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Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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1:33 PM
December 5th, 2020

Important Facts about Face Masks and COVID

 

 

 

The face mask is one of the best defenses we have against the COVID virus. All face masks, however, are not alike. Here we explore the history of medical masks and discriminate the most effective from the less effective.

 

History and Purpose of Surgical Masks

 

In the 1860s, Louis Pasteur proposed that microorganisms caused spoiling of wine, beer, and milk and invented the process of pasteurization to avoid the “diseases” of wine.1 He believed that microorganisms also caused animal and human disease. Shortly thereafter, Joseph Lister2 began using carbolic acid to inactivate germs on surgical wounds and instruments.

 

Finally, in 1897, after learning from bacteriologist Carl Flügge that respiratory droplets carry culturable bacteria, Polish surgeon Johann Mikulicz began wearing a mask in the operating room. French surgeon Paul Berger, began doing likewise.3

 

Early surgeons knew that a majority of the respiratory droplets were expelled through talking. Consequently, they made it routine to avoid talking in the operating room, instead using hand gestures to request instruments. This was quite prescient. Less prescient was that they ignored the respiratory droplets potentially coming from the nose and consequently often wore the mask only covering the mouth.

 

The year 1919 saw the patenting of reusable cotton surgical masks. Then, in the 1960s, single use, disposable surgical masks began replacing the cotton varieties.

 

In the early 1900s, masks were considered important only in protecting the surgical patient from the exhalations of physicians and nurses. This changed with the Manchurian plague of 1910 and the influenza pandemic of 1918, which saw the mask as protecting physicians, nurses, and civilians from the exhalations of potentially infected patients.3

 

Types of Masks

 

The two most popular masks are the “surgical mask” and the N95 mask.

 

The “surgical mask” is the familiar rectangular mask with horizontal pleats, white inside and colored (usually green or blue) outside worn by securing an upper and a lower pair of ties or ear loops. The white and colored layers sandwich a middle layer of microfibers that obstruct particles mechanically and/or hold them with an electrostatic charge.4

 

 On the other hand, the N95 mask or N95 respirator is a roughly cup-shaped device, sometimes with a vertical fold, and of the same color (usually white) both inside and outside, with a middle layer of microfibers that obstruct particles mechanically and/or hold them by an electrostatic charge.

Differences between the Two Masks

 

  • Layers
  •      -- The surgical mask has different inner and outer layers. The outer layer is fluid resistant as additional protectionfrom infected droplets contacting the mucous membranes of the nose or mouth of the wearer.
  •      -- In the N95 mask, the same materials compose the inside and outside layers.

 

Fit

  •      -- The surgical mask does not conform well to the face and permits unfiltered air to enter and exit around the mask. This is more pronounced on inhalation when the mask tends to collapse on the wearer’s face.
  •      -- The N95 mask has improved conformance to the features of the face and improved stability to reduce air flow in and out around the mask.

 

Original Purpose

  •      -- The surgical mask was intended to protect the patient from the surgeon’s exhalations and the surgeon from irrigating fluid splashes during surgery.
  •      -- The N95 mask descends from masks intended to protect workers from particle inhalation.

 

Filtration

  •      -- Surgical masks differ in filtration but most effectively filter particles of 3.0 micron size and some effectively filter particles of 0.1 micron size.
  •      -- N95 masks filter 95% of particles size 0.3 microns; this is the origin of their name N95. For comparison, the COVID-19 virus has a reported size of 0.05 to 0.2 microns.5

 

Effectiveness

  •      -- N95 masks are considered more effective than surgical masks in part because their shape reduces leaks around the mask.
  • For this reason, the N95 masks are recommended for healthcare workers and prioritized to them by the World Health Organization (WHO)6 and the Centers for Disease Control (CDC)7.

 

Correct Wearing of Masks

     -- The World Health Organization has produced this excellent infographic on the correct wearing of masks.8

 

Other Face Coverings

 

Although it would seem that any face covering is better than no face covering, this is seldom the choice, as surgical masks, if not N95 masks, are usually readily available and they are certainly the most efficacious.

