same as other respiratory viruses”. This is why thorough frequent handwashing and surface sanitizing are recommended. It includes such simple measures as properly covering a cough.

· What is social distancing? Social distancing is the deliberate act of minimizing person-to person contact. It is a part of what is called Non Pharmaceutical Interventions, or NPIs.

· How is it treated? Unlike for flu, there are not specific antiviral medications at present. For people with severe life-threatening symptoms, supportive intensive care is use. Efforts are underway to find medications that are effective against this coronavirus infection. Efforts also are underway to develop a vaccine, which according to experts at the National Institutes of Health (NIH) might be available to the public in about a year.

· Should I wear a mask? Now here is where the guidance gets muddy…

Isolation versus Quarantine:

Although these terms have different meaning, they are, unfortunately, interchanged quite often in the media. However, these distinctions matter a lot, as people will be expected to care at home for people with the coronavirus infection, according to the Centers for Disease Control and Prevention (CDC) and the public health community.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html

Isolationis the separation of a person with a contagious disease from people who are well.

Quarantineis confining the movement of people who were exposed to a contagious disease while waiting to see if they become sick.

So, isolated people are ill; quarantined people are not yet ill, but are exposed and at risk to becoming ill. If a quarantined person becomes ill, then they are in isolation.

The N95 Mask:

So, do we need to buy and wear these things or not? The answer is … maybe. Here’s some information that may make the guidance easier to interpret.

If you are just walking down the street, the answer is that there is no evidence to suggest that wearing an N95 is protective. That said, if someone very near you is ill and coughing uncontrollably and without the courtesy of cough protection, you may need PPE. Of course, if you are in close contact as defined by CDC and World Health Organization (WHO) as roughly 6 feet, then just like with a healthcare worker in contact with a patient, some protection is warranted. This also includes eye protection.

Interim Guidance for Preventing the Spread of Coronavirus Disease 2019 (COVID-19) in Homes and Residential Communities:

If instructed to render home care and support by your health department and healthcare provider, then the same provisions of PPE apply to you that apply to any other healthcare provider. In addition to keeping the person as isolated as possible from the rest of the household (having the person stay out of common areas, sanitizing eating utensils, using disposable items and isolating the trash of the sick person), you should use caregiver PPE. This includes wearing a mask and eye protection, washing one’s hands after caring for the person and wearing a barrier garment in the sick person’s separate area and removing it before returning to common areas. The whole idea is to minimize exposure to the other members of the household. The article posted at the following link describes the appropriate sequence for the putting on and taking off PPE.

https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf

So in this situation having an N95 is warranted.

What can you do? The guidance cascade:

If someone becomes ill and might have COVID-19, contact your healthcare provider BY PHONE and your local health department as well. A list of health department contacts nationally is posted on the National Association of City and County Health Officers website(https://www.naccho.org/membership/lhd-directory).Just click and go!

If you are instructed to stay home and care for a family member or other household member, there are ways to maximize the safety and protection of others in the household. These can be found at - https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html

Some practical advice:

There’s little sense in considering home care and isolation without considering the logistical support necessary to make it happen. In other words, it all falls apart if you don’t have sanitizer, soap, food, trash bags and (as is often forgotten) … toilet paper. Think about how much food you will need. Also consider whether members of your household require regular medications like statins, hypertension medications, or insulin. If the answer is, yes, then making sure that those elements are in place for the duration is critical to doing all the rest successfully.

Additionally, masking, not necessarily with an N95, of the sick person in the home can help contain the droplets that otherwise can expose others.

Other peripheral distractions and threats:

We also have a flu going around. Get vaccinated. If you are at risk for respiratory illness, discuss things like pneumococcal vaccination with your provider. And again, if you need therapy or medication regularly, discuss with your caregiver how need could be addressed during a period of quarantine or isolation.

Stay informed:

Media, as a starting point, is fine, but source material is better. You can build your own dashboard for checking the information on television and the web by including the following:

The daily global situation report from WHO https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

Updates from CDC https://www.cdc.gov/coronavirus/2019-ncov/index.html

Matthew Minson, MD is a physician and has served as a local, state, and federal health official and the author of the Prepare to Defend Yourself series of books, published by Texas A&M University Press, promoting healthcare and social advocacy. He is a contributor to C-Span, NPR, PBS and more. www.preparetodefendyourself.com

References:

· Interim Guidance for Preventing the Spread of Coronavirus Disease 2019 (COVID-19) in Homes and Residential Communities

· Recommended precautions for household members, intimate partners, and caregivers in a nonhealthcare setting1

· https://www.cdc.gov/ncird/index.html

· Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for 2019 Novel Coronavirus (2019-nCoV)

Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) orPersons Under Investigation for COVID-19 in Healthcare Settings https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html


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