I’ve been dealing with a fairly minor medical issue but it was one that required a procedure that could not wait for the Corona virus to run its course in the US. So I had to travel across state lines on a six hour road trip and stay in a hotel for four days, not an ideal thing but unavoidable. Also for 14 days prior to the trip I had to self quarantine to protect the health care workers at the hospital. It did not matter that I live in an area that is nearly covid19 free and the hospital is in a Corona hotspot. But I did not mind the extra precautions at all, we owe our health care heroes all the protection we can provide. However what I saw in my four days in and out of various hospital buildings on their campus did surprise me.
And it was all about the masks. Because I knew I’d have to wear a mask when I was being shuttled around the medical facility for four days I took one with me. I happened to have had a couple of the n95 certified masks at home. One I had bought years ago for use in dusty off-road trail rides and another was given to me by a friend who had a suppressed immune system for a few years and had one left over. He found out I was headed out of state and dropped one off with my wife.
If you aren’t up on all the particular ratings of masks the n95 is the Cadillac of masks, it blocks 95% of 0.3 micron and larger particles. That’s good enough to significantly protect you from the droplets of contagion that an infected person is constantly putting into the air around them. It also protects others from you fairly well. The next most common mask you see in medical settings is a surgical mask. It looks a lot like a n95 but it does not filter out small particles nearly as well. It is primarily designed to prevent the person wearing the mask from spraying droplets out and infecting others. It does not do much to protect the person who wears it from infection. It isn’t useless as far as protection goes but it isn’t very effective. The third common masks are the cloth masks, many homemade. These are the least effective in both protecting others from you and in protecting you from others, but they do cut down some on the amount of droplets containing virus that you might otherwise breathe, sneeze or cough out into your neighbor’s airspace.
I have some familiarity with masks and respirators because as a chemical engineer and former plant firefighter I worked with all levels of breathing protection. I used everything from supplied air self contained breathing apparatus gear to n95 masks because we sometimes had to enter areas with unsafe levels of smoke or toxic dust.
What many people do not realize is that all masks are uncomfortable and all of them restrict your ability to breathe to some degree. In the summer they are crazy hot on your face and it feels like you are rebreathing the same air over and over. For people with asthma, like me, some of the more efficient masks, like the supplied air type (where you carry your own air tank on your back) and the n95 are not feasible to wear. Unless you have good lung capacity the extra restriction n95 and higher rated masks impose on your breathing ranges from highly annoying to dangerous.
I did not fully realize that until I walked to my first appointment yesterday wearing the n95. After all it had been decades since I had worn one on the job so I really did not remember much about the experience. The first question the nurse asked me was if I always looked so flushed? The answer is no, in fact I run 15 miles a week and play high level tennis. I do have some breathing difficulties but I’ve offset those with my endurance training. However, add just a little more restriction to my ability to breathe with a n95 mask and I became absolutely miserable.
And maybe you would toss that off to my particular condition but as I walked the medical center campus I noticed that every person in the facility was wearing the same kind of mask. And it wasn’t an n95 like mine. I finally asked a nurse practitioner about it and she said that almost nobody could stand working in an n95 unless they were in direct contact with covid19 patients and had no other choice. Instead they all wore surgical masks as did all the patients they were caring for, like me, that were non-virus cases. They segregated the hospital into covid19 and non-covid19 areas and only the people on shift in the Corona virus areas had to wear the n95’s, which they universally detested due to how annoying they felt. She gave me and my wife a couple of the more comfortable surgical masks, and while I still hate how it feels to wear one, at least I can get enough air to function.
I don’t know the statistics but my guess is that very few medical professionals are wearing n95 masks while they work now. And it may not have much to do with a shortage of masks. Instead it may be due to the huge human factors issue involved in wearing them. I can’t imagine a nurse on a 12 hour shift having one of those things on their face the entire time. I’m claustrophobic anyway and when every breath I take starts with me rebreathing my own hot breath I’m creeped out in a major way. If you wear glasses you also face the fact that the mask fogs up your glasses any time you breathe hard. Oh, and since the masks make you breathe hard that means you are looking at the world in a fog pretty much all the time.