 

Valved N95 Type Masks

These are distinctly inferior or surgical or N95 masks. The valve closes on inhalation so that inflowing air is filtered. It then opens on exhalation. This is appealing as it makes exhalation easier and reduces moisture and heat buildup inside the mask. However, it fails to protect others from the wearer’s exhalations. The mask may also generate a false sense of effectiveness since it looks like an N95 mask.

 

Homemade Masks

Homemade masks of cotton or T-shirt material vary in effectiveness directly as the number of layers of cotton in the mask and inversely as the number of times the mask has been laundered. Regardless, however, the best homemade masks are inferior to the surgical or N95 masks.9

 

Neck Gaiters

Neck gaiters fared even worse in effectiveness experiments.9 Of course, the stretchy construction makes for ease in pulling up or down, but it also creates more permeability in the fabric. Certainly, being able to see through the face covering when it is held up to the light is an indication of the covering’s ineffectiveness.

 

Bandanas

At the bottom of the effectiveness list are bandanas according to experiment.9

These permit easy escape of virus-laden droplets both through and out the bottom of the covering.

 

Face Shield 

Th transparent face shield was never designed to be respiratory protection for the wearer

or proximate persons. The wide openings at the bottom and sides permit broad inflow and

outflow of unfiltered air. However, since virus particles gain access to the body through th

mucous membranes of the eyes as well as those of the nose and mouth, the face shield

was designed to protect the eyes from splashes containing microbiological contaminants.

 

 

Conclusion

 

Until widespread inoculation with COVID-19 vaccine can be implemented, surgical and N95 masks are some of the best weapons against the corona virus. To achieve this goal, they must be chosen over less effective options and used correctly, certainly until we can view this epidemic as passed.

 

Thomas Falasca, DO FACA FACPM

 

References

 

1 Louis Pasteur. (2020, November 29). Retrieved December 3, 2020, from https://en.wikipedia.org/wiki/Louis_Pasteur 

2 Joseph Lister. (2020, November 29). Retrieved December 3, 2020, from https://en.wikipedia.org/wiki/Joseph_Lister

Strasser, B. J., & Schlich, T. (2020, May 22). A history of the medical mask and the rise of throwaway ... Retrieved December 3, 2020, from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31207-1.pdf

4 Surgical mask. (2020, November 28). Retrieved December 5, 2020, from https://en.wikipedia.org/wiki/Surgical_mask

5 Severe acute respiratory syndrome coronavirus 2. (2020, December 04). Retrieved December 5, 2020, from https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2

6 Mask use in the context of COVID-19: Interim guidance, 1 December 2020. (2020, December 01). Retrieved December 5, 2020, from https://apps.who.int/iris/handle/10665/337199

7 Centers for Disease Control (CDC). (2020, August 08). Personal Protective Equipment: Questions and Answers. Retrieved December 5, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

8 World Health Organization (WHO). (2020, December 01). When and how to use masks. Retrieved December 5, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

9 Dockrill, P. (2020, August 10). Simple New Experiment Reveals Which Face Masks Are Best at Blocking Droplets. Retrieved December 5, 2020, from https://www.sciencealert.com/simple-low-cost-experiment-reveals-which-face-masks-are-best-at-blocking-droplets

 

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Lessons to Learn from the COVID Pandemic -- Dr. Thomas Falasca

The COVID pandemic has deluged us with adversity, but we can learn plenty from it. Here are some lessons. ...See More

Lessons to Learn from the COVID Pandemic -- Dr. Thomas Falasca

 

What Lessons Did We Learn from COVID-19?

 

The COVID pandemic has deluged us with adversity, but we can learn plenty from it. Here, for starters, are some lessons.

 

LESSON 1 - Vaccine Complacency

The relative success of vaccine development during the pandemic may well inspire vaccine complacency that is unjustified for several reasons.

 

First, there is no guarantee that the next infectious disease will lend itself to the rapid development of a successful vaccine.

 

Second, many deaths would occur before even a successful vaccine’s discovery, manufacture, and distribution.

