I sometimes think of an unusual title for my blogs to draw people in.
I was actually going to call this one ‘facemasks’ but thought that would do the opposite.
I’ll keep going.
Well, yes, it does relate to facemasks.
In the past week I have said ‘facemask’ and ‘PPE’ (Personal Protective Equipment) often. A lot.
In most respects this is because I believe they are important.
I do need to explain the rationale, however.
I know when you see a picture of people going about in China – in those places where people are allowed to go out; or, historical pictures of China and Japan, you see lots of facemasks.
It is and has always been a thing.
In the past, most of us have just accepted it as a ‘cultural thing’ and got on with life.
Now the world has changed, the role of facemasks has too.
My points however are:
- Most people do not require facemasks when going about – when going shopping, when sitting at home, walking the dog.
- Some people do need facemasks – this in particular if you are in contact with someone who is infected with Covid and who may spread it to you (or you to them)
- There is a problem with the facemask and other PPE items in the global supply chain.
Well, there has been lots of toing and froing nationally as to whether nurses going into the homes of patients who do not have Covid should wear masks; the national guidance is that they should not. (guidance changing imminently).
This however conflicts with the logic of Social Distancing and what we have learned about the potential for people to have Covid and remain either asymptomatic (very mild infection or, in the first few days of acquiring the infection) or have been in contact with someone who has Covid without knowing it and passing-it on unawares.
How does this match with the idea that most people don’t need facemasks? Couldn’t we all be infected, potentially infected or carriers of infection?
Well, yet; but that is not the point.
The point is how close you come into contact with another person.
Most of us can keep a reasonable distance away from others – that is friends, acquaintances and strangers; Social Distancing. Two meters; more if you like.
If you do that, then no mask needed.
Yes, we walk past people at a distance of less than 2 meters when in the street or the supermarket. Walking past doesn’t count. Maybe if someone coughs on you who has Covid although I honestly can’t remember the last time anyone coughed on me. (And, being a doctor, I meet lots of people with coughs). (That was not an invitation).
So, who needs the masks?
Well, and this is me just being a physician, someone who has worked with people who have infections and similar disorders for the past 20 years; I believe that the people who should have PPE are –
- Those NHS, social care and other emergency services who are coming into close sustained contact with others. The last phrase is set at more than 20 to 30 minutes. It is very difficult to either treat someone, for example, in the home of a vulnerable patient, change wound dressing or to wash and change someone who is immobile in bed without close physical contact which is longer than 20 minutes (times likely vary). Equally, it is probably hard to arrest someone who is resisting without being close to them for this period of time.
I can’t think of many other reasons; there are likely more.
In the supermarket last night, I kept my distance from the woman on the till; she seemed quite happy with the situation.
Hopefully she knows the second most important part of all of this beyond ‘distancing’ is washing your hands – not so often that they crack and bleed, but enough so that if you put your hands in your mouth, rub your nose or eyes your hands will be clean.
- The other group are people who might be spending less than 20 minutes but are working in very high risk areas – for example on the high-dependency unit or on a ‘hot’ hospital ward – a place where people who have or likely have Covid will be supported as opposed to the person who ‘just’ has a heart attack or stroke (these haven’t stopped happening because of Covid).
Beyond this, I don’t think anyone should be wearing facemasks.
I have one mask in my bag that someone gave me a few weeks ago; I am carrying in case there is an emergency and I need to urgently attend a patient.
For the past fortnight I have not come closer than perhaps a mile from any of my patients;
Everything I have done with or to patients has been via the phone or with videoconferencing. (Yes, very old people have and can use smartphones too).
I don’t want to go into the details of the latter as some of that is still very raw, suffice it to say, I held final conversations with patients, talked with relatives who have been deprived of the chance to be with their mum or dad as they die, to say goodbye.
In case you have jumped to the end; my point, which is the same as what I wrote about asthma – I am a doctor, I am trying my best to support and help as many people as possible. The way I am protecting myself and my patients is using technology to connect and either sitting at home and working or by myself in the surgery.
I haven’t worn a facemask during any of the epidemic.
(Excepting the one in the photo which belongs to my dog and which is actually a bandana.)
I have asthma; I don’t have any antibiotics or steroids stashed at home.
Let’s look after those who are most at risk – health, social care and staff in emergency services.
If you have a stockpile of masks (in sealed boxes) why not take them round to your GP or the hospital; you won’t necessarily get inside as most places have locked the doors, although using some imagination you can probably work out how to deliver or pass to someone who knows someone who is a doctor, nurse or carer.
Be well and take care.