45. Masks, Face Shields, and COVID-19

What’s the story with masks, face shields, and COVID-19?

As of today, March 31st, the WHO and CDC are still saying that healthy individuals don’t need to wear masks when conducting normal activities, like shopping for groceries, especially because there has been a shortage of PPE for healthcare providers. However, the news media are beginning to question whether it might be protective and beneficial for healthy people to wear masks in public. At this juncture, I thought it would be useful to offer some guidance on the question of whether or not masks are useful/necessary for routine activities. Key points are as follows:

1. Although COVID-19 is present in respiratory droplets, the primary mode of transmission is hand to face, due to contact with individuals who are contagious. In other words, your hands get contaminated with virus acquired from a colleague or family member, and then you touch your eyes, nose, or mouth, infecting yourself. Anything we can do to prevent hand-to-face transmission is useful.

2. If wearing a mask prevents you from touching your face, then it’s useful to wear a mask. Personally, whenever I wear a mask, I find it annoying, so I tend to touch my face MORE than I would without the mask. For me, therefore, wearing a mask in public is probably not useful.

3. On the other hand, if an entire population of people wears a mask in public, that is useful. Any people who are shedding virus (including asymptomatic but contagious people) will be less likely to infect others if everyone wears a mask at all times. In other words, it’s harder to share your respiratory droplets if you’re sick and sneezing into a mask.

4. If you’re caring for someone who is sick with COVID-19, both you and the patient should wear a mask.

5. You do not need to wear an N-95 mask while shopping for groceries. A simple surgical mask is fine. Even a homemade mask might be useful if it reminds you not to touch your face. If the mask is sliding around and you keep adjusting it, then the mask is less useful.

6. Gloves are useful if they remind you not to touch your face.

7. What is the best way to avoid touching your face? In my opinion, face shields are much better than masks for preventing access. If the goal is not to touch your face, then face shields are a great option.

8. If someone coughs/sneezes near your face, you can still inhale respiratory droplets while wearing a face shield. This is why people in healthcare are wearing a combination of a face shield plus a mask while seeing patients.

9. N-95 masks are only being used during medical procedures that cause viral particles to be aerosolized, such as suctioning the trachea of an intubated patient. Please don’t wear one while grocery shopping. It upsets the healthcare providers in the vicinity.

10. Keeping hands clean by washing or using Purell is another good way to prevent hand-to-face transmission.

11. What am I going to wear in Stop and Shop? Maybe just a face shield. Still debating. Complicated.