"The debate is over. You should be wearing a mask when you go out."

Now let’s talk about the right way to use masks:
Each person in your home should have a mask — absolutely no sharing.
The mask should cover the bridge of your nose and cup your chin.
There should be two straps, one that goes above your ear, and the other below
How to put it on and take it off — what we call donning and doffing in my field (yes, those are the terms we use) — is also important. To put it on, use one hand to hold the outside of your homemade mask and put the top strap over your head, followed by the strap that goes below your ear. To take it off, don’t touch your mask, which could have infectious particles on it if you came into contact with someone infectious. Instead, take it off using the two straps.
If you make one mask, wash it daily.
If you make multiple masks, place the recently worn one in a bag and set it aside for five days (there shouldn’t be any virus left after that time). Wear a new one each day.
Wash your hands when you’re done.

https://www.washingtonpost.com/opinions/...you-should-too/

If I'm lucky I'll find my masks to buy around July!

Good information. Important to remember that te mask will be the most contaminated item you have in your house, since it has been live trapping virus form 4-8 liters of air per minute while you are wearing it.

OTOH, this is why the gov has been slow to recommend public use of masks

Without training, respirators are likely to be worn incorrectly. NIOSH conducted research in New Orleans after Hurricane Katrina in order to evaluate the correctness of N95 FFR donning by the public for mold remediation and found that only 24% of participants demonstrated proper donning technique.10 Common mistakes included the clip (the metal band at the top of the FFR) not being pressed or tightened against the contours of the user’s face, straps incorrectly placed, and putting the respirator on upside down. Users should follow manufacturers’ guidance and the best practices below for guidance.
Without fit testing, it is not possible to know how well the respirator you use fits you. Fit testing is a critical step as it increases the chances that you will receive expected levels of protection. Studies have shown that face seal leakage from a poor fit is the largest contributor to poor protection11, aside from not wearing your respirator at all or wearing it incorrectly. See best practices below for fit testing recommendations.
Improvised devices such as bandanas and t-shirts, non-NIOSH-approved single-strap dust masks, and loose-fitting facemasks will not provide the same level of protection as a NIOSH-certified respirator. The reason for this is two-fold.
NIOSH-approved respirators provide higher levels of filter efficiency than improvised devices, facemasks, and dust masks.12-14 This is not surprising as only the NIOSH-approved respirators are tested against a near “worst-case” aerosol challenge (i.e., mass median aerodynamic diameter particle of about 0.3 microns) and demonstrated to be at least 95% efficient. This ensures that filters in NIOSH certified respirators will very efficiently collect aerosols of all sizes and shapes, including air pollutants (such as PM2.5 which is particulate matter 2.5 microns or less) and biological aerosols. Other test methods exist for testing loose-fitting facemasks used in hospitals, but are far less stringent.15 (More about worst-case testing in this NIOSH video, A Particle is a Particle.)

The part that worries is the magical thinking: I have a mask/gloves so I am safe.

I have a mask/gloves so I am safe “virtue signaling”. I have a mask that’s only good to 1.0 micron but is reusable/washable. It can be pinched at the nose bridge and the elastic all around makes for a good fit. It is advertised as being antimicrobial but I don’t really know what that means with regard to COVID-19. That said, it’s better than a bandana or scarf.

Gloves are 9 mil nitrile. When I shop for groceries the staffer at the door gives me a hit of hand sanitizer which should sanitize the outside of the gloves and help stop spreading whatever else the gloves have touched prior to the store. Unless you have a hospital’s/dentist’s budget and can toss nitrile gloves after a single use, hand sanitizer should keep them going longer. PPE is in great demand by professionals now so we civilians need to stretch out what we have.

FWIW

Is sanitizer safe to use over gloves or does it break down the material the glove is made of? I honestly don't know, that's why I ask.

It seems to be fine on nitrile gloves — I’ve kept reusing that same pair with no ill effects. They are still pliable and fit well — no rips or tears. First sign of deterioration and they get tossed. OTOH I would not try that with Latex gloves. IMO latex gloves aren’t nearly as resilient as nitrile.

It's interesting to watch the CDC evolution from no public masks, to recommended public masks. Currently the CDC recommends health care workers wear an N-95 fit-tested mask, washable face-shield and non-sterile cover gown, with lots of emphasis on donning and doffing.

