Nursing & Healthcare News

Making Sense of Masks

Cutting through the mixed messages

Illustration of a woman shopping at the grocery store while improperly wearing a mask just covering her mouth

  • Effectiveness depends on the type of mask and whether it’s worn correctly
  • Social distancing is still vital
  • Nurses can model good behavior for the public

With all the changes in facemask recommendations, many people have been understandably confused about the role masks play in fighting COVID-19. Let’s take a closer look at the considerations public health officials have had to weigh in making their recommendations.

Imperfect Protection

There is evidence that proper use of medical masks — supplemented where appropriate with a respirator and/or face shield — may protect the wearer from contracting COVID-19, which, like influenza and measles, appears to spread primarily through respiratory droplets.

Unfortunately, medical masks don’t provide 100 percent protection, and the protection they do provide depends greatly on correct use. That includes making sure your mask is properly fitted; regularly replacing it (after each use or as often as supplies permit); avoiding touching the mask while wearing it and after removing it; and treating discarded masks as hazardous waste.

Although most clinicians understand the guidelines for proper mask use, that isn’t necessarily true of the general public, and even people who understand the appropriate precautions may not be in a position to follow them outside of a clinical setting.

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Improperly used medical masks, or nonmedical or improvised ones, may provide little meaningful protection for wearers. If you’ve seen people at the grocery store wearing masks on their chins or lifting their masks to scratch their noses, you can readily understand why!

Limiting the Spread

While masks’ protective value is at best imperfect, even improvised masks can effectively prevent an infected wearer from transmitting the disease to others by containing the spread of respiratory droplets. However, the value of masks for what epidemiologists call source control — especially during a pandemic that can be transmitted by someone with no symptoms — depends on how many people are masked.

Because wearing a mask provides little protection for the average untrained user, a single unmasked, infected person can potentially infect dozens of others, whether those people are masked or not. For that reason, the surest way for members of the public to protect themselves from COVID-19 is still to minimize contact with anyone outside their household.

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Mixed Messages

One of the principal reasons the World Health Organization (WHO) and other Western health experts were initially reluctant to recommend masks for the general public was the concern that widespread mask use might make people feel safe when they’re not, thereby discouraging them from staying home and limiting their social contacts.

Health officials were also afraid of exacerbating PPE shortages for healthcare workers, which have forced those who most need masks and respirators to compromise their infection control protocols. (WHO has consistently recommended medical masks for healthcare workers.)

The shift from recommending masks only for healthcare workers to requiring them for almost everyone does not reflect any significant change in the scientific consensus on the value or limitations of mask use. The principal change has been one of public health priorities, driven by the belated realization that social distancing alone isn’t enough to limit the spread of the disease.

Such mixed messages have done little to mollify people who want a quick return to business as usual, or who see mask requirements as government overreach. While skeptics might grudgingly accept masks to protect themselves, asking them to bear the inconvenience and discomfort to protect others is apparently a bridge too far for some.

We’re in This Together

The bottom line for nurses? Follow your facility’s PPE guidelines, wear a nonmedical mask in public, stay home as much as possible and encourage others to do the same. The only sure way to end this pandemic is for everyone to do their part.

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