 

Third, a vaccine does not replace development of tests and implementation of contact tracing. Testing gives a picture of the scope of the epidemic and contact tracing is the first step in the containment of the disease. Both are centrally important in addition to vaccine development.

 

LESSON 2 – Rapid Robust Clinical Trials

The UK, despite its difficulty containing the epidemic was able to conduct such rapid clinical trials that American companies chose to test their drugs there.1

Development of an ability to institute rapid mid-sized and large clinical trials should be a priority during this inter-pandemic period.

 

LESSON 3 – Decisions under Incomplete Information

Decisions under incomplete information are the norm, and the earlier in a situation, the more incomplete the information. Early in the epidemic, it was supposed that masks were important only for medical personnel and for civilians under high exposure, such as supermarket cashiers. As further information became available of the high infectivity of COVID, it became apparent that masking was also important for the general population.

 

LESSON 4 – Early Suppression

The COVID pandemic has demonstrated the value of early suppression of the virus. The longer the virus circulates, the more time it has for mutation and the more people it infects. The more people it infects, the greater the exposure to uninfected people.

 

LESSON 5 – Telehealth Limitations

Telehealth has greatly expanded during the pandemic. However, not all problems are equally amenable to telehealth nor are all patients. Complicated problems of medicine or surgery may not be as amenable as those of dermatology or psychiatry. Additionally, the elderly, who may live alone, have poor vision or poor hearing, and who lack technologic skills or equipment, may be a poor patient selection for telehealth.2

A significant post-epidemic problem would be the reckless application of telehealth universally.

 

LESSON 6 - Oversimplification

The epidemic has necessitated, in the interests of decreasing infection exposure and increasing patient flow, the temporary streamlining or omission of some processes and procedures. Some of these changes may be improvements that translate over to the return of normality, others may be reluctant compromises that carry over because of inertia or shameless profit.

 

LESSON 7 – Tunnel Vision about Economic Consequences

The pandemic has inspired a false perception of strict dichotomy between economic consequences and health consequences of epidemic containment measures. However, the supposition of a strict dichotomy ignores the reality that while inadequate partial containment measures favor economic protection short-term they have profound long term economic consequences as more people sicken and fail to contribute to the economy.

 

LESSON 8 – Need for Transparency

The authorities in Wuhan, China, detained and silenced in December 2019 physician Dr. Li Wenliang on charges of spreading false rumors after he reported a novel illness in his patients. Dr. Wenliang died of COVID at age 34 in February 2020.3 Avoiding economic and political consequences short-term can lead to disastrous long-term economic, political, and humanitarian consequences.

 

LESSON 9 – Age Matters … Good Health Matters More

The protective value of good health is a critical lesson from the COVID pandemic.

 

Researchers at the University of Glasgow examined the risk of death from COVID among the general population, the healthier older population, and the less healthy older population. Their robust study included 470,034 people. Although the risk of fatal COVID infection was four times higher in healthy people over 75 than all people under 65, the fatality risk was 13 times higher in those with high blood pressure, obesity, or pulmonary conditions.4

 

LESSON 10 – Aerosol Studies and More

Scientists now understand better how singing, cheering, and loud talking generate aerosols even more aggressively than coughing, talking, and breathing. This topic seems to have received insufficient study because it did not fit neatly into the categories of virology, medicine, or engineering.5 There may be many more such topics requiring identification and investigation for future emergencies.

 

LESSON 11 – Fragmented Response

An Indian friend, a geology professor who lost both parents to COVID in the surge of the last few weeks, lamented to me that the Indian Government’s response to the epidemic was severely impaired by a large population and a federal form of government. These same problems, to a lesser extent, confront us in the United States. The problems of federalism, if not large population, confronted even the framers of the US Constitution. Nevertheless, the pandemic stresses the urgency of addressing these problems, to accommodate both individual freedom and public health concerns.

 

Conclusion

Winston Churchill, in the 1940s, said “Never let a good crisis go to waste.” He was referring to the opportunity to learn from adversity, of which we have seen plenty during the pandemic.