Might be more economical and safer to use gloves intended to be reused, along with a washable face shield, and a washable cotton mask for maximum sustainable protection.

It will help to keep a cloth mask moist.

Like the simplicity of this DIY face shield.

https://making.engr.wisc.edu/shield/#DIY

I would prefer that medical professionals get the masks over the general public. Until there is no more mask shortage, I consider it extremely selfish for the general public to be buying up and storing these things for themselves when they could be better used elsewhere. The general public should just stay inside their homes. That will prevent the spread of the virus better than any mask could ever hope to. Leave the masks for those who can't stay at home, those who are out there trying to save you, those who need them more than you do. When the mask shortage is over, fine, THEN go out and get yourself a mask. In the meantime, just stay inside - you'll actually go good for others that way, rather than virtue signalling by going out in public wearing a mask.

Well said, haertig.
Or improvise: a bandanna mask, a welding helmet, and welding gloves solve the problem for me, no impact on the HCW logistics stream, and it really seems to encourage people to maintain social distance.

Yeah, I’ll stockpile a box or three of N-95 masks when they’re back in stock at Home Depot. Meantime, I’ll make do with what I have available.

Today while shopping I wore one of my neck gators with a very fine, tight weave. It was designed to protect your throat and lungs during dust-storms (again, bought to wear during wildfires), but these days it helps me with my virtue signaling while shopping. A simple mask (scarf/bandana/ neck gator) combined with social distancing (which I really like, but then I’m a solo walker/hiker) should afford you the isolation you need. That, and local LE will apparently start enforcing the State’s stay-at-home orders. I’ll stop there, more and I’d go all political...

LOL, next I’ll start wearing my half-face respirator and after that I go full-face with stacked cartridges (particles and gaseous fumes) just to be sure. I don’t have a pressurized full body hazmat suit ... yet.

You don't want to be in one of those things, I can tell you. One time, luckily only in training, we were shown what it is like. You put on your normal SCBA positive pressure breathing gear. Then coworkers zip you up in this really thick full rubbery suit. You can't get out of that on your own. Especially when they go around taping up all potential access points with heavy duty tape. Then they make you walk around briskly while waiting ... waiting for you low air alarm to go off. You were intentionally put in there with an almost empty tank just so you could feel the panic when that alarm bell goes off, knowing there's nothing you can really do about it. And panic does set in, I'll readily admit to that! In normal SCBA gear, your brain always tells you that if push comes to shove, you can rip your mask off. Of course you don't ever want to do that, but your brain still holds on to the idea as its last hope, you could possibly be the one lucky sole that survives anyway, without your gear. Now you wear that SCBA gear inside a big, thick, heavy sweaty, balloon that you could not get out of. Even though your brain knows you have 5 or so minutes of air after that alarm bell starts ringing, you do start panicking. Maybe with more exposure and training you could better control that - but your first time in, wow, that's an eye opener!

I'm not talking one of those lightweight white suits, I'm talking about the totally airtight orange monster suits.

Keep in mind that only an N95 (or higher) respirator properly fitted to your face so it is sealed protects the wearer.

All this other stuff covering the mouth and nose: surgical masks, bandanas, scarves, plastic bags, ... does not protect the wearer, but rather are intended to try to protect other people in the area.

There are those wondering about the consequences of people walking through secured area (banks, courthouses, airports,...) with masks.

I need to invent a toothpaste that reacts to dangerous communicable diseases and displays as bright orange when you spit it out each morning. I think I'll do that this afternoon.

When it is officially recommended there might be no consequences. Some may feel a little ill at ease. Refusing to allow the customer to take recommended precautions may not work out well for a business. Courthouses have more power but a little coughing might make the security rethink.
I experience it as a motorcyclist. At some gas stations the cashier does not say a word when motorcyclists wear their full face helmets and sunglasses at others they complain even when I enter with my modular helmet open to show my face. The latter are going to loose business.

Yes, you are safe using hand sanitizer and some surface sanitizers on good quality medical gloves. I would be wary with the cheaper, food service style gloves.

I would save gloves for use for cleaning and specific handling of unclean or potentially infected surfaces/items. Cleaning your hands well, not touching your face etc will provide the needed protection. Every person I have seen with gloves on in public were getting NO protection from the gloves... touching the shopping carts, things on the shelves in the grocery store, their phone, wallet, car door, steering wheel etc all with the same gloves on! Washing hands, disinfecting surfaces, minimizing touching things in public in general would have provided better protection.

