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.
And?
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 don’t.
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.
Dr Rod’s Odd Blog (almondemotion) 
Good points your raise, Rod, particularly about the actual chance of breathing in Covid during our daily locked-down activities.
One of the main places that many of use are currently visiting is the grocer shop or supermarket. I agree with you – the chance of someone coughing in your face in this environment is low. However, and do correct me if you think I’m wrong, the chance of picking up the virus by touch is probably significantly higher. For this reason, don’t you think wearing disposable gloves (plastic or rubber), and a face mask is recommended. The gloves would be disposed of when returning home, while the mask would act as a barrier to you touching your face, or putting your fingers in your mouth. Just a thought.
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Hi Nigel,
I need to write a part 2 as to why gloves and masks are actually a BAD idea – will expand in a little while.
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Hi all,
I’ve had a question from my brother re what to do when in the supermarket;
I popped into Tesco last night.
They are limiting the numbers of people so it feels a little odd; like when you go there at midnight, back in the days when it used to be open at midnight. Kind of serene.
He asked about masks and gloves in supermarkets.
Well, there are a few points:
1) If you havn’t been trained in infection control and understand the principles of putting masks and gloves on and off and have a good understanding of something called ‘germ theory’ there is a major risk you will actually accidentally put yourself at more risk with gloves.
Using non-disposable gloves just results in gloves that are little Covid incubators.
Using disposable gloves can reduce attention to handwashing which is the thing that makes the difference.
People may think, ‘I have a mask and gloves,’ I am OK or not at risk or don’t have to do the distancing or handwashing.
This isn’t right.
2) The risk of picking it up just from brushing past someone is very very low.
3) We are very low on PPE – all our PPE in the UK should be used by doctors, nurses, therapists, carers and others working in emergency services.
There are 2 major risks from Covid:
1) People who are at risk (in particular) – (your mum, dad, grandparents, people with diabetes, heart and kidney disease for example)
2) The ‘collapse’ of healthcare as has happened in Northern Italy which has resulted in people who don’t have Covid dying because there is no capacity in the hospital i.e. if you have a heart attack, stroke, sepsis (not from Covid)
We can reduce 1) by distancing and hand washing, we can reduce 2) by ensuring the hosptial and emergency services aren’t threatened with collapse because they don’t have enough PPE.
If you have an unopened box please hand it in to the hospital/surgery.
We can’t accept opened ones.
Apologies for my lack of tech knowledge;
Rod
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Very useful indeed and very clear, thankyou.
What do you think please, regarding disabled /elderly/vulnerable people having a food delivery where the delivery person brings the items into the house? For the delivery person and for the customer , but where there are no current symptoms?
I am looking very differently at my ‘ Marigolds ‘ -ittle potential covid incubators!
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Keep 2m from deliverer, wash fruit and veg, wash hands before eating. Remember that what they touch in the house eg door handle could become
Contaminated hence the advice re washing. People shouldn’t go crazy about it though.
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Thankyou very much indeed.
I don’t know that there is an answer but I have heard recently of a carer grieving so much for a parent who died in hospital {with covid} without family and I have a friend who helps an elderly close relative who is now in hospiyal with a different likely terminal illness and obviously family not able to visit. You mention a last conversation via technology and it occurred to me that this may be a person at home also possibly dying without family there. We are still supporting by phone or other technology the members of our support group who all either have a life-limiting illness , or other illnesses as carers and former carers. People do die at home or in hospital but being alone will occur perhaps more often and we have to be prepared to support in these situations.
Sorry to meander on but it has just been on my mind since I read your blog.
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Makes sense Rod
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Apropos your comment about gloves. I have OCD (mild version) and was washing my hands frequently anyway, and am running out of nitrile gloves and can’t get any more in my size (small – so my husbands ones will just fall off), and today I contemplated using my rubber washing-up gloves but thought “nope – what if those little bastards get in there and breed…” I do try to remember to wash my hands before putting them on and when I take them off, because of that… but that’s just me.
I don’t agree with you about the masks, though. If surgeons need to wear masks, why not other doctors? My dentist wears a mask when he’s working on my mouth, why not doctors? As for people passing never coughing in your face – if you are going in one direction and the other person is going in the other, as you pass each other, it could happen.
But maybe this is just my OCD talking? Or is it…?
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Yes, someone could cough on you but they would need to have covid at that time; the vast majority of the population dont have covid therefore statistically the chances of someone with covid coughing on you as you walk past and breathe in is a billion to one.
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not sure what i said about the masks – yes; every clinical person should wear one when treating a patient.
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