We have looked closely at the Hawaii Mayor and Governor recommendations, CDC recommendations, the Presidential Coronavirus Guidelines, the World Health Organization, and other published research in regards to wearing a mask in our office.
It is of utmost importance that our patients ALWAYS feel safe and comfortable in our office. We do not take this lightly. We make decisions based on evidence, science, and also common sense, keeping in mind the health of our community.
We believe that the body is strong, capable and resilient. That we have an immune system and that there are viruses, bacteria, bugs, and germs around us all day, every day. Could this virus be different? Possibly, but shouldn’t our body be able to handle it? Of course.
We choose to do the things that promote greater strength and resilience. We focus on those. We trust that our body is self healing, self regulating, and self adapting. We choose NOT to live in FEAR and have made the decision that the world is not a hostile environment, but a friendly one.
In our last newsletter, we laid out our policy for disinfecting, sanitization, screening practices, and patient flow to best mitigate the possibility of spreading infection. You can find that newsletter here.
With that said, we completely want to respect your comfort level around the situation. While being compliant with state rules, we thought we would share the science behind it all.
Cloth Mask Research — April 24, 2020
Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis
“Our analysis confirms the effectiveness of medical masks and respirators against SARS. Disposable, cotton, or paper masks are not recommended. The confirmed effectiveness of medical masks is crucially important for lower-resource and emergency settings lacking access to N95 respirators. In such cases, single-use medical masks are preferable to cloth masks, for which there is no evidence of protection and which might facilitate transmission of pathogens when used repeatedly without adequate sterilization.”
Facemasks for the prevention of infection in healthcare and community settings.
BMJ. 2015 Apr 9;350:h694. doi: 10.1136/bmj.h694.
The use of reusable cloth masks is widespread globally, particularly in Asia, which is an important region for emerging infections, but there is no clinical research to inform their use and most policies offer no guidance on them.
Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients
Bae S, Kim M, Kim JY, et al. Effectiveness of Surgical and Cotton Masks in Blocking SARS–CoV-2: A Controlled Comparison in 4 Patients. Ann Intern Med. 2020; [Epub ahead of print 6 April 2020]. doi: https://doi.org/10.7326/M20-1342
Objective: To evaluate the effectiveness of surgical and cotton masks in filtering SARS–CoV-2.
Methods and Findings: The institutional review boards of 2 hospitals in Seoul, South Korea, approved the protocol, and we invited patients with COVID-19 to participate. After providing informed consent, patients were admitted to negative pressure isolation rooms. We compared disposable surgical masks (180 mm × 90 mm, 3 layers [inner surface mixed with polypropylene and polyethylene, polypropylene filter, and polypropylene outer surface], pleated, bulk packaged in cardboard; KM Dental Mask, KM Healthcare Corp) with reusable 100% cotton masks (160 mm × 135 mm, 2 layers, individually packaged in plastic; Seoulsa).
Discussion: Neither surgical nor cotton masks effectively filtered SARS–CoV-2 during coughs by infected patients. Prior evidence that surgical masks effectively filtered influenza virus (1) informed recommendations that patients with confirmed or suspected COVID-19 should wear face masks to prevent transmission (2). However, the size and concentrations of SARS–CoV-2 in aerosols generated during coughing are unknown. Oberg and Brousseau (3) demonstrated that surgical masks did not exhibit adequate filter performance against aerosols measuring 0.9, 2.0, and 3.1 μm in diameter. Lee and colleagues (4) showed that particles 0.04 to 0.2 μm can penetrate surgical masks. The size of the SARS–CoV particle from the 2002–2004 outbreak was estimated as 0.08 to 0.14 μm (5); assuming that SARS-CoV-2 has a similar size, surgical masks are unlikely to effectively filter this virus.
Masks-for-all for COVID-19 not based on sound data
Cloth masks as source control
In sum, given the paucity of information about their performance as source control in real-world settings, along with the extremely low efficiency of cloth masks as filters and their poor fit, there is no evidence to support their use by the public or healthcare workers to control the emission of particles from the wearer.
Cloth masks as PPE
A randomized trial comparing the effect of medical and cloth masks on healthcare worker illness found that those wearing cloth masks were 13 times more likely to experience influenza-like illness than those wearing medical masks.
In sum, very poor filter and fit performance of cloth masks described earlier and very low effectiveness for cloth masks in healthcare settings lead us to conclude that cloth masks offer no protection for healthcare workers inhaling infectious particles near an infected or confirmed patient.
Advice on the use of masks the community, during home care and in health care settings in the context of the novel coronavirus (2019-nCoV) outbreak
Community setting Individuals without respiratory symptoms should: -avoid agglomerations and frequency of closed crowded spaces; – maintain distance of at least 1 meter from any individual with 2019-nCoV respiratory symptoms (e.g., coughing, sneezing); – perform hand hygiene frequently, using alcohol-based hand rub if hands are not visibly soiled or soap and water when hands are visibly soiled; – if coughing or sneezing cover nose and mouth with flexed elbow or paper tissue, dispose of tissue immediately after use and perform hand hygiene; – refrain from touching mouth and nose; – a medical mask is not required, as no evidence is available on its usefulness to protect non-sick persons. However, masks might be worn in some countries according to local cultural habits. If masks are used, best practices should be followed on how to wear, remove, and dispose of them and on hand hygiene action after removal (see below advice regarding appropriate mask management).
Individuals with respiratory symptoms should: – wear a medical mask and seek medical care if experiencing fever, cough and difficulty breathing, as soon as possible or in accordance with to local protocols;
A cluster randomised trial of cloth masks compared with medical masks in healthcare workers
“The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm.”
This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection.
Masks may actually increase your coronavirus risk if worn improperly, surgeon general warns
US Surgeon General Dr. Jerome Adams
“Folks who don’t know how to wear them properly tend to touch their faces a lot and actually can increase the spread of coronavirus.”
Based on the research, “there is NO EVIDENCE that masks can prevent someone from infection with respiratory viruses, including COVID-19.”
If you have other research that you would like the doctors at Atlas Specific Spine Center to read regarding this situation, please send it our way. We appreciate your understanding and concern for the community as a whole.