Covid19 continues to change the face of our world. Currently this is most visible in how we are able to experience relationships. In person it is through a mask or from 6 feet away, otherwise, it is through a digital interaction, and health care is no exception. Recently Johns Hopkins posted a piece about home health and telemedicine that is well worth the read. With many of their patients being elderly and chronically ill, JHOME’s medical director says in the article, “if they did contract the coronavirus, the mortality rate in our patient population would be upwards of 20%.” While extensive PPE and increased telemedicine capability have helped them protect their patients, they do note that there have been occasional problems with communication and recognition due to the practice.
Masks aren’t just affecting dementia patients or the hard of hearing. On May 5th, the San Diego County Board of Supervisors met and received a couple public questions worth relating. One caller representing an early childhood school in Rancho Bernardo raised the issue of adherence and efficacy in a classroom with young children. “Wearing a mask, for a teacher, in front of a child, (can be) traumatic. To keep a mask on a child is impossible…” Another “mother and educator in San Marcos” criticized the members physically present at the meeting, “Every one of you has touched the outside of your masks to readjust… and that risks contamination across the population as a whole.” And we have previously written about the concerns of the lack of education when mandating masks.
Our patient population includes many pediatric patients, in the home and school setting. We had one pediatric patient tell his nurse she looked “creepy” in the mask and another pediatric patient refused to speak or interact with her nurse in any way while the mask was on. Preexisting health conditions do place some of our younger patients as at risk of Covid19 as any could possibly be. As such, we do work hard to make masks a positive experience for the child. By making the experience a game, using positive reinforcement, and by fitting the right nurse with the right patient we do what we can to encourage positive habits like wearing masks.
A 2013 study showed homemade masks were effective in “preventing droplet transmission from infected individuals”, but provided no other protection. A 2015 study raised concerns regarding moisture retention in cloth masks causing an increased risk of infection for the wearer. More relevant to today’s crises, a study modeling Covid19 in NY and WA, concludes widespread mandated masks create a small and nontrivial effect only when combined with other non-pharmaceutical interventions. So, if everyone wears a mask but nobody washes their hands or socially distances, and the subways are only cleaned once every 115 years, we’re not going to get a positive effect from masks on a community wide level.
To be fair, the leadership in San Diego County seems to be responding to these concerns. Following the May 5th meeting, the county HHSA put out an updated emergency health order effective May 8th. Daycare providers can increase their stable group size to 12 and staff and children are not required to wear masks, assuming social distancing and sanitation practices are being followed.
So What Do We Do?
The masks are mandated and must be worn when in public and within 6 feet of other people. To make this practice as effective as possible for the individual and the community, be educated on how to don and doff your masks safely, and follow the other non-pharmaceutical interventions. Perform hand hygiene often, socially distance, and clean frequently touched surfaces regularly. #InThisTogetherSD
By Steven J.
Reviewed by: Heather Hemming