 

Learning from the pandemic may not be inevitable. Harvard epidemiologist expressed serious doubt when he said, “I am not sure the US has learned much at all — or what it even can learn given the federal nature of the country and the balkanized state of the health care system.”1

 

Nevertheless, overcoming the problems of complacency and fragmentation presents a valuable opportunity for learning the above lessons and for bringing to light others hidden in the dark.

 

Thomas Falasca, DO

 

 Dr. Falasca - ECMS

 

 

References

 

1 Scott, D. (2021, May 03). The US is in danger of learning the wrong lessons from covid. Retrieved from https://www.vox.com/

 

2 8 lessons the COVID-19 pandemic has taught us. (2020, November 03). Retrieved from https://www.aoa.org/

 

3 Florman, R., Atun, R., McKee, M., & Mossialos, E. (2020, May 5). 12 lessons learned from the management of the coronavirus. Retrieved June 5, 2021, from http://www.elsevier.com/locate/healthpol

 

4 Harrar, S., Hochman, D., & Kaysen, R. (2021, March 04). 15 Lessons the coronavirus pandemic has taught us. Retrieved June 5, 2021, from https://www.aarp.org/bulletin/

 

5 Tate, N. (2020, December 23). From Public to Personal: Pandemic Lessons Learned. Retrieved June 6, 2021, from https://www.webmd.com/lung/news/20201223/from-public-to-personal-pandemic-lessons-learned

 

 

 

Covid and Herd Immunity

What is herd immunity and what percentage of immune individuals in a population will achieve it? ...See More

Covid and Herd Immunity

 

 

 

Herd immunity is humanity’s perceived salvation from COVID. The major questions are: what is herd immunity and what percentage of immune individuals in a population will achieve this. These questions are easier to ask than to answer. The reasons why are many.

 

 

What is Herd Immunity?

 

Herd immunity is the indirect protection from an infectious disease that can occur when a sufficient percentage of a population has become immune to the infection, through vaccination or prior infection. This, then, reduces the risk of infection for persons without immunity but who cannot be vaccinated.

 

 

How Much of the Population Must be Immune to Confer Herd Immunity?

 

The question naturally arises, what percentage of a population must be immune to COVID, either by vaccination or by having survived a prior infection, to establish herd immunity?

 

This depends on many factors. These include Ro value, vaccine efficacy, duration of immunity, variability of immunity with time and acquisition mode, mutation of the virus, types of immunity, and parallel measures.

 

 

Ro Value

 

The R0 or basic reproductive number of a pathogen in a given population is the average number of people in that population that one infected person is expected to infect if no other measures are taken.

 

The R0 of COVID in a naïve population is generally considered to be 2.5 to 3.5. Based on this alone, the herd immunity would occur when 60-71% of the population is immune, as given by the basic formula Im = (1 – 1/R0).1

 

Putting this in perspective, the R0 of measles is usually cited as 12 to 18. This puts the immune percentage of the population required to establish herd immunity to measles at 92% to 95%.

 

 

Vaccine Efficacy

 

But this presupposes that everyone in the population is susceptible and that all those vaccinated become immune. However, the effectiveness of the vaccines at this time appear to be Pfizer 95%, Moderna 94%, and Johnson & Johnson 72-85%.2

 

The imperfect vaccine effectiveness must be added into the formula, and, when it is the formula becomes Im = (1 – 1/R0) / e. If e is 80%, the percentage of immune population required for herd immunity increases to 75% to 89%.

 

 

Duration of Immunity

 

This also assumes that immunity to COVID will last indefinitely. This may not be the case. Immunity to many infectious diseases decreases with time and is the reason that some vaccines require booster doses. As immunity decreases, individuals tend to reduce the immune population and replenish the susceptible population.

 

Duration of immunity is difficult to estimate at this early point. It reveals itself often in Phase 4, post-marketing, studies that use the required long periods of observation of large populations.

 

 

Variability of Immunity … with Time

 

Additional complications involve the variability of immunity. How many individuals will achieve immunity only to severe disease, how many to milder disease, how many will have no symptoms but be infectious, and how many will be unable to transmit the disease.