If you’ve got some n95’s stored away you just might want to try to see if you can make it for even three or four hours straight wearing one. I’m guessing there is a fair chance you’ll be climbing the walls after thirty minutes. If that is the case then consider donating the unused ones to those who have to wear them and just get a cloth mask for home use, or make your own. Maybe one positive outcome from this pandemic will be the fact that health officials will realize that having respiratory protection that degrades people’s ability to function at a high level is not satisfactory. There is a need to develop an effective mask or filter system that health workers (like my APN) do not consider highly annoying. Otherwise they are going to opt down to a much less effective level of protection. Which is exactly what I’ve witnessed all week. Because protection that prevents someone from doing their job isn’t much protection at all.
Maybe I’m just crazy, but have you tried an n95 mask or a surgical mask for multiple hours of continuous wear? Could you stand it?
Any medical professionals who will tell what criteria they are using to select the type of mask they are using on the job?
Is anybody working 12 hour shifts wearing an n95 mask? Is it no big deal or are you on the verge of insanity?
My company just issued a requirement for us to wear masks for the entirety of our time in the building. We have N95’s (from our chemical production facility) but there’s no way I’m wearing that all day. I think I will fashion some other sort of covering, or just ignore the edict. The only thing worse is wearing those masks with a bunny suit. I will never miss the clean room days!
I don’t think most people have a clue how oppressive wearing a mask that actually forces all the air through it is. They see Grey’s Anatomy and everyone is perfectly normal wearing a mask, but that’s not real world. I think our military people, when they have to wear protective gear against chemical warfare will testify how hard it is to function when you are in a ziplock bag. I can’t imagine working all day in a n95, I really could not do it and an n95 and a bunny suit, just kill me now.
Steve,
Bullseye regarding your comment on the oppressiveness of wear a mask that you referenced. Speaking of references, check out this link from a prominent Swedish epidemiologist, Dr Johan Giesecke:
https://www.realclearpolitics.com/video/2020/04/18/swedish_epidemiologist_johan_giesecke_why_lockdowns_are_the_wrong_policy.html
Donning CBRN equipment is miserable and people will riot having to wear N95 masks all day.
All the best with your surgery.
Semper FI,
Luis
I came through fine! Great link, seems like a better policy than ours for sure. I wonder why we aren’t following it? I think an Israelite study concluded much the same.
as you might guess, steve, i spend about half my life in some form of PPE in a chemical plant. thankfully most of it is just safety glasses and safety shoes, which are second nature. i have worked several hours straight in a half-face respirator and it is workable more so than an n-95 type which tends to fog the glasses. i’ve also worked a couple of hours in one of those level A high hazard suits with SCBA and that was pretty hot and miserable. i wrote a PPE post a couple of weeks ago extolling the virtues of an elastomeric half face respirator but like you said not everyone is eligible to even wear one safely. plus, it’s hard to communicate with one of those things on your grill. my fearless prediction is somebody is working hard on a more comfortable solution as we speak.
Great points Freddy, I’ve worn that level A stuff in training, it is a trip for sure. I skipped the half face respirators because while those are probably the best of the lot I just didn’t think they were widely available in this situation. In fire training we had smoke house, a house we purposely filled with a smoke generator. Usually the kind of training structures fire fighters have. I was the worst in the class. You have limited air, as you know, maybe 15 minutes, on your back and you can’t see your hand in front of your face. We were supposed to navigate the house and find the mannequin “victims” and drag them out. Ran out of air in the first room, I had a plan but it got Mike Tyson’d. Thanks for the good information, and I agree this may be the thing that makes them finally come up with a design that balances comfort with protection.
I got a dust mask and a half face respirator a few years ago when I worked on a wood working project. They are so uncomfortable. After a while, I stopped wearing it except when I really need to. It’s hard to do any kind of exertion with one of those on.
That’s the problem, it is very hard to function and for people with any kind of lung issues it is impossible.
The recommendation for day-to-day is to not use the N95 so we have been using cloth masks made from a combination of cotton and spandex. These are comfortable, form-fitting and provide enough protection for a grocery run.
I think that is pretty much the consensus, the only problem is whether the cloth masks work or work well enough to make a difference.
I have a bunch of surgical masks that my company sent out for when we are ready to start visiting customers when travel is lifted. As you stated the masks are good for helping stop the spread of aerosols. Depending on the brand, the particle size cut-off for “aerosols” is between 0.3-10 micron (um). They are 95% effective based on a study that I read. Now, the particle size of the virus that we currently fighting is around 100 nanometers, (nm). Tiny, but when it’s riding on the wave of water droplets or vapor, it’s much bigger, but carrying quite a viral load in the aerosol.
