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Universal Masking in Hospitals in the Covid-19 Era | NEJM.
We know that wearing a mask outside health care facilities offers little, if any, protection from infection. Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes). The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal. In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.
Of course, this is just the New England Journal of Medicine.
The article is about what people should do in hospitals. This one is for nurses and doctors to know, and written for them and hospital administrators. So yes here is a quote by the doctors, qualified to talk about safety in hospitals.
ReplyDeleteLet's break it down.
We know that wearing a mask outside health care facilities offers little, if any, protection from infection.
So true. A person does not wear a mask on the street, because she will not get covid-19, but in order that she does not wittingly or unwittingly infect someone else. Hospitals mask patients, however.
Public health authorities define a significant exposure to Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-19 that is sustained for at least a few minutes (and some say more than 10 minutes or even 30 minutes).
So true. And "significant" is a key word. These meetings are significant because the person without the mask is in danger -- the longer she is exposed to the unmasked person. Distance matters too. If minglers get as close as 3 feet apart, there's greater danger than being 5 feet apart. At 5 feet apart, everyone should be wearing a mask.
The chance of catching Covid-19 from a passing interaction in a public space is therefore minimal.
Public health officials are well aware of this, and it informs policy decisions. It's especially true when compared with what the article is about, precautions in hospital settings. Let's add to this, though, the unmasked joggers and unmasked singers and shouters, especially indoors. These spreaders increase the distance and time that their more numerous droplets are airborne.
On this score, they also talk about how intensely the virus spreads in hospital situations -- which is different from going carelessly to the beach or going to church or other events without distancing or masks. Yet, this is just where the virus spreads from -- not as intensely as from hospitals and nursng homes, but intensely enough to kill. You and I stopping for a brief unmasked chat is risky enough, never mind you getting close to D when she is not feeling well.
In many cases, the desire for widespread masking is a reflexive reaction to anxiety over the pandemic.
I am not aware of this study, and have not spoken with anyone who is experiencing anxiety as such -- anger that some people would not wear masks and not keep their distance, yes, maybe anxiouos about the diffcult social situation they have found themselves because of a careless person, but anxious in the first place? Let's step back. Let's be good scientists and question this assertion. Let's be doctors and not blanket diagnose -- something that may be outside the purview of these doctors and nurses.
Do we not touch a hot stove because of kitchen anxiety, or have we learned just to be safe? Do we go around with hikers anxiety that we will jump off a cliff, or do we just know better. Do we not go out without our masks because of covid anxiety, and do we shy away from people who are careless because of such anxiety, or because we know better? I want to see their reference.
ReplyDeleteEarly on, there was talk of people having anxiety dreams. This was understandable as people processed the fact of loved ones dying and thousands around them having the virus, and whatever else -- and I did not read the study, so it may have been attributed to something else. But can we call a person with an N95 mask out in public anxious? I used to wear a folded cloth napkin, with hair ties to go around the ears. Then a home health nurse gave me masks, which are even better, N95, so I use them.
Back to the hospital, what the article is about, where and what these good people have chosen to practice. And I will note here a bit off topic, that while the authors look at masks, they do not talk about face shields, something worn to protect from the virus entering the eyes as well as the mouth, or disposable gowns and such. No one is suggesting that we wear such PPE outside.
So back to the masks. Let's jump past how employees may not realize that they have the virus and are spreading it, to what the article suggests happens to a patient upon admission, if you or I entered the hospital, just as we are:
Such -infection-control] measures include vigorous screening of all patients coming to a facility for symptoms of Covid-19 and immediately getting them masked and into a room; early implementation of contact and droplet precautions, including eye protection, for all symptomatic patients and erring on the side of caution when in doubt . . . The entire paragraph is informative, if not repetitious to what public health officials outside hospitals are aware of as well -- how to protect you from us and us from you, all the while caring for you.
Here's an interesting excerpt to touch on:
Modelers assessing the spread of infection in Wuhan have noted the importance of undiagnosed infections in fueling the spread of Covid-19 while also acknowledging that the transmission risk from this population is likely to be lower than the risk of spread from symptomatic patients.
That model from March 16 was fed with old information, now updated with a later pre-print from last week I think it was, which showed that on average a person is asymptomatic while being most infectious. Interesting. Indeed, only 2 days into having the virus, the victim is most infectious, and the worse, if not every bit of the bad news, is yet to come for him.
That should have said, "These meetings are significant because the person with (not without) the mask is in danger"
ReplyDeleteThe article was dated 1st April, Rus. Coincidence, I assume, but I laughed anyway.
ReplyDelete