 

Ultimately of interest is if, or how, this immunity will vary with time from vaccination or natural infection. Will immunity diminish with time from inability to transmit infection to immunity only from severe disease?

 

 

Variability of Immunity between Vaccination and Natural Infection

 

Vaccination and natural infection are different.

 

In vaccination, inoculation is with a constituent protein of the virus, not with live or dead virus. Additionally, all recipients get the same carefully controlled quantity of inoculum in vaccination. Only their physiologic response may be different.

 

In natural infection, inoculation is with live virus and the quantity of inoculum varies from minimal to massive. The physiologic response again varies.. Speculation exists that individuals who have survived more severe illness may have more intense or more enduring immunity.

 

 

Mutation of the Virus

 

Of course, evolutionary pressure, while occasionally mitigating a highly virulent infection, more frequently makes the virus more resistant to countermeasures. As a virus becomes more resistant, the effectiveness of the existing vaccines decreases, increasing the percentage of immune persons needed to achieve herd immunity.

 

Certainly, this is another reason to vaccinate as many people as quickly as possible, to allow the virus less time to mutate. As stated by Dr. Joshua Barocas, "The sooner we can get vaccines into arms, the less important the variants become."2

 

 

Parallel Measures

 

Parallel measures also influence herd immunity. Lockdown measures, mask wearing, social distancing, anything that reduces the number of people a patient can infect, that is, which reduces the R0, reduces the percentage of immune individuals in the population needed to achieve herd immunity. Of course, this means that the needed percentage varies with external conditions.

 

 

Natural Infection and Herd Immunity

 

Certainly, some of the immune individuals in the herd immune population have acquired their immunity by surviving natural infection. This has led some to suggest that this might be sufficient to achieve herd immunity. This thinking is wrong.

 

First, the cost of acquiring immunity from natural infection is too high. The fatality rate from COVID infection varies from 1% to 3.4%. The cost to immunize 96 to 99 people is 1 to 3.4 deaths. Second, there are those who survive but have long-term sequelae of their illness. Third, is the difficulty of patients with non-COVID illnesses accessing a health system overwhelmed with COVID patients. Fourth, this is a slow way to achieve herd immunity and it allows more time for the virus to mutate. A large bank of mutations favors survival of the virus.

 

 

Conclusion

 

The beginning question of what percentage of a population must be immune to COVID, either by vaccination or by having survived a prior infection, to establish herd immunity? A widely accepted estimate is about 80%. The estimate, however, is subject to many variables, including vaccine efficacy, duration of immunity, variability of immunity with time and mode of acquisition, mutation of the virus, types of immunity, and parallel measures. The aforementioned considerations provide an insight into why establishing the percentage is so challenging.

 

 

Thomas Falasca, DO FACA FACPM  

 

 

References

 

1Anderson, R., Vegvari, C., Truscott, J., & Collyer, B. (2020, November 4). Challenges in creating herd immunity to SARS-CoV-2 ... Retrieved February 16, 2021, from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32318-7/fulltext

 

Fiore, K. (2021, March 05). How Do COVID-19 Vaccines Compare? Retrieved March 10, 2021, from https://www.medpagetoday.com/special-reports/exclusives/91489

 

3 McNamara, D., & Franki, R. (2021, February 13). At Current Vaccination Pace, When Can US Expect Herd Immunity? Retrieved February 17, 2021, from https://www.medscape.com/viewarticle/945699

 

 

 

 

Important Facts about Face Masks and COVID

Face Masks: What You Need to Know ...See More

Important Facts about Face Masks and COVID

 

 

 

The face mask is one of the best defenses we have against the COVID virus. All face masks, however, are not alike. Here we explore the history of medical masks and discriminate the most effective from the less effective.

 

History and Purpose of Surgical Masks

 

In the 1860s, Louis Pasteur proposed that microorganisms caused spoiling of wine, beer, and milk and invented the process of pasteurization to avoid the “diseases” of wine.1 He believed that microorganisms also caused animal and human disease. Shortly thereafter, Joseph Lister2 began using carbolic acid to inactivate germs on surgical wounds and instruments.

