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 Table of Contents  
LETTER TO EDITOR
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 27-28

I wear a mask because I care about you


Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission31-Jul-2022
Date of Acceptance01-Sep-2022
Date of Web Publication12-Nov-2022

Correspondence Address:
Dr. Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_28_22

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How to cite this article:
Gupta H. I wear a mask because I care about you. J Patient Saf Infect Control 2022;10:27-8

How to cite this URL:
Gupta H. I wear a mask because I care about you. J Patient Saf Infect Control [serial online] 2022 [cited 2022 Dec 6];10:27-8. Available from: https://www.jpsiconline.com/text.asp?2022/10/1/27/361007



'In light of evolving evidence, @WHO advises governments to encourage the general public to wear masks where there is widespread #COVID-19 transmission and physical distancing is difficult, such as on public transport, in shops or in other confined or crowded environments'.- Dr Tedros Adhanom Ghebreyesus, Director General of World Health Organization, 06 June 2020.[1]

Mirada et al. presented their research article at the Annual Conference of Hospital Infection having the title 'Knowledge and practices of healthcare workers regarding face mask in hospital'. The Journal published this article on 22nd July 2022, which is an official publication of the Hospital Infection Society, India. To collect the data regarding the study, the authors write, they talked to healthcare workers serving in the hospital, sometimes observed them and conducted their interviews. In the article, they mention surgical mask and cloth mask at several places and assess what the workforce thinks about the barriers. Moreover, after collecting the data, they get it examined by a statistician and then prepare various tables and figures to present the findings in an easy-to-understand manner.[2] I am thankful to the workaholic researchers for their astute planning and then carrying out the real-world study from which we can learn a lot.

Nevertheless, there are certain gaps in the study which I am unable to reconcile. Nowhere in the study either the authors or did any of the workers talk about high-end respirators or N95 masks. As the investigators made the investigation during the second wave, that is, June 2021, it is unusual that they were not having seriously ill patients then. Now, we know that the Delta variant was in vogue then which had a high mortality and hospitalisation rate.[3] Therefore, it was more necessary than ever to have the sophisticated mask on but surprisingly the study does not shed a light there.

Second, as the second wave of COVID-19 rapidly ascended to its peak (and then rapidly fell afterwards), health-care facilities were facing certain unique challenges in that period. Although personal-protective equipment kits were not in short supply at the national level as the pandemic had been in existence for (more than) a year then, sometimes some drugs got zero stock in hospital inventory; sometimes, it was health-care workforce crunch and sometimes vaccines went out-of-stock. And as the situation was rapidly evolving due to changing disease dynamics, supplies were rushed to those spots of necessities as well with equal alacrity.

Nonetheless, there are the stories of hospitals running out of supplies temporarily despite the best possible efforts. And when such an eventuality arose, it provided an opportunity for innovation, alternative thinking, discovering solutions in a novel way, and making alterations which nobody previously did or even thought. And one such model was double-masking when N95 respirators went out of stock or sometimes were found leaking.[4] But despite that strangely enough in this study, there is no conversation between staff members on this particular issue when the authors made their observations at the height of the largest wave of the pandemic.

Third, the US Centres for Disease Control and Prevention advises the general public about the use of masks and respirators. There, it runs a web page with the title 'Types of mask and respirators'.[5] Therein, it has a subheading 'Procedure Masks'. Here, it talks about Ways to have better fit and extra protection with cloth and disposable masks. Under this subheading, the federal agency states that wearing 'two masks' correctly provides its wearer more protection when one observes certain basic rules. Extraordinary times demand extraordinary measures and so the world-renowned agency is making its best possible effort to update all providing the best possible guidance leveraging its skill, knowledge base and status even when nobody perfectly knows about masks and lives are on stake.

The Result indicates that 22 staff members were wearing cloth masks. Moreover, the authors knew that they have less efficacy to trap viral particles than made of higher varieties. Here, I want to draw their attention to this Morbidity and Mortality Weekly Report by the US CDC, published on 11 February, 2022.[6] This page states that people who reported always wearing a mask in indoor public settings were less likely to test positive for COVID-19 than people who did not. Further, in [Table 1]. Types of face mask or respirator worn in indoor public settings among persons with positive or negative SARS-CoV-2 test results – California, September–December, 2021, the agency found that cloth masks are there having efficacy less than a surgical mask but work better than no mask. Hence, these findings strengthen the case of observers of this study.
Table 1: Practice assessment for correct use of face mask by HCW

Click here to view


This preprint article by Lindsley et al. tests various cloth masks on several parameters and compares them with medical-grade respirators to control the spread of infectious particles. It shows that all the cloth masks are not the same and their properties depend on their material, fitting and few other factors.[7] As the information about the pandemic is evolving with the passage of time, we need to learn that is true for the protective measures too.

Few health-care workers did not cover their nose with mask. Hereupon, we need to have a conversation with them. More than three-fourth of the staff belongs to the <30 years of age group. We'd tell them that if they get infected, most probably they will not develop any symptoms but if an elderly patient with obesity or comorbidity gets inadvertently infected due to the lack of concern, he may be in serious trouble. Mask should not be looked on as a cover hiding your face and its associated myriad expressions. Rather it should bestow care for an unknown person who may not be harmed anyway and gets only our love, compassion, empathy, solidarity and untrammelled forgiveness. When we wear a mask on duty, we truly show our face!

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Dr Tedros, on Twitter. Available from: https://twitter.com/DrTedros/status/1268992914694299649?s=20&t=fA8LEo2yTIyoxH4rBMRNwQ. [Last accessed on 2022 Jul 31].  Back to cited text no. 1
    
2.
Maradia M, Patil R, Gajjar S. Knowledge and practices of health-care workers regarding face mask in hospital. Patient Saf Infect Control 2021;9:91-4. Available from: https://www.jpsiconline.com/text.asp?2021/9/3/91/351731. [ Last accessed on 2022 Jul 31].  Back to cited text no. 2
    
3.
Mallapaty S. Delta threatens rural regions that dodged earlier COVID waves. Nature 2021;596:325-6.  Back to cited text no. 3
    
4.
Parker-Pope T, Blum D. How to Double Mask Correctly. New York Times. 28 March 2021. Available from: https://www.nytimes.com/article/double-masking-tips-coronavirus.html. [ Last accessed on 2022 Jul 31].  Back to cited text no. 4
    
5.
US CDC. Types of Masks and Respirators. Available from; https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/types-of-masks.html. [ Last accessed on 2022 Jul 31].  Back to cited text no. 5
    
6.
US CDC. TABLE 3. Types of Face Mask or Respirator Worn in Indoor Public Settings Among Persons with Positive or Negative SARS-CoV-2 Test Results—California, September–December 2021. Available from: https://www.cdc.gov/mmwr/volumes/71/wr/mm7106e1.htm. [ Last accessed on 2022 Jul 31].  Back to cited text no. 6
    
7.
Lindsley WG, Blachere FM, Beezhold DH, Law BF, Derk RC, Hettick JM, et al. A comparison of performance metrics for cloth face masks as source control devices for simulated cough and exhalation aerosols. medRxiv [Preprint]. 2021:2021.02.16.21251850. doi: 10.1101/2021.02.16.21251850. Update in: Aerosol Sci Technol. 2021 Jun 14;55(10):1125-1142. PMID: 33619500; PMCID: PMC7899465.  Back to cited text no. 7
    



 
 
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