I'm thinking everyone should start wearing Darth Vader helmets. Stylish. Practical. Makes a statement. Maybe a little warm in summer, but fashion is not for the meek.

All you need is a red lightsaber, and you will be set.

Jeanette Isabelle

While it is true the primary purpose of encouraging everyone to wear a mask while shopping in public is to prevent them from unknowingly infecting others, there is marginal protection from others as well.

As far as basic mask (home made or basic surgical mask) disinfection, how about ironing it. Enough heat will also kill virus based on what I have read.

Just my opinion, but there seems to be a psychological effect to wearing a mask. It makes you more conscientious of your breathing and it prevents you from incidentally touching your face. That, and I feel much less need to shave...

BTW, much reduced line at the grocery store today compared to the last few times I was there. I stood at the front of the line for a while finishing my coffee before going in — actually I was the line, no one in front or behind. Once inside I found the shelves mostly stocked (still no peas), but the quantity limits had been lifted. I guess the panic buying is over.

Now we wait for HD to restock N-95 masks... oh yeah, 3M is feeling some heat...

If for whatever reason I had to fly or be in a high risk crowd of people I would probably want to wear the best protection I have which is the 3M half-face respirator with the two side-mounted pink filters.

Question: If I were to wear such a half-face respirator through an airport, what do you think people would do? Do you think I'd be harassed by security or other travelers? Would I be shamed and told that I should have turned it over to healthcare workers? Your thought??

All things considered, some folks would be thinking, “that’s a little over-kill”, while others would be thinking, “I wish I’d thought of that”.

I wouldn’t consider turning my years old 3M half-face respirator over to a healthcare organization that couldn’t plan ahead and purchase their own. I’ve got a supply of PPE (gloves and masks) here that are years old.

This is a wake-up call that the healthcare industry has been way too reliant on just-in-time inventory management and foreign sources. Anyone with a bit of common sense knows that when things are needed by many (as in a pandemic) those items may not arrive just-in-time — if ever. Foreign suppliers have demonstrated that regardless of how well they perform in benign environments, they are totally unreliable when under stress.

It’s why we stockpile when things are readily available rather than panic buying when they’re not.

Hopefully, they will still consider providing healthcare to you, even though you didn't plan ahead and earn your own medical degree.

I think it is basically a case of enlightened self interest. i was surprised at how many masks I had stored away in various nooks and crannies and came up with more than one hundred. I offered them to my doctor, who had suspended normal operations.

I am simply trying to keep those alive and healthy who will ultimately keep me alive and healthy. Other terms that come to mind are cooperation and teamwork.

Considering that the gov wants all of us to wear PPE when we’re out in public, you are being very generous to give yours away.

I think that recommendation only came down in the last 24 hours. Up til yesterday the party line was only doctors and nurses or the already-sick needed a mask. We'll see what they say tomorrow!

I donated all my protective gloves and masks except what we need literally for our own health. My wife handles medicine that can't contact her skin, so she needed gloves there, and with barns we need workable (sealed & not fogging glasses) dust protection - especially me, so I don't end up in the hospital, thus the half-face respirators.

I actually have a 3M face shield too, but I bought it for protection when using an angle grinder after getting chunks on my lower face.

I'll admit that the recent issue related to 3M concerns me a bit because most all of my protective gear is from them. Time will tell on that.

Well, I didn't relinquish all of them.

That’s probably true, but at least here in CA I was seeing more people each day wearing surgical type masks as well as the reusable masks with & without valves in public. I like the washable type, but when woodworking and sawdust is flying that old 3M respirator is preferred. Regardless, simple observation showed we were moving in the direction of the public being asked to wear masks in public and now it’s official.

Watching the news, apparently the heat is on 3M to deliver their N95 masks to the domestic market — their CEO is doing PR. Apparently an official in Florida raised a big twitter stink because the masks he had cash to buy were being exported (foreign buyer) — next thing you know POTUS signed an executive order. So 3M masks (10 million a week if I heard correctly) should be entering the supply chain. Would my single respirator make a difference — no, that would be virtue signaling of a different type. If I had a few unopened boxes of N-95 or surgical masks on the shelf I’d take them over to the local hospital. One respirator which still requires two of the correct cartridges to function? No, that stays on my bench. YMMV

Speaking of wood dust, just before this all happened I had purchased an RZ mask setup from Amazon for woodworking based upon online feedback. It claimed to be N95, but awaiting certification. It was deep in winter when I bought it, so no chance to use it yet.