 

Finally, in 1897, after learning from bacteriologist Carl Flügge that respiratory droplets carry culturable bacteria, Polish surgeon Johann Mikulicz began wearing a mask in the operating room. French surgeon Paul Berger, began doing likewise.3

 

Early surgeons knew that a majority of the respiratory droplets were expelled through talking. Consequently, they made it routine to avoid talking in the operating room, instead using hand gestures to request instruments. This was quite prescient. Less prescient was that they ignored the respiratory droplets potentially coming from the nose and consequently often wore the mask only covering the mouth.

 

The year 1919 saw the patenting of reusable cotton surgical masks. Then, in the 1960s, single use, disposable surgical masks began replacing the cotton varieties.

 

In the early 1900s, masks were considered important only in protecting the surgical patient from the exhalations of physicians and nurses. This changed with the Manchurian plague of 1910 and the influenza pandemic of 1918, which saw the mask as protecting physicians, nurses, and civilians from the exhalations of potentially infected patients.3

 

Types of Masks

 

The two most popular masks are the “surgical mask” and the N95 mask.

 

The “surgical mask” is the familiar rectangular mask with horizontal pleats, white inside and colored (usually green or blue) outside worn by securing an upper and a lower pair of ties or ear loops. The white and colored layers sandwich a middle layer of microfibers that obstruct particles mechanically and/or hold them with an electrostatic charge.4

 

 On the other hand, the N95 mask or N95 respirator is a roughly cup-shaped device, sometimes with a vertical fold, and of the same color (usually white) both inside and outside, with a middle layer of microfibers that obstruct particles mechanically and/or hold them by an electrostatic charge.

Differences between the Two Masks

 

  • Layers
  •      -- The surgical mask has different inner and outer layers. The outer layer is fluid resistant as additional protectionfrom infected droplets contacting the mucous membranes of the nose or mouth of the wearer.
  •      -- In the N95 mask, the same materials compose the inside and outside layers.

 

Fit

  •      -- The surgical mask does not conform well to the face and permits unfiltered air to enter and exit around the mask. This is more pronounced on inhalation when the mask tends to collapse on the wearer’s face.
  •      -- The N95 mask has improved conformance to the features of the face and improved stability to reduce air flow in and out around the mask.

 

Original Purpose

  •      -- The surgical mask was intended to protect the patient from the surgeon’s exhalations and the surgeon from irrigating fluid splashes during surgery.
  •      -- The N95 mask descends from masks intended to protect workers from particle inhalation.

 

Filtration

  •      -- Surgical masks differ in filtration but most effectively filter particles of 3.0 micron size and some effectively filter particles of 0.1 micron size.
  •      -- N95 masks filter 95% of particles size 0.3 microns; this is the origin of their name N95. For comparison, the COVID-19 virus has a reported size of 0.05 to 0.2 microns.5

 

Effectiveness

  •      -- N95 masks are considered more effective than surgical masks in part because their shape reduces leaks around the mask.
  • For this reason, the N95 masks are recommended for healthcare workers and prioritized to them by the World Health Organization (WHO)6 and the Centers for Disease Control (CDC)7.

 

Correct Wearing of Masks

     -- The World Health Organization has produced this excellent infographic on the correct wearing of masks.8

 

Other Face Coverings

 

Although it would seem that any face covering is better than no face covering, this is seldom the choice, as surgical masks, if not N95 masks, are usually readily available and they are certainly the most efficacious.

 

Valved N95 Type Masks

These are distinctly inferior or surgical or N95 masks. The valve closes on inhalation so that inflowing air is filtered. It then opens on exhalation. This is appealing as it makes exhalation easier and reduces moisture and heat buildup inside the mask. However, it fails to protect others from the wearer’s exhalations. The mask may also generate a false sense of effectiveness since it looks like an N95 mask.