If you’re wearing a mask and an infected person coughs or sneezes within 2 feet of you, the mask will help, but your eyes are exposed and a blink of eye is all it takes. I wear wrap around safety glasses with my mask. (but the darn things fog up on me at times).
Ok, that’s enough of the spooky stuff.
The N95 masks are ideal, but should be saved for the front line team.
If you have surgical masks or homemade cloth masks, you can add another layer of protection quickly, easily and cheaply. Line a doubled over paper towel inside your current mask. (cut to size) This does two things:
1. A paper towels particle size cut-off is 20um. Doubling it will provide you an additional 10um of protection along with an additional torturous path after your initial barrier.
2. The paper towel gets moist with use, so you can discard it and replace it at your convenience. (cut a few to size and tuck it in when your mask is on.)
3. The paper towel method can nearly match the particle size cut-off of the virus itself. So if are going to be in a situation with high volume people in a closed area, the triple protection with a properly worn mask can help reduce the risk of the situation.
4. Recently I started to staple the paper towel sheets inside my paper surgical mask so it does not slide around. ( Sharp side of staples toward the outside please.)
(I have experience with virus mitigation methods in the production of biological drug products in liquids, and buffers which is why I am familiar with virus sizes from a previous jobs). Layering and folding work for liquids as well as air filters.
There’s an entire science around creating torturous paths for air, microbes and viruses.
However there is an unavoidable problem. To the degree you increase filtration you also restrict air flow. So people that struggle with masks will struggle even more with a mask plus a paper towel. As someone with lung issues even the standard surgical mask is very uncomfortable. The n95 mask is basically unwearable for more than about five minutes.
I only use a regular cloth mask whenever I go out of the house and I couldn’t stand it. It’s very hot and humid where I live (I live in the Philippines) and my face keeps on sweating a lot. Sometimes, I have to take it off just to wipe the sweat off my face with my hankie. It’s not allowed here to go out without mask though so I always check my surroundiings before I take it off to avoid unnecessary encounters with the police/military.
I feel for you, my running partner is from the Philippines and when it gets below 60 degrees F she’s running in a parka! I’m in the southern US so in the summer it will get in the hundreds here, I can’t imagine having to wear a mask then. Plus from what she tells me in the Philippines the concept of personal space is much different, compared to the US people are practically embracing when they have conversations where here they are much more stand offish.
I work in a hospital (in Clinical Informatics, so not often interacting with patients) and we’re all required at this stage to wear a mask for the purposes of preventing us from spreading anything we may have. Anyone working in direct patient care is required to don proper PPE.
As you mention, nobody enjoys wearing an N95 given the nature of the user experience. I’ve won them only for short periods of time, never for a full twelve-hour stint, and am glad to be able to say that.
All the best with recovery from your procedure.
Take care,
Ryan
Thanks, I am well now. Glad you don’t have to wear the n95 for long periods!
Hey Steveark. You bring up some good points. I’m in LA and wear a homemade cloth mask whenever I go out. But I wear glasses and they fog – so it really sucks.
My wife is a dental-assistant and resumes work on Monday, which will be very interesting. It’s been hard for them to acquire the right PPE equipment to open the office and we’ve also talked a lot about masks in my house because all her coworkers are not used to wearing them all the time. She knows how hard this new adjustment is going to be.
It is tough for anyone but for someone with asthma or other air flow limiting conditions it can be impossible. I hope they settle on surgical masks, they are much easier to tolerate than n95. Usually n95 is not required except for people treating known covid patients.
My son is scheduled to take his Step 1 Board exam as a 2nd year medical student. It is THE most important exam of his medical journey as the scores basically determine what medical specialty you can hope to pursue. The exam is about 8 hours and he is required to wear a mask. I feel for him but he’ll be in a room with others and I understand the requirement. I told him to try out various types before hand . What a crazy situation! Hope he can still do his best regardless.
My son is a resident MD right now, so I understand what a big deal the Step board exams are! My son aced his and he matched in radiation oncology which is usually a difficult match. I’d suggest he practice wearing a mask all day for at least a couple of days prior to the exam so he will have developed a tolerance for it. I remember back in high school I aced the SAT but when I took the ACT I had a terrible allergy attack and runny nose and that hit me right when the test started. I scored much worse on that exam because I could barely breathe and I simple could not focus. So I’d practice wearing a mask for extended periods to get over the initial reaction people have, which is almost always worse than once they get used to it. Of course as a med student he may have already been wearing one often, I’m not sure how much of that has happened by year 2.