Now if I search Amazon for the RZ mask nothing is found. That makes me think that this respirator "shortage" will be very long term for non healthcare folks, otherwise Amazon would just say it's out of stock.

Amazon, Home Depot... they’re all out.

One of the reasons that retailers are out is the federal government has declared eminent domain over protective clothing in order to make sure the supplies are going to healthcare, first responders and other critical sectors.

Another major issues is the Strategic National Stockpile was severely depleted over the last decade and not replenished. So there weren't enough supplies that healthcare and first responders were told they could rely on in a disaster or crisis.

The problem is getting solved, it just isn't something that is going to be fixed overnight. Reputable manufacturers are revamping their production to make the needed masks and other PPE, once they get going the supplies will become available.

Aren't most (all?) of the 3M factories in China? You know, the place that has banned export of the very same masks that 3M is supposedly ramping up on?

Hopefully this little detail won't be lost on corporate management who choose where they manufacture their products. If China's poor quality, poor working conditions, and mandated turn over of intellectual property weren't enough reason to return to US manufacturing, maybe this will be. I'm not sure I'd want a N95 mask that was manufactured by an employee who just returned from their lunch of bat sandwich.

You both bring up excellent points that should not be forgotten in the wake of this.

As early as March 4th, reports were coming in from overseas experience that the median serial interval of Coronavirus was shorter than the median incubation period. This means that someone who is infected can spread the virus (for potentially on the order of a week) before they even feel sick, or show signs and symptoms. This pre-symptomatic spread frustrated early efforts of isolation and containment.

https://pubmed.ncbi.nlm.nih.gov/32145466/

https://www.cidrap.umn.edu/news-perspect...der-containment

For this reason, it was worrisome that our updated EMS guidelines still relied on "flu like symptoms" to judge whether or not to practice source control on our patients or don PPE ourselves. The safest course of action would have been for everyone to consider themselves a potential source even if they don't feel sick, and cover their face along with social distancing, hand hygiene and so on. Masks are of course no panacea, but as part of a comprehensive strategy to mitigate risks can help (with caveats).

With the working theory at the time of aerosolized spread being the primary means of transmission, masks were known to be effective at mitigating risk when used in conjunction with other best practices, however, the decision was made to definitively proclaim that masks are not effective for the general public in order to reduce panic buying (which unfortunately happened anyway) as Dr Fauci implicitly admitted in an article shortly before the announcement on April 3rd that everyone should wear them.


https://www.politico.com/news/2020/03/31/fauci-mask-recommendation-coronavirus-157476

I understand the need to try and avoid panic, but there are two things wrong with that.

Firstly, there should never be a reason that we lack mission critical items (especially PPE, given the universal nature of its importance) necessary to do the job, and that unfortunately represents a failure of leadership. Our stockpile consisted of somewhere around 112 million N95 masks, reduced after the H1N1 epidemic in 2009-2010 to just 12 million and never replenished at any time during the subsequent decade.

Even if it had been, 112 million masks would have lasted around a week during a fully developed nationwide pandemic... it should have been on the order of 3.5 billion according to one testimony by HHS Secretary Alex Azar, which at $2.50 / kg represents less than $200 million in material costs.

That's stupid cheap, in the grand scheme of things, even accounting for having to replace them due to expiration dates. Sometimes distribution can understandably be a problem (such as immediately following a natural disaster) but supply should not be -- panic buying is a known variable that can be accounted for in emergency management planning, and whether or not the public panic buys should therefore be irrelevant to mission readiness on the healthcare end if things are running as they should. Unfortunately, we are where we are, you fight with the army you have, and that will hopefully be addressed in the after action report.

Secondly, it's disingenuous to deliberately mislead people about the efficacy of an intervention at mitigating potential risk in order to manipulate their actions (in other words, saying "masks do not help the general public" driven not by actual evidence that they're ineffective, but because we're short and want to avoid panic buying) and is extraordinarily unethical and would likely be career ending if anyone else was caught doing it. The layperson may not be subject matter experts but they know when something doesn't add up, and it understandably sounded suspect when officials implied that coughing into your arm helps, as do masks for medical professionals, but nothing else is effective. People aren't stupid, and they really don't like being misled. Public threads on social media indicated that a non trivial number of people immediately referenced the Surgeon General and parroted the claims that masks don't help, which indicates that this unfortunately disseminated misinformation.