 

Homemade Masks

Homemade masks of cotton or T-shirt material vary in effectiveness directly as the number of layers of cotton in the mask and inversely as the number of times the mask has been laundered. Regardless, however, the best homemade masks are inferior to the surgical or N95 masks.9

 

Neck Gaiters

Neck gaiters fared even worse in effectiveness experiments.9 Of course, the stretchy construction makes for ease in pulling up or down, but it also creates more permeability in the fabric. Certainly, being able to see through the face covering when it is held up to the light is an indication of the covering’s ineffectiveness.

 

Bandanas

At the bottom of the effectiveness list are bandanas according to experiment.9

These permit easy escape of virus-laden droplets both through and out the bottom of the covering.

 

Face Shield 

Th transparent face shield was never designed to be respiratory protection for the wearer

or proximate persons. The wide openings at the bottom and sides permit broad inflow and

outflow of unfiltered air. However, since virus particles gain access to the body through th

mucous membranes of the eyes as well as those of the nose and mouth, the face shield

was designed to protect the eyes from splashes containing microbiological contaminants.

 

 

Conclusion

 

Until widespread inoculation with COVID-19 vaccine can be implemented, surgical and N95 masks are some of the best weapons against the corona virus. To achieve this goal, they must be chosen over less effective options and used correctly, certainly until we can view this epidemic as passed.

 

Thomas Falasca, DO FACA FACPM

 

References

 

1 Louis Pasteur. (2020, November 29). Retrieved December 3, 2020, from https://en.wikipedia.org/wiki/Louis_Pasteur 

2 Joseph Lister. (2020, November 29). Retrieved December 3, 2020, from https://en.wikipedia.org/wiki/Joseph_Lister

Strasser, B. J., & Schlich, T. (2020, May 22). A history of the medical mask and the rise of throwaway ... Retrieved December 3, 2020, from https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(20)31207-1.pdf

4 Surgical mask. (2020, November 28). Retrieved December 5, 2020, from https://en.wikipedia.org/wiki/Surgical_mask

5 Severe acute respiratory syndrome coronavirus 2. (2020, December 04). Retrieved December 5, 2020, from https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome_coronavirus_2

6 Mask use in the context of COVID-19: Interim guidance, 1 December 2020. (2020, December 01). Retrieved December 5, 2020, from https://apps.who.int/iris/handle/10665/337199

7 Centers for Disease Control (CDC). (2020, August 08). Personal Protective Equipment: Questions and Answers. Retrieved December 5, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

8 World Health Organization (WHO). (2020, December 01). When and how to use masks. Retrieved December 5, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

9 Dockrill, P. (2020, August 10). Simple New Experiment Reveals Which Face Masks Are Best at Blocking Droplets. Retrieved December 5, 2020, from https://www.sciencealert.com/simple-low-cost-experiment-reveals-which-face-masks-are-best-at-blocking-droplets

 

Hand Sanitizing in the Time of COVID

Hand Sanitizing and Washing in the Time of COVID and Flu ...See More

Hand Sanitizing in the Time of COVID

 

Hand Sanitizing and Washing in the Time of COVID and Flu

 

Now, in the time of COVID and flu, hand sanitizing and washing is more important than ever. These simple measures, done frequently and effectively, help prevent COVID and flu as well as many other infections. However, their use is not so intuitive as imagined. Let’s examine the why, when, and how.

 

Why Sanitize or Wash?

 

Many infectious diseases have no reliable vaccination or treatment. Even for treatable infectious diseases, the better way to deal with them is not to have them. Prevention is the purpose of hand sanitizing and washing.

 

People who are infectious, whether or not they are sick, understandably contaminate their hands with the germs. Then our hands touch their hands or surfaces they have touched. We then touch our hands to our faces, in fact, according to some studies, an average of 20 times per hour. But the mucous membranes of eyes, nose, and mouth provide easy access to the body for germs, especially for viruses because of virus’ small size. We should keep our hands away from our faces as much as possible, even when the hands appear clean. However, still we touch, mostly inadvertently. Doing so, we become infected.

