- What’s the current science on masks and which type should I be using?
Even though there is cause for optimism with hospitalizations and ICU admissions starting to decline in Orange County, we can’t afford to let down our guard now. Mask wearing and social distancing remain the most effective ways to control the pandemic until widespread vaccinations are available for everyone and we can determine if those who have been vaccinated can still be contagious, and also if the vaccines are effective against new variants of the virus. Below I will summarize some facts about masks that have been published just in the last week.
The face mask that could end the pandemic
Here’s the face mask that could end the coronavirus pandemic.
Read in CNN: https://apple.news/A-N5L2p8xRY6bc4p6JIrZ3g
They are talking about N95 masks in the headline, but the headline is somewhat misleading because there is still a dire shortage of N95 masks for even medical personnel.
“Studies have shown that masks significantly decrease the chances of transmitting or contracting the coronavirus. But not all masks provide equal protection. Depending on the fabric and number of layers, homemade and simple cloth masks have a range of effectiveness that can be as low as 26%, which leaves the wearer vulnerable.”
Dr. Fauci: Double masking ‘makes common sense’ during pandemic. The idea of “double-masking” generated buzz when people like Amanda Gorman and Pete Buttigieg wore surgical masks underneath cloth masks to the inauguration. Read in NBC: https://apple.news/AaRVXyKQLQ9eDWgUJPlbf9w
“Researchers say that wearing a surgical mask underneath a cloth mask provides maximal protection, because the surgical mask acts as a filter and the cloth adds an additional layer and helps with fit, according to commentary on mask-wearing published on Jan. 15. In places where it’s difficult to maintain social distance, such as on an airplane or at the store, two masks would provide additional protection. The next best option would be a three-layer mask that contains an inner filter.
Studies have shown that multilayer cloth masks can both block up to 50%-70% of fine droplets and particles and limit the spread of Covid. The CDC recommends that people wear masks that have at least two layers of tightly woven cotton fabric, such as quilting fabric or cotton sheets.”
Uniting Infectious Disease and Physical Science Principles on the Importance of Face Masks for COVID-19 https://www.cell.com/med/pdf/S2666-6340%2820%2930072-6.pdf
This scientific article is a great summary of the existing (and compelling) supporting evidence for mask wearing to decrease viral transmission, and includes 15 references.
“This commentary will summarize the evidence on face masks for COVID-19 from both the infectious diseases and physical science viewpoints; standardize recommendations on types of masks that afford the best protection to the public; and provide guidelines on messaging for this important non-pharmaceutical intervention as we await widespread vaccine distribution.”
Why N95 Masks Are Still In Short Supply In The U.S. Early in the pandemic, shortages of N95 respirators and other medical gear prompted panic across the world. A year later, the masks still aren’t widely available to U.S. consumers. Read in NPR: https://apple.news/A8pKyu40tRMizRfq3cBYfIg
Great article about the challenges of producing more N95 masks in the U.S.
Analysis | Shape-Shifting Virus Threatens Cycles of Illness, Lockdowns
More-virulent and potentially deadlier variants of Covid-19 first identified in Britain, South Africa and Brazil are spreading, just as the rollout of vaccines had raised hopes for a broad-based economic recovery. Read in The Wall Street Journal: https://apple.news/AdqpF676IR4aXI89EI2BVtw
Good explanation of why we need to continue mask wearing for health and economic reasons.
Wearing 2 masks? What to know as we face more contagious variants. As vaccinations ramp up and variants emerge, experts weigh in on mask safety. Read in ABC News: https://apple.news/AxqaFE3m6Q12fsxJ7WvdwNQ
Another article explaining the importance of mask wearing in the face of more contagious variants of the virus.
- The following information is from the January 29, 2021 Hoag Newsletter from the Office of the Chief of Staff. To get an idea of the continuing urgent situation our hospitals are in right now, I’ve also included information from Hoag about elective procedures and vaccine availability.
1-Elective surgeries
“The restarting of all elective surgeries is top of mind for many of our physicians. Although Governor Newsom lifted the state “Stay at Home Order” this past Monday (January 25), there is a “Hospital Surge Order” initiated by the California Dept of Public Health on January 5, 2021 that is still in place.”
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Amendment-to- the-Order-of-the-State-Public-Health-Officer-Hospital-Surge-1-15-2020.aspx.
State Public Health Officer Order
Amending the January 5, 2021, Hospital Surge Order, Issued January 15, 2021
“California has been experiencing an unprecedented and exponential surge in COVID-19 cases, and staffing and other resources have become strained. COVID-19 hospitalizations have increased sevenfold over the last two months, while COVID-19 Intensive Care Unit (ICU) hospitalizations have increased by over sixfold over the last two months, and large proportions of California hospitals have reached significant strain on their ability to provide adequate medical care to their communities. Over half of California hospitals have requested waivers for conventional staffing ratios per patient, and more anticipate ongoing staffing shortages. There is a shortage of ICU bed availability and many hospitals have added surge ICU beds but still need additional staffing to meet the ongoing demand. The distribution of COVID-19 hospitalizations is focused in some areas and hospitals, and the burden of care needs to be shared across our statewide healthcare resources. If this increase of COVID-19 patients continues, hospitals may be unable to provide necessary emergency and critical care to Californians.”
The “Hospital Surge Order” limits the types of elective surgeries that can be performed at hospitals to only ESAS (Elective Surgery Acuity Scale) 3a and 3b cases; these are high acuity cases such as cancer surgeries and/or those patients who are highly symptomatic and would be detrimental to postpone. Here is the scale (I’ve included all tier suggested actions for your information and more complete understanding):
Elective Surgery Acuity Scale (ESAS)
Reprinted with permission: Sameer Siddiqui MD, FACS, St Louis University
| Tiers/Description | Definition | Locations | Examples | Action |
| Tier 1a | Low acuity surgery/healthy patient Outpatient surgery Not life threatening illness |
HOPD ASC Hospital with low/no COVID- 9 census |
Carpal tunnel release Penile prosthesis EGD Colonoscopy |
Postpone surgery or perform at ASC |
| Tier 1b | Low acuity surgery/unhealthy patient | HOPD ASC Hospital with low/no COVID-19 census |
Postpone surgery or perform at ASC | |
| Tier 2a | Intermediate acuity surgery/healthy patient Not life threatening but potential for future morbidity and mortality. Requires in hospital stay |
HOPD ASC Hospital with low/no COVID-19 census |
Low risk cancer Non urgent spine Ureteral colic |
Postpone surgery if possible or consider ASC |
| Tier 2b | Intermediate acuity surgery/unhealthy patient | HOPD ASC Hospital with low/no COVID-19 census |
Postpone surgery if possible or consider ASC | |
| Tier 3a | High acuity surgery/healthy patient | Hospital | Most cancers Highly symptomatic patients |
Do not postpone |
| Tier 3b | High acuity surgery/unhealthy patient | Hospital | Do not postpone |
HOPD – Hospital Outpatient Department
ASC – Ambulatory Surgery Center
2- Vaccines
Hoag has vaccinated 80% of the medical staff members and is now opening up vaccine availability to those 65 yo and older. If you qualify, you can either try to get an appointment through one of the county-run vaccine clinics (accessible through www.Othena.com) or now through Hoag (https://covid19.hoag.org/vaccine- community/). Appointments for the Hoag vaccine clinic will be released depending on the vaccine supply that we are able to obtain from the county which, at this time, remains extremely limited.
Well, that’s all for now, folks. Stay safe.
Dr. Weiss
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