Their contention was likely that if you're practicing social distancing like you should be doing, the general public doesn't need masks, and combined with the severe shortage of PPE they were hoping it would trick the populace into not panic buying. Not only did it not prevent panic buying, but downplaying the seriousness and significant potential for pre-symptomatic transmission (relative to things like Flu, SARS and MERS) which were known, caused everyone down the line to drag their feet in their response, and it illustrated a fundamental disconnect between ostensible guidelines and the realities on the ground, as evidenced by the pictures in mid-March of standing room only crowds at the airport and essential businesses being slow to implement social distancing measures. Those people really thought masks didn't help.

So I get their contention, but this isn't China or HBO's Chernobyl, this is the United States and it's unethical IMO to not be fully truthful to the public for fear of them not being responsible enough to do what is necessary. We can't make informed decisions if the information we're being given is deliberately misleading, and unfortunately the result is that it hurt the public trust, potentially irrevocably. During the April 3rd press conference they tried to play this information off as if they didn't have it the whole time and were keeping us up to date with the latest developments. Their approach was conduct unbecoming and this should not be forgotten in the wake of this, because without a doubt their actions cost lives that didn't have to be lost.


Here were further studies showing masks + hand hygiene and social distancing was most effective:

https://ncbi.nlm.nih.gov/pubmed/20088690
https://ncbi.nlm.nih.gov/pubmed/19652172
https://ncbi.nlm.nih.gov/pubmed/22280120

We are where we are though, and hopefully in the end will be a stronger, more resilient populace with a robust ability to absorb hardship whether it be through natural disaster, terrorism, scarcity, or otherwise. I bet april of next year most people will have a box of N95 masks and plenty of TP, just in case

Yes, Americans love conspiracy theories to begin with an trust in public officials is at an all time low. This didn't help. When the public is flat-out lied to, that just hurts credibility next time around. We really need a reboot. I'd like to say maybe from here on out things will be done more effectively but I don't see much evidence of that.

Unfortunately that is the case around here too. The reported usefullness of masks increased with the perceived probability of obtaining some.
While there are a few instructions for sewing masks, there are none for proper donning and doffing. Consequently most people I see use gloves and masks in way that makes contamination of hands face more likely.

Excellent post. Particularly appreciate the pubmed footnotes.

That said, the epistemology of public health practitioners is fundamentally different from that of front line clinicians. Public health folk focus on the course of illness in populations; clinicians focus on the course of illness in an individual patient. And there are overtones of the epistemic difference between lawyers and scientists: lawyers believe that truth comes from the process of argument by skilled advocates before a disinterested judge or jury; scientists believe that truth comes from rigorous, reproducible experimentation reported to and evaluated by the scientific community.

Which explains the antipathy between physicians and lawyers, and the truly odd behavior that ensues when lawyers and physicians interact in trials.


So, the public health crowd sees that health care workers (HCW) fail often to correctly use ppe. Fail to choose to use it all, choose a type unsuited to the pathogen or procedure, or fail to follow donning and doffing procedures, All this despite aggressive training, retraining, policy and procedure, and some very threatening pathogens.
Dealing with untrained users, they fall back on two very reliable infection control practices: distance and hand washing. Cheap, effective, and the foundation of all infection control. Because nothing works without program compliance, and the program needs to be as simple as possible.

So, if my friend wants to obtain a firearm for personal protection, I might suggest a medium caliber revolver, or a single barrel shotgun. Not maximally efficient, but effective and with a pretty brief manual of arms. Shorter training period, shallower learning curve, better choice. And there are friends t whom I have recommended a baseball bat. Depends on the friend.

I am a hcw, so the public-facing position of the CDC regarding civilian use of masks seems manipulative and counterfactual to me, too. But it makes perfect sense to the politicians and public health types. Which is reassuring, because much of the stuff done by pols and political docs seems manipulative and counterfactual. But their intentions are good.

The road to Hell is paved with good intentions.








HCW compliance with ppe usage standards

HCW respiratory protection practices

Good analysis, nursemike! I suppose things are rarely as simple as we like to think.