 

Sanitizing Hands or Washing Them

 

Hand sanitizer is a potent hygienic weapon during the frequent circumstances when hand washing is not available. While hand washing removes germs and harmful chemicals, hand sanitizers inactivate a large number of the germs without removing. They accomplish this because sanitizers containing at least 60% ethyl alcohol denature the proteins of bacteria and viruses in only about 15 seconds.

 

Hand sanitizers are less effective when hands are visibly dirty or greasy as the dirt can protect the germs from complete contact with the sanitizer. Of course, it is senseless to use sanitizer to smear dirt more widely when removal by washing is an option.

 

Children should use hand sanitizers under adult supervision as swallowing hand sanitizers can cause alcohol poisoning. Children may be more likely to swallow hand sanitizers that are scented, brightly colored, or attractively packaged. Hand sanitizers should be stored out of the reach of young children.

 

Disposable Gloves

 

Disposable gloves may create a false sense of security. Certainly, they shield the skin of the hands from contamination, but the gloves become contaminated and must either be treated with hand sanitizer or disposed of. Further, in removing the contaminated gloves for disposal, the previously clean hands may become contaminated.

 

When to Sanitize or Wash Hands

 

The most obvious time to sanitize or wash is after contact such as

     • After touching high-hand-contact surfaces such as public touch screens, door handles, elevator buttons,      handrails, and poles or handles on public transportation.
     • Touching the outside of a face mask.
     • Touching money.
     - Tying shoes.
     - Coughing, sneezing, or blowing the nose.
     - Touching a sick person,
     - Touching an animal, animal feed, animal waste, or garbage.
     - Using the bathroom or changing diapers.
     - Treating a cut or wound

 

Important also is sanitizing or washing before

  •      - Touching face.
  •      - Eating, drinking, or tooth brushing.
  •      - Preparing food.
  •      - Touching a sick person.
  •      - Treating a cut or wound.
  •      - Finally, stores or venues may require sanitizer use before entering to reduce contamination on their merchandise or facilities.

 

How to Sanitize Hands

 

Using a small hand sanitizer is easy and convenient.

  •         - Choose a sanitizer with at least 60% ethyl alcohol.
  •      - Keep the sanitizer easily accessible. This negates the temptation to skip it. It also avoids germs on hands from contaminating the insides of pockets and handbags while rooting around for the sanitizer.
  •      - Use only enough sanitizer to contact germs on all hand surfaces. The idea is to kill germs by contact with the sanitizer, not to wash germs away.
  •      - Spread the sanitizer to contact all surfaces of the hands and fingers, including under the fingernails and the outside of the sanitizer bottle.
  •      - The sanitizer does its work within 15 seconds of contact.
  •      - Here is the illustration.

Hand Sanitizer

 

 

How to Wash Hands

 

Hand washing may not be always intuitive.  

     - Use plenty of warm, running water and sufficient soap. At faucet temperature, the warmth of the water does not kill germs, However, warmer water and soap improves the dissolution of any dirt protecting the germs and reduces the germs’ adherence to the skin.

     -  Rub hands together with sufficient pressure. The idea is not to kill germs, but to remove them. Sufficient pressure and a sufficient volume of water improve the liklihood of dislodging germs and carrying them away.

     - Wash front and back of hands, all fingers, between the fingers, and under the nails for at least 20 seconds. Twenty seconds is about the time it takes to hum two repetitions of the Happy Birthday Song.

     - Avoid drying hands with cloth towels since this may transfer other people’s germs. Better are electric hand dryers as found in public rest rooms. Be sure to press the dryer’s on-off switch with your elbow. Finally, paper towels, although the least ecological hand-drying option, are the most hygienic. Additionally, use a dry paper towel to turn off the faucet and to touch the door handle when leaving a public rest room. If there is no used-paper-towel depository by the door, let the paper drop to the floor, the public rest room maintainers will get the message to provide a depository.

 

Conclusion

 

Now, in the time of COVID and flu, hand sanitizing and washing is more important than ever. Above are the why, when, and how. Remaining is only the do … and the do is up to me and you!

 

Thomas Falasca, DO

 

Thomas Falasca, DO

 

 

 

 

 

